2. AN INTRO TO COCAINE
Cocaine is a naturally occurring alkaloid found
within the leaves of coca plant. It has 4 forms;
*coca leaf-<2% cocaine
*cocaine HCL-powder
*free base-paste
*crack-rock cocaine
Its first use as a local anesthesia . In the late 19th
century ,cocaine was use for the treatment of
depression and cachexia.It is a strong stimulant of
CNS,appetite suppressant and topical anesthetic.It can
be taken as injected,smoked or sniffed.
3. HOW IS COCAINE USED?
Cocaine can be snorted, injected, smoked or
eaten. The level and length of the effects
depend on how the drug was induce
ONSET DURATION
SNORTED 1 MINUTE 20-40 MIN
INJECTED 1-5 SECONDS 15-20 MIN
SMOKED IMMIDIATE 5-15 MIN
4. EPIDEMIOLOGY
RESEARCH BY US IN 2005:
1)FREQUENCY:
According to the National Survey on Drug Use & Health
(NSDUH) for the age group 12 years and older
Approximately 33.7 million Americans have tried cocaine at
least once in their lifetimes, representing 13.8% of the 12
years and older population
2)Mortality/morbidity:
On average, cocaine alone or in combination with other
drugs was reported in 39% of drug misuse deaths
5. 3)RACE: more common in whites then africans.
4)Sex: the 2005 National Youth Risk Behavior
Survey, 8.4% of males and 6.8% of females
had used cocaine at least once in 2005.
5)AGE:19 to 28 age
6. Common S/S of Cocaine
• Decreased Appetite
• Increased Body Temperature
• Increased Heart Rate
• Dilated Pupils
• Nausea/Vomiting
7. • Severe Nose Damage (when snorted)
• Violent Behavior
• Kidney Failure
• Seizure and/or Stroke
• Heart Attack
9. • Confused Behavior
• Increased Fear
• Extreme Paranoia
• Severe Anxiety Attacks
• Hallucinations (in extreme cases)
• Aggressive Behavior
10. ADDICTION AND WITHDRAWAL
EFFETCTS
• Those who use cocaine heavily or regularly find it extremely difficult to
stop and often suffer through serious withdrawal symptoms such as:
• Severe Irritability
• Chronic Depression
• Excessive Sleep
• Eating Disorders
• Nausea / Vomiting
• Diarrhea
• Heart Attack
• Paranoia
• Loss of Sex Drive
• Insomnia
15. PNS
*Block of NE transporter
sympathomimetic syndrome
Tachycardia,HTN,tachypnea,mydriasis,sss
diaphoresis and agitation
16. PNS CONTINUED…
• Blocking of Na +channels,interfere with AP
Local anesthesia + in heat it will leads to
type 1 antidysrythematic activity and more
over leads to prolong QRS complex
17.
18. DSM-IV-TR
• DSM-IV-TR describes 10 cocaine induced psychiatric disorders and gives
codes to them are as follows;
305.60 Abuse
304.20 Dependence
292.89 -Induced anxiety disorder
292.84 -Induced mood disorder
292.11 -Induced psychotic disorder, with delusions
292.12 -Induced psychotic disorder, with hallucinations
292.89 -Induced sexual dysfunction
292.89 -Induced sleep disorder
292.89 Intoxication
292.81 Intoxication delirium
292.9 -Related disorder NOS
292.0 Withdrawal
19. 1)COCAINE INTOXICATION:
Diagnosed when the patient must have used cocaine
recently and must have developed clinically significant
behavioral or psychological changes.
Features:
a) Euphoria
b) Talkativeness
c) Grandiosity
d) Anxiety
e) impaired judgment
f) Anger
g) Impaired judgment
20. Signs and symptoms:
1)Tachycardia or bradycardia
2)Mydriasis
3)Perspiration
4)Nausea or vomiting
5)Weight loss
6)Weakness, respiratory depression, chest pain, or
dysrhythmia
7)Disorientation, seizures, dyskinesias, dystonias, or
coma
8)Mental state examination shows
irritability, impaired attention and poor judgment
21. 2)COCAINE WITHDRAWAL
Diagnostic criteria:
include cessation or reduction in previously heavy or prolonged
cocaine use.The patient also must have a dysphoric mood
associated with 2 of the following 5 physiological changes which
are;
1) Fatigue
2) Unpleasant dreams
3) isomnia/hypersomnia
4) Inc appetite
Mental health exam:
may show a sleepy, slowed-down patient who complains of
depressed mood and has a restricted affect. They may express
suicidal ideation.
22. 3)COCAINE INTOXICATION DELIRIUM
Diagnostic criteria:include both a disturbance in
consciousness resulting in a reduction of the patient's
ability to focus, sustain, or shift attention and a change
in cognition. These changes must develop over a short
period and fluctuate in severity
Mental health exam: shows
*patient is distractible and confused with a variable
affect and mood.
*Visual illusions may also be present.
*Judgment is extremely poor, as is orientation.
* suicidal and homicidal ideation may not be present.
23. 4)COCAINE INDUCED PSYCHOTIC
DISORDERS+DELUSIONS
Diagnostic Criteria: include prominent
delusions developing during or within a month of
cocaine intoxication or withdrawal.
• Presenting features:psychosis,communication
and interaction gap with others, inability to
recognize and accept reality.
• Mental state exam:shows
*tense patientwho appear fearful or anxious.
*They may be suspicious of questions asked.
*Impaired judgement
*may think for homicidal or suicidal acts
24. 5)Cocaine Induced Psychotic Disorders
+ Halucinations
The diagnostic criteria :prominent
hallucinations developing during or within a
month of cocaine intoxication or withdrawal.
Mental status examination: shows
* a patient who is distracted by internal
stimuli, may show thought blocking (verbal
outflow is stopped mid thought by internal
stimuli)
*Attention is variable
*homicidal and suicidal ideation may be present.
25. 6)Cocaine Induced Mood Disorders
diagnostic criteria: a prominent and persistent disturbance in
mood that arises only in association with the abuse of cocaine must
occur. The symptoms must develop during or within 1 month of cocaine
use, and the use of cocaine closely corresponds to these symptoms.
presenting features:depressed mood,dec interest in daily
activities,apathy,wt changes,fatigue,excessive guilt,feeling of
worthlessness
Mental state exam: shows
*depressed mood with restricted or flat affect,
*depressed mood with slowed movements and responses
*reduced concentration and suicidal ideation
*Orientation is intact. If manic, their affect is reactive
*mood is elevated and/or irritable
*speech is pressured
*Judgment is often impaired
26. 7)Cocaine Induced Anxiety Disorder
Diagnostic criteria: a patient must have prominent anxiety, panic
attacks, obsessions, or compulsions. The symptoms must develop
during or within 1 month of cocaine use, and the use of cocaine
closely corresponds to these symptoms.
PF:diffuse, highly unpleasant, often vague feeling of apprehension
accompanied by one or more bodily sensations, such as tightness in
the chest or pounding heart.
Mental health exam:shows
*a pat with reactive affect
*anxious mood
*restlessness
*difficulty in concentrating
*Judgment and orientation are usually intact.
*Due to distress, suicidal ideation may be present.
27. 8)Cocaine Induced Sexual Dysfunction
• Diagnostic criteria: a patient must have
prominent sexual dysfunction that results in
distress or interpersonal difficulty.
• PF: impaired sexual desire, impaired
arousal, impaired orgasm, or sexual pain.
28. 9)Cocaine Induced Sleep Disorder
• Diagnostic criteria: To be diagnosed with
cocaine-induced sleep disorder, a patient must
have a The symptoms must develop during or
within 1 month of cocaine use, and the use of
cocaine closely
• corresponds to these symptoms. The symptoms
must not be better accounted for by another
sleep disorder that is not induced by
cocaine, must not occur exclusively during
delirium, and must cause significant impairment
in areas of functioning, such as social or
occupational.
30. LAB INVESTIGATION
1) CBC:for anemia,leukocytosis,leukopenia
2) Electrolytes:hypokalemia because acute
intoicaion shift intracellular k+ ions.in severe
condition hyperkalemia may occur->cardiac
arrythmia.
3) Renal function test:check for rhabdomyolysis
and renal artery thrombosis has been
reported for te use of cocaine
31. LAB INVESTIGATION
4)Serum bicarbonate levels: dec
5)Urine analysis: to check myoglobin dur to
rhabdomyolysis
6)Glucose: should be checked in every patirent
having altered consciousness due o
hypoglycemia
7)Creatine kinase: for rhabdomyolysis
32. LAB INVESTIGATION
8)Plasma cocaine levels
9)Cardiac enzymes
10)LFTs:heaptic damage occus after acute
intoxication of cocaine + patients who take
cocaine are at the high risk of developing
infectious hepatitis.
11)Urine drug screen:to detect benzoylegonine
which is a metabolite of cocaine excreat in
urine for 60 hours after first dose of cocaine.
33. LAB INVESTIGATION
12) Imaging studies:
*CXR: for pulmonary signs of cocaine like
Pneumomediastinum, pneumothorax, pneumoni
a, pulmonary embolism, atelectasis
*head CT scan:Patients exhibiting acute mental
status changes or focal neurological signs and
symptoms may require a head CT scan. Cocaine
use has been associated with intracranial
bleeding and embolic and thrombotic strokes.
13)EKG :for dysrhythmia
34. TREATMENT:
• Establish the patient's airway, breathing, and
circulation (ABCs)
• Ensure adequate ventilation if patient is unconscious.
• provide oxygen
• frequently check vital signs
• monitor glucose levels for patients with altered mental
status; carefully use naloxone for patients with altered
mental status.
• Benzodiazepines are the drugs of choice for the
management of patients with agitation, seizures,
tachycardia, and hypertension.
35. TREATMENT
• If the condition persist specific antihypertensive
therapy (e.g., intravenous nitrates or calcium-
channel blockers) can be given.
• If the patient is volume depleted this is corrected
with intravenous isotonic saline.
• Patients should be continued to be observed until
they have normal vital signs and mental status.
• Manage the temperature
36. TREATMENT
• Manage Cardiac arrhythmias;
*ventricular tachycardiaequires immediate
defibrillation.
*wide –complex tachycardias can be treated
withsodium bicarbonate
