- 1 WHAT IS IT?
- 2 WHAT CAUSES IT?
- 3 WHY IS IT A PROBLEM?
- 4 WHAT MAKES US SUSPECT IT?
- 5 HOW DO WE CONFIRM A DIAGNOSIS?
- 6 HOW DO WE RULE OTHER DIAGNOSES OUT?
- 7 HOW DO WE TREAT IT?
- 8 HOW WELL DO THE PATIENTS DO?
- 9 WAS THERE A WAY TO PREVENT IT?
- 10 WHAT ELSE ARE WE WORRIED ABOUT?
- 11 OTHER HY FACTS?
- 12 FURTHER READING
WHAT IS IT?
Cocaine abuse is a substance use disorder
WHAT CAUSES IT?
Excessive usage of cocaine (or rather…any usage of cocaine) is the cause of this disorder. Cocaine is a stimulant, local anesthetic, indirect general adrenergic agonist, and reuptake inhibitor (it blocks the re-uptake of both norepinephrine and dopamine). Cocaine will cause the following to occur:
WHY IS IT A PROBLEM?
Given that cocaine prevents the re-uptake of catecholamines, it activates the sympathetic nervous system. This can lead to increased vasoconstriction (due to the α1-agonist activity of catecholamines) and can lead to interrupted blood flow in the various contexts:
- Blood flow to the placenta: which leads to fetal hypoxia
- Ischemia of the heart (MI) due to vasospasm
- Pulmonary hypertension due to constriction of the pulmonary vasculature
WHAT MAKES US SUSPECT IT?
Initial Presentation: this will depend on the nature
- Tactile hallucinations may be experienced. The feeling of bugs crawling on one’s skin is not uncommon (“cocaine crawlies”)
- Impaired judgement is often evident
- Paranoid ideation is not uncommon in those who have taken cocaine
- Severe craving for cocaine
Physical Exam Findings
- Dilated pupils in patients who are intoxicated
- Constricted pupils in patients who are withdrawing
HOW DO WE CONFIRM A DIAGNOSIS?
HOW DO WE RULE OTHER DIAGNOSES OUT?
HOW DO WE TREAT IT?
Cocaine intoxication can be treated with:
HOW WELL DO THE PATIENTS DO?
WAS THERE A WAY TO PREVENT IT?
WHAT ELSE ARE WE WORRIED ABOUT?
Sudden cardiac death can be caused by cocaine usage
Coronary vasospasm can lead to myocardial infarction
Dilated cardiomyopathy can be caused by cocaine usage
Pulmonary arterial hypertension (PAH) can be caused by cocaine usage
OTHER HY FACTS?
Never give beta-blockers to individuals with suspected cocaine intoxication: this is because it can lead to unopoosed α1 activation and extreme hypertension)
Cocaine’s effect on the fetus:
- Abnormal fetal growth
- Fetal addiction
- Placental abruption