Cocaine Abuse

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?

Risk factors

 

Initial Presentation: this will depend on the nature

Intoxication: 

  • 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

Withdrawal:

  • Hypersomnolence 
  • Malaise
  • Severe craving for cocaine 
  • Depression/suicidality  

Physical Exam Findings

HEENT exam: 

  • 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: 

  • Alpha-blockers
  • Benzodiazepines
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
FURTHER READING

DynaMed

UpToDate

 

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