Cocaine

Cocaine

Cocaine is an alkaloid derived from the coca plant. It is widely used as a recreational stimulant. The price of cocaine has fallen sharply in the past decade resulting in cocaine toxicity becoming a much more frequent clinical problem. This increase has made cocaine a favourite topic of question writers.

Mechanism of action

• cocaine blocks the uptake of dopamine, noradrenaline and serotonin

Adverse effects

• cardiovascular
  • coronary artery spasm
    coronary artery spasm
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    → myocardial ischaemia/infarction
  • both tachycardia and bradycardia may occur
  • hypertension
  • QRS widening and QT prolongation
  • aortic dissection
• neurological
  • seizures
    seizures
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  • mydriasis
  • hypertonia
  • hyperreflexia
• psychiatric effects
  • agitation
  • psychosis
  • hallucinations
• others
  • ischaemic colitis
    Think ischaemic colitis in patients presenting with abdominal pain or rectal bleeding following cocaine ingestion
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    Importance: 95
    is recognised in patients following cocaine ingestion. This should be considered if patients complain of abdominal pain or rectal bleeding
  • hyperthermia
  • metabolic acidosis
  • rhabdomyolysis

Management of cocaine toxicity

• in general, benzodiazepines are generally first-line for most cocaine-related problems
  benzodiazepines are generally first-line for most cocaine-related problems
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• chest pain:
  • benzodiazepines
    Patients with MI secondary to cocaine use should be given IV benzodiazepines as part of acute (ACS) treatment
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    Importance: 98
    + glyceryl trinitrate
  • if myocardial infarction develops then primary percutaneous coronary intervention
• hypertension: benzodiazepines + sodium nitroprusside
• the use of beta-blockers
  beta-blockers
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  in cocaine-induced cardiovascular problems is a controversial issue
  • the American Heart Association issued a statement in 2008 warning against the use of beta-blockers (due to the risk of unopposed alpha-mediated coronary vasospasm) but many cardiologists since have questioned whether this is valid
  • if a reasonable alternative is given in an exam it is probably wise to choose it

+PassMedicine Notes

Cocaine is an alkaloid derived from the coca plant. It is widely used as a recreational stimulant. The price of cocaine has fallen sharply in the past decade resulting in cocaine toxicity becoming a much more frequent clinical problem. This increase has made cocaine a favourite topic of question writers.

Mechanism of action

• cocaine blocks the uptake of dopamine, noradrenaline and serotonin

Adverse effects

• cardiovascular
• coronary artery spasm --> myocardial ischaemia/infarction
• both tachycardia and bradycardia may occur
• hypertension
• QRS widening and QT prolongation
• aortic dissection
• neurological
• seizures
• mydriasis
• hypertonia
• hyperreflexia
• psychiatric effects
• agitation
• psychosis
• hallucinations
• others
• ischaemic colitis is recognised in patients following cocaine ingestion. This should be considered if patients complain of abdominal pain or rectal bleeding
• hyperthermia
• metabolic acidosis
• rhabdomyolysis

Management of cocaine toxicity

• in general, benzodiazepines are generally first-line for most cocaine-related problems
• chest pain:
• benzodiazepines + glyceryl trinitrate
• if myocardial infarction develops then primary percutaneous coronary intervention
• hypertension: benzodiazepines + sodium nitroprusside
• the use of beta-blockers in cocaine-induced cardiovascular problems is a controversial issue
• the American Heart Association issued a statement in 2008 warning against the use of beta-blockers (due to the risk of unopposed alpha-mediated coronary vasospasm) but many cardiologists since have questioned whether this is valid
• if a reasonable alternative is given in an exam it is probably wise to choose it