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Cocaine

Aka: Cocaine
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  1. See Also
    1. Amphetamine
    2. MDMA
    3. Methamphetamine
    4. Chemical Dependency
    5. Substance Abuse Evaluation
  2. Background
    1. Naturally derived from Coca plant
      1. South American shrub
      2. Not the same as the cocoa plant
    2. Class
      1. Stimulant
      2. Local anesthetic
      3. Schedule I
  3. Street Names
    1. Coke
    2. Snow Flake
    3. Toot
    4. Star Dust
    5. Happy Dust
    6. Bernice
  4. Pharmacokinetics
    1. Cocaine (20-300 mg)
      1. Duration: 2-4 hours
      2. Half life: 90 minutes
    2. Metabolized by serum and hepatic cholinesterases
    3. Excreted by Kidneys
    4. Crosses the placenta by simple diffusion
    5. Affects Neurotransmitters
      1. Norepinephrine
      2. Dopamine - arousal
      3. Serotonin - awakening
    6. Prolonged Duration and toxicity
      1. Excessive intake
        1. "body packers" with ruptured bag
      2. Concurrent Alcohol ingestion
  5. Forms
    1. Swallowed
    2. Snorted
    3. Intravenous
    4. Freebase residue,
    5. Smoked (solid crack)
  6. Peak Toxicity
    1. Swallowing: 60-90 minutes
    2. Snorting: 30-60 minutes
    3. Intravenous or Smoked: Minutes
  7. Signs: Toxicity (Systemic Sympathomimetic Effect)
    1. See Sympathomimetic Toxicity
    2. Hypertensive
    3. Tachycardia
    4. Diaphoresis
    5. EKG with QRS Widening
      1. Contrast with Amitriptyline overdose which causes dryness (instead of diaphoresis)
  8. Management: Toxicity
    1. See Sympathomimetic Toxicity
  9. Management: Withdrawal
    1. Ativan until adequate Sedation
      1. May require significant dosages
    2. Propranolol 20 mg qid (indicated for chills)
  10. Management: Abstinence
    1. Study of effective options for therapy
      1. Cognitive behavior therapy
      2. Disulfiram (effective even if no Alcohol Abuse)
      3. Caroll (2004) Arch Gen Psychiatry 61:264-72
  11. References
    1. Shih (1996) Hosp Physician p. 11-20

Cocaine (C0009170)

Definition (MEDLINEPLUS)

Cocaine is a powerful drug that stimulates the brain. People who use it can form a strong addiction. They may have to use more and more of the drug to get high. It's sold on the street as a fine, white powder. There are two forms of cocaine: hydrochloride salt and freebase. The salt dissolves in water. People can take it in a vein or in the nose. The freebase form can be smoked. Crack is the street name of a smokable form of cocaine.

No matter how cocaine is taken, it is dangerous. Some of the most common serious problems include

  • Heart problems, including heart attacks
  • Respiratory effects, including respiratory failure
  • Nervous system problems, including strokes
  • Digestive problems

Any of these can be fatal. Using cocaine with alcohol is a common cause of drug-related death.

NIH: National Institute on Drug Abuse
Definition (NCI) A tropane alkaloid with central nervous systems (CNS) stimulating and local anesthetic activity. Cocaine binds to the dopamine, serotonin, and norepinephrine transport proteins and inhibits the re-uptake of dopamine, serotonin, and norepinephrine into pre-synaptic neurons. This leads to an accumulation of the respective neurotransmitters in the synaptic cleft and may result in increased postsynaptic receptor activation. The mechanism of action through which cocaine exerts its local anesthetic effects is by binding to and blocking the voltage-gated sodium channels in the neuronal cell membrane. By stabilizing neuronal membranes, cocaine inhibits the initiation and conduction of nerve impulses and produces a reversible loss of sensation.
Definition (MSH) An alkaloid ester extracted from the leaves of plants including coca. It is a local anesthetic and vasoconstrictor and is clinically used for that purpose, particularly in the eye, ear, nose, and throat. It also has powerful central nervous system effects similar to the amphetamines and is a drug of abuse. Cocaine, like amphetamines, acts by multiple mechanisms on brain catecholaminergic neurons; the mechanism of its reinforcing effects is thought to involve inhibition of dopamine uptake.
Definition (CSP) alkaloid ester extracted from the leaves of plants including coca; has powerful central nervous system effects similar to the amphetamines and is a drug of abuse; acts by multiple mechanisms on brain catecholaminergic neurons; the mechanism of its reinforcing effects is thought to involve inhibition of dopamine uptake; it is also a local anesthetic and vasoconstrictor and is clinically used for that purpose.
Concepts Organic Chemical (T109) , Pharmacologic Substance (T121) , Hazardous or Poisonous Substance (T131)
MSH D003042
SnomedCT 14816004, 387085005
English Cocaine, cocaine, 8-Azabicyclo(3.2.1)octane-2-carboxylic acid, 3-(benzoyloxy)-8-methyl-, methyl ester, (1R-(exo,exo))-, cocaine in any form, cocaine product, Blow, Coke, C, Flake, Snow, (1R,2R,3S,5S)-2-Methoxycarbonyltropan-3-yl Benzoate, Cocaine [Chemical/Ingredient], cocaine substance, cocaine (Schedule I substance), Cocaine product, Cocaine (product), Cocaine (substance), COCAINE
Swedish Kokain
Czech kokain
Finnish Kokaiini
Russian KOKAIN, КОКАИН
Japanese コカイン塩基, ベンゾイルメチルエクゴニン, コカイン, エリスロキシリン
Croatian KOKAIN
Polish Kokaina
Spanish cocaína (producto), cocaína (sustancia), cocaína, Cocaina, Cocaína
French Cocaïne
German Cocain, Kokain
Italian Cocaina
Portuguese Cocaína
Sources
Derived from the NIH UMLS (Unified Medical Language System)


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