Cocaine: quick review

PATHOPHYSIOLOGY:

• Release of NE, blocks NE reuptake
• Release & reuptake blockade of serotonin and dopamine
• Na channel blockade – local anesthetic effect
• Fat soluble - crosses blood brain barrier
• Stimulates CNS, especially limbic system, which potentiates dopaminergic transmission - pleasurable behavioral effects
• REMINDER: don't treat with a beta-blocker (shunts to unopposed alpha receptors)

NOTABLE NUMBERS:

Route	Onset	Peak(min)	Duration(min)	Half-life (min)
Inhalation	7s	1-5	20	40-60
IV	15s	3-5	20-30	40-60
Nasal	3min	15	45-90	60-90
Oral	10min	60	60	60-90

DEATH BY...

• Tachydysrhythmias cause most non-traumatic deaths
• Stroke
• SAH
• Hyperthermia
• MI (acute vasospasm, dysrhythmia, chronic accelerate atherogenic disease)

HEART BREAKER:

• Patients with cocaine-related MI often have fixed atherosclerotic lesions.
• Cocaine can induce increased heart rate and BP, resulting in increased myocardial oxygen demand.
• effects of cocaine also include myocarditis and dilated cardiomyopathy.

10-SECOND RECAP:
--stims norepi, serotonin, dopa release, blocks reuptake; also Na+ channel blocker
--DON'T treat with beta-blocker (unopposed alpha-receptor action)
--inhaled/IV works in seconds, nasal/oral works in minutes, lasts hour(s)
--sympathomimetic response, and resulting problems (dysrhythmias, MI, stroke, SAH, hypertherm, etc.)
--say NO to drugs.


Submitted by J. Gullo. 

Reference(s): emedicine.com: cocaine toxicity in emergency medicine, picture