Transcript
Cocaine
Ihab Abdallah
Under Supervision: Dr. Mayada Wazaify
References
1- drugabuse.gov
2- Uptodate
3- National Institute of Drug Abuse (NIDA).
What is Cocaine
• Cocaine (Benzoylmethylecgonine)
Is a crystalline alkaloid prepared from the leaves of the
Erythroxylon coca plant .Cocaine
White
Bitter Odorless
Crystalline
NIDA
According to the National Institute of Drug Abuse (NIDA)
A powerfully addictive drug that can be
Cocaine
Snorted Injected Chewed Smoked
Cocaine ( Schedule II )
The 2nd Harmful Drug
COCAINE ( SCHEDULE I )
Form’s of Cocaine
Cocaine HCL (powder)
Prepared by dissolving the alkaloid in hydrochloric
acid, forming a water soluble salt.
Crack Cocaine
Produced when cocaine hydrochloride is mixed
with sodium bicarbonate and water, and then
heated.
Must Watch
• Video
Route of Administration
Cocaine can be administered as a drug of abuse in the following ways :
1. Cocaine hydrochloride: Snorting (intranasal)
Intravenous injection
2. Crack Cocaine: Inhalation of vapor from heated foil or pipe. (Smoked)
3. Coca leaves: Chewed or ingested.
Route of Administration
Comparison
Route Onset of Action Duration of Action
Smoking 7 seconds 20 minutes
Intravenous injection 15 seconds 22-30 minutes
Snorting 3 minutes 45-90 minutes
Oral 10 minutes 60 minutes
Brain Storming
3 12
The most common cause of
Recurrent Epistaxis in young adult
is ???
Cocaine use
Ref: USMLE
Mechanism of Action Mechanism of Action
Clinical Usage
Cocaine is used by health care professionals to
temporarily numb the lining of the mouth, nose,
and throat (mucous membranes) before certain
medical procedures (biopsy, stitches, wound
cleaning).
It is an anesthetic that works quickly to numb
the area about 1-2 minutes after application.
Reward System
Cycle of Addiction
Cocaine
Release of the impulses from NA to activate the reward system
This pathway activated also in the absence of cocaine Craving
Cocaine Addiction
(Craving)
Cocaine Dependence
(Anhedonia)
Inability to feel pleasure
Metabolism
• Serum half life of 45-90 minutes.
• Only 1% of the drug is recovered in urine after ingestion.
• Cocaine can be detected in blood or urine only for several
hours after its use.
• Cocaine metabolites are detectable for 2-5 days.
• Hair analysis provides a very sensitive marker for cocaine
use within the preceding weeks to months.
Short Term Effect
Initial Dose
Physical Effect Psychological Effect
Tachycardia Euphoria
Dilated pupils Sense of well being
Sweating Impaired reaction time
Reduced appetite Impaired attention span
Reduced need for sleep Impaired learning of new skills
Reduced lung function
Short Term Effect
Increased Doses
Physical Effect Psychological Effect
Seizures Anxiety, Irritability, Insomnia
Cardiac arrhythmias Depression, Paranoia
Myocardial infarction Aggressiveness, Impulsivity
Stroke Delusions
Respiratory arrest Agitated, Excited delirium
Reduced psychomotor function
Long Term Effect
Physical Effect Psychological Effect
Erosions, necrosis Dependence
Rhinorrhea and nasal eczema Disturbed eating
Chest pain, muscle spasms Disturbed sleeping patterns
Sexual impotence
Weight loss
Malnutrition
Vascular disease
Specific Organ Systems
Central Nervous System Central Nervous System
o Cocaine euphoria is associated with transient increases
in EEG activity.
o Seizures may occur in persons without a seizure
history, even with first time use of cocaine.
o These are usually single, generalized tonic-clonic
seizures occurring within 90 minutes of cocaine use.
o Cerebral vasoconstriction, cerebrovascular disease,
and hemorrhagic and ischemic stroke are increased
in cocaine users.
o MRI, PET imaging in chronic cocaine users
demonstrate structural and functional brain
abnormalities.
Central Nervous System Central Nervous System
Central Nervous System Central Nervous System
o A pathologic study using melanin immunoreactivity
found cocaine users to have 16 percent fewer midbrain
dopamine neurons than non-using subjects.
This and related findings
o suggest that cocaine may have a neurotoxic effect on
dopamine neurons, contributing to development of
cocaine dependence in some users.
Central Nervous System Central Nervous System
o Cocaine use is associated with a variety of movement
disorders:
• Cocaine users are at increased risk of acute dystonic
reactions from neuroleptic (antipsychotic) medications.
Stereotyped Behaviors
Acute Dystonic Reactions
Choreoathetosis
Akathisia (Crack Dancers)
Buccolingual Dyskinesia
Tourette’s Syndrome
PET PET
Brain images showing decreased dopamine2 receptors in the brain of a person addicted to cocaine versus a nondrug user. The dopamine system is important for conditioning and motivation, and alterations such as this are likely responsible, in part, for the diminished sensitivity to natural rewards that develops with addiction.
Respiratory System
o The effects of cocaine on the respiratory system
depend on the route of administration.
o Intranasal cocaine use (snorting) may cause chronic
rhinitis, perforation of the nasal septum, oropharyngeal
ulcers.
Why ?? Due to vasoconstriction and resulting ischemic necrosis.
Respiratory System
o Smoked cocaine use produces acute respiratory
symptoms in up to half of users.
Including
These effects are probably due to direct damage to the alveolar-
capillary membrane by cocaine or inhaled micro particles.
Productive Cough
Wheezing Exacerbation of
Asthma
Shortness of Breath Chest Pain
Hemoptysis
Cardiovascular System
Cardiopulmonary symptoms are the most frequent
complaints in cocaine users who seek medical help,
with chest pain being the most frequent symptom.
Cocaine
• Increase HR • Increase BP• Increase SVR
By increasing adrenergic
activity in the heart, and
indirectly via the CNS.
Cardiovascular System
The increased myocardial oxygen demand, coupled
with decreased coronary blood flow from vasospasm
and vasoconstriction, can cause acute myocardial
infarction.
Cocaine appears to enhance the progression of renal
disease in patients with hypertension.
Cocaine use increases risk for cardiac arrhythmias and
sudden death.
Cardiovascular System
Chronic use is associated with left ventricular
hypertrophy, cardiomyopathy, myocardial fibrosis, and
myocarditis.
DSM V
1- Cocaine is often taken in larger amounts or over a
longer period than was intended.
2- There is a persistent desire or unsuccessful efforts to
cut down or control cocaine use
3- A great deal of time is spent in activities necessary to
obtain cocaine, use cocaine, or recover from its effects
4- Craving, or a strong desire or urge to use cocaine
5- Recurrent cocaine use resulting in a failure to fulfill
major role obligations at work, school, or home.
6- Continued cocaine use despite having persistent or
recurrent social or interpersonal problems caused or
exacerbated by the effects of cocaine.
7- Important social, occupational, or recreational activities
are given up or reduced because of cocaine use.
8- Recurrent cocaine use in situations in which it is
physically hazardous.
9- Tolerance.
10- Withdrawal.
≥ 2
10
Cocaine Tolerance
o Cocaine produces an intense high and may not cause
an emotional depression when the drug wears off.
The user may conclude that cocaine is
harmless.
o A craving as well as a tolerance for the drug develops.
With Repeated use
As a result
Initially
Cocaine Tolerance
• Over time, the high produced by a given amount
of cocaine decreases while the depression when
the drug wears off deepens.
• The addict ends up "chasing a high" by taking
ever-increasing amounts of cocaine more and
more frequently. When the supply of cocaine is
gone, the addict is left with an intense craving
along with severe depression that may reach a
suicidal level.
Cocaine Frenzy
o As tolerance to cocaine develops, an increased
susceptibility to seizures and psychosis also develops.
• An extreme form of this reverse tolerance can be called
“Cocaine frenzy"
• The person in a cocaine frenzy displays psychotic and
violent behavior, panic, and superhuman strength.
HIV & Hepatitis B and C
o Cocaine abusers are at increased risk for contracting
such infectious diseases as HIV (AIDs) and viral
hepatitis.
o This risk stems not only from sharing contaminated
needles and drug paraphernalia but also from engaging
in risky behaviors as a result of intoxication.
o Potentially lead to risky:
1-sexual encounters 2- Needle
sharing
3-Trading sex for drugs—by both men and
womens.
o Hepatitis C (HCV) has spread rapidly among injecting
drug users.
o Risk begins with the first injection, and within 2 years,
nearly 40% of injection drug users (IDUs) are exposed
to HCV.
o By the time IDUs have been injecting for 5 years, their
chances of being infected with HCV are between 50-
80%.
HIV & Hepatitis B and C
PregnancyPregnancy
Common Adverse Effect of Cocaine use in Pregnancy!!
1- Restricts blood flow to the uterus, cause fetal hypoxia.
2- Uterine contractions, CNS infarction, Heart defects.
3- Persistent neonatal arterial hypertension.
4- Decreased neonatal weight and size ( head circumference).
5-sudden infant death syndrome, Mental retardation.
6- Babies may be irritable at birth and exhibit symptoms such as: tremor, hypertension, abnormal reflexes, tachypnea, autonomic instability, vomiting, diarrhea, seizures and poor feeding.
Brain StormingBrain Storming
Why baby look like this ???
Crack Baby !!!!
A baby who is not strong and
healthy at birth and whose mother
used crack cocaine while she was
pregnant.
3 2 1
Treatment
Psychosocial Treatment
lead to small reductions in cocaine useBY:
Motivational interviewing
Cognitive therapy
Behavioral therapy
Supportive therapy
Psychodynamic
o More intensive treatment.
o More frequent visits.
o Longer duration of treatment.
o Cocaine Anonymous.
Associated with better outcomes
Behavioral Treatment
o One of behavioral therapy that is showing positive
results in cocaine addicted population is contingency
management or motivational incentives (MI).
o MI: is particularly useful for helping patients achieve
initial abstinence from cocaine and for helping patients
stay in treatment.
o Cognitive behavioral therapy: is an effective approach
for preventing relapse.
Medications
1- Cocaine Vaccine:
Is composed of a cocaine hapten conjugated to
inactivated cholera toxin B, resulting in the creation of a
molecule capable of stimulating an antibody response.
Cocaine vaccine that prevents entry of cocaine into the
brain holds great promise for reducing the risk of
relapse.
2- Others:
Medications
TopiramateVigabtrin
Disulfiram Modafinil Tiagabine
Show promise and have been reported to reduce cocaine use in controlled clinical
trials.
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