M.Irsyadul Fuad J.

M 201210401011002
 Cocain is naturaly occuring alkaloid found within the leaves of a shrub (Erythroxylon coca)
 Back to times when the ancient inhabitants of Peru used the leaves for religious
ceremonies
 Cocaine was first isolated from the coca leaf in 1859. Its first use as a local anesthetic was
reported in 1884 In the late 19th century
 Cocaine may be abused through a number of different routes. The most widespread routes
of administration include
 inhaling (snorting),
 subcutaneous injection (skin popping),
 intravenous injection (shooting-up),
 smoking (freebasing or smoking crack)
 The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5)
recognizes substance related disorders resulting from the use of ten separate
classes of drugs:
 Alcohol
 Caffeine
 Cannabis
 Hallucinogens (phencyclidine or similarly acting arylcyclohexylamines)
 Hallucinogens (LSD, inhalants, opioids, sedatives, hypnotics, anxiolytics)
 Stimulants (including amphetamine-type substances, cocaine, and other stimulants)
 Tobacco, and other or unknown substances.
 The time to peak effects of cocaine depends on the dose and route of
administration. When cocaine is injected intravenously or crack is smoked, the
onset of action is within seconds and peak effects occur within 5 minutes. When
snorted, the onset of action of cocaine is within the first 5 minutes and its effects
typically peak within 30 minutes. Cocaine can be absorbed across any mucosal
surface, including the respiratory, gastrointestinal, and genitourinary tracts.
 Two major routes account for cocaine's metabolism: (1) enzymatic metabolism by
both liver esterases and plasma cholinesterase to ecgonine methyl ester and (2)
nonenzymatic degradation to benzoylecgonine. The half-life of cocaine is 30-90
minutes. The metabolites ecgonine methyl ester and benzoylecgonine are excreted
in the urine. Drug screens detect the presence of benzoylecgonine, which may be
present in the urine for 2-3 days, depending on the dose and chronicity of usage.
Rare cases of benzoylecgonine detection in the urine for 22 days following cocaine
use have been reported.
 The following statistics are from the 2014 National Survey on Drug Use & Health (NSDUH) for
the age group 12 years and older. [2]
 In 2014, there were 1.5 million current cocaine users aged 12 or older, or 0.6 percent of the
population. About 913,000 people aged 12 or older in 2014 had a cocaine use disorder, which
represents 0.3 percent of the people aged 12 or older.
 The incidence of cocaine use generally rose throughout the 1970s to a peak in 1980 (1.7
million new users) and subsequently declined until 1991 (0.7 million new users). Cocaine
initiation steadily increased during the 1990s, reaching 1.2 million in 2001.
 In Mexico, for example, patients in drug abuse treatment programs in 16 cities report cocaine
as the primary drug of choice.
 The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) classifies
cocaine use under the category of stimulant-related disorders. The five disorders now
recognized as :
 Stimulant use disorder
 Stimulant intoxication
 Stimulant withdrawal
 Other stimulant-induced disorders
 Unspecified stimulant-related disorder
 Tachycardia
 Hypertension
 Hyperthermia
 Tachypnea
 Diaphoresis
 Examine the skin for evidence of intravenous (track marks) or subcutaneous (skin
popping) drug abuse
 Mydriasis
 Nasal septa perforations
 Vomiting, diarrhea, and hyperactive bowel sounds may be noted with acute
cocaine abuse.
 The US National Institute on Drug Abuse estimates that approximately 10% of people who
begin to use cocaine progress to become chronic abuse.

 Approximately 50% of those who abuse illicit drugs also have a co-occurring mental
disorder for example, individuals who abuse cocaine have higher rates of antisocial
personality disorder, depression, anxiety, and attention-deficit/hyperactivity disorder and
low levels of family bonding and high levels of peer antisocial activity were consistently
associated with higher prevalence of illicit drug initiation among youths aged 12-21
 Amphetamine-Related Psychiatric Disorders
 Anxiety Disorders
 Attention Deficit Hyperactivity Disorder (ADHD)
 Bipolar Disorder
 Delirium
 Delusional Disorder
 Depression
 Hallucinogen Use
 Panic Disorder
 Phencyclidine (PCP)-Related Psychiatric Disorders
 Schizoaffective Disorder
 Schizophrenia
 Schizophreniform Disorder
 Sleep Disorders
 Electrolytes ( Hypokalemia may occurs in acute cocaine intoxication from intracellular
shifts of potassium ions and metabolic acidosis also may be observed in acute cocaine
intoxication.)
 Toxicology
 Urine drug screens: Benzoylecgonine, a metabolite of cocaine, may be present in the
urine for 60 hours a
 Plasma cocaine levels: Because cocaine has a short half-life of 30-45 minutes and the
metabolites are present in the urine for a much longer period after a single use of
cocaine
 Arterial blood gas determination
This test may be useful in patients with either marked tachypnea or a decreased serum
bicarbonate level to further delineate the etiology.
 Chest radiographs
Chest radiographs should be obtained in patients exhibiting pulmonary signs or
symptoms after cocaine use.
 Head CT scan
Patients exhibiting acute mental status changes or focal neurological signs and symptoms
may require a head CT scan.
 ECG
ECG should be obtained if an individual who abuses cocaine reports chest pain, shortness
of breath, syncope, or palpitations.
 Benzodiazepines are the drugs of choice for acute cocaine intoxication with
extreme agitation.

 Pharmacologic therapy depends on presenting signs and symptoms (eg, treat

chest pain with oxygen, benzodiazepines, aspirin, and nitroglycerin)

 Avoid use of beta-blockers because of the unopposed alpha-agonist activity. The

mood shifts, abnormal sleep and even delusions associated with acute cocaine
intoxication or withdrawal often are transient and do not require medications.
 The key to deterrence and prevention is education.
 Thoroughly review the complications of cocaine abuse with these patients at a level at
which they can understand.
 The earlier the intervention, the more likely the patient will succeed without long-term
adverse health effects.
Complications may include the following:
 Rhabdomyolysis
 Acute coronary syndrome
 Cerebral vascular accidents
 Acute renal failure
 Seizures
 Hyperthermia
 Pneumothorax
 Pneumomediastinum
 Pulmonary infarct
 Pulmonary edema
 Among subjects who present for cocaine dependence treatment, concurrent alcoholism
predicts higher relapse risk and poorer outpatient therapy attendance.
 Studies suggest that patients who have used cocaine as a primary drug of abuse for
extended periods constitute a group with particularly high underlying psychopathology.