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Source: Doering PL, Li RM. Substance-related disorders I: overview and depressants, stimulants, and hallucinogens. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 10th ed. New York, NY: McGraw-Hill; 2017. http://accesspharmacy.mhmedical.com/content.aspx?bookid=1861§ionid=146064131. Accessed April 12, 2017.
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CONDITION/DISORDER SYNONYMS
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Substance-related disorders include disorders of:
Intoxication.
Dependence.
Withdrawal.
Intoxication: maladaptive behavior during waking state after recent ingestion and presence in body of substance causing central nervous system (CNS) effects.
Substance dependence: continued pattern of substance use in spite of repeated adverse consequences related to repeated use.
Physical dependence: state of adaptation manifested by withdrawal syndrome following:
Withdrawal: development of substance-specific syndrome after cessation or reduced intake of substance that had been used regularly.
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10% of people who begin using cocaine progress to serious, heavy use.
After having tried cocaine, progression to frequent, chronic use unpredictable.
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Cocaine hydrochloride is inhaled or injected.
Can be converted to cocaine base (crack or rock) and smoked to achieve almost instant absorption and intense euphoria.
Euphoria from snorting lasts 15–30 min; euphoria from smoking lasts 5–10 min.
Tolerance to euphoria develops quickly.
In presence of alcohol, cocaine is metabolized to cocaethylene, longer-acting compound than cocaine with greater risk for causing death.
Cocaine elimination half-life: 1 hour.
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CLINICAL PRESENTATION
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Cocaine intoxication:
Agitation.
Elation.
Euphoria.
Grandiosity.
Loquacity.
Hypervigilance.
Sweating or chills.
Nausea.
Vomiting.
Tachycardia.
Arrhythmias.
Respiratory depression.
Mydriasis.
Altered blood pressure.
Seizures.
Complications of cocaine use include:
Withdrawal signs and symptoms:
Fatigue.
Sleep disturbances.
Nightmares.
Depression.
Changes in appetite.
Bradyarrhythmias.
Myocardial infarction.
Tremors.
Withdrawal symptoms begin within hours of discontinuation and last up to several days.
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