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Source: Doering PL. Substance-Related Disorders: Overview and Depressants, Stimulants, and Hallucinogens. In: DiPiro JT, Talbert RL, Yee GC, Matzke GR, Wells BG, Posey LM, eds. Pharmacotherapy: A Pathophysiologic Approach. 8th ed. http://accesspharmacy.com/content.aspx?aid=7987346. Accessed June 9, 2012.

  • Cocaine synonyms:
    • Cake
    • Snow
    • Flake
    • Blow

  • 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:
    • Cessation
    • Rapid dose reduction
    • Decreasing blood levels
    • Administration of antagonist
  • Withdrawal: development of substance-specific syndrome after cessation or reduced intake of substance that had been used regularly.

  • 10% of people who begin using cocaine progress to serious, heavy use.
  • After having tried cocaine, progression to frequent, chronic use unpredictable.

  • 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 minutes; euphoria from smoking lasts 5–10 minutes.
  • 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.

  • In 2009, 4.8 million Americans age 12 and older had abused cocaine in any form and 1 million had abused crack at least once in year prior to being surveyed.
  • 2010 study showed that:
    • 1.6% of 8th graders, 2.2% of 10th graders, and 2.9% of 12th graders had abused cocaine in any form.
    • 1.0% of 8th graders, 1.0% of 10th graders, and 1.4% of 12th graders had abused crack at least once in year prior to being surveyed.

  • Positive family history of substance abuse related to speed of developing cocaine dependence and earlier age of onset.

Signs and Symptoms

  • 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:
    • Ulceration of nasal mucosa
    • Nasal septal collapse
    • Tachycardia
    • Heart failure
    • Hyperthermia
    • Shock
    • Seizures
    • Psychosis (similar to paranoid schizophrenia)
    • Sudden death
  • 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.

Laboratory Tests

  • When toxicology screens necessary, blood or urine should be collected immediately when patient presents for treatment.

Differential Diagnosis

  • Cessation of use of drug
  • Termination of drug-seeking behaviors
  • Return to normal functioning

  • Establish airway.
  • Provide oxygen.
  • Monitor cardiac function.
  • Ensure IV access.

  • Treat cocaine intoxication pharmacologically only if patient agitated or psychotic.
  • Lorazepam 2–4 mg IM every 30 minutes to 6 hours as needed for agitation.
  • Haloperidol 2–5 mg (or ...

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