Cocaine is a sympathomimetic substance with CNS-stimulating effects and euphoric properties. High doses can lead to panic, schizophrenia-like symptoms, seizures, hyperthermia, hypertension, cardiac arrhythmias, stroke, aortic dissection, intestinal ischemia and Myokardinfakrt. Of intoxication is countered by supportive treatment, u. a. with i.v. Administration of benzodiazepines (when energized, hypertension, and convulsions) and cooling measures (for hyperthermia). The withdrawal is manifested primarily as depression, impaired concentration and drowsiness.
Most consumers take cocaine one only occasionally. However, about 25% meet (or more) users the criteria for abuse or dependence. The use among young people has declined in recent times. The availability of highly biologically active forms like crack has exacerbated the problem of cocaine dependence. Most cocaine in the US has a purity of about 45 to 60%, so it can contain a wide range of fillers, extenders and impurities.
Cocaine is a sympathomimetic substance with CNS-stimulating effects and euphoric properties. High doses can lead to panic, schizophrenia-like symptoms, seizures, hyperthermia, hypertension, cardiac arrhythmias, stroke, aortic dissection, intestinal ischemia and Myokardinfakrt. Of intoxication is countered by supportive treatment, u. a. with i.v. Administration of benzodiazepines (when energized, hypertension, and convulsions) and cooling measures (for hyperthermia). The withdrawal is manifested primarily as depression, impaired concentration and drowsiness. Most consumers take cocaine one only occasionally. However, about 25% meet (or more) users the criteria for abuse or dependence. The use among young people has declined in recent times. The availability of highly biologically active forms like crack has exacerbated the problem of cocaine dependence. Most cocaine in the US has a purity of about 45 to 60%, so it can contain a wide range of fillers, extenders and impurities. Most cocaine in the United States is vaporized and inhaled, but it can also be snorted or injected i.v. be injected. For inhalation the powder-like hydrochloride salt by addition of NaHCO3, water and heat is converted into a more volatile form. The resulting precipitate (crack) is prepared by heating (it is not combusted) volatilized and inhaled. The effect is faster, and the “high” feeling is how significantly strengthened with the injection. For cocaine, there is the development of tolerance; during heavy use of the withdrawal by fatigue, difficulty concentrating, increased appetite and depression is characterized. After a period of withdrawal the desire for a renewed cocaine use is strong. Pathophysiology cocaine, an alkaloid in the leaves of the coca plant, increases noradrenaline, dopamine and serotonin activity in the central and peripheral nervous system. An improvement in dopamine activity is the most likely cause of an abuse of the substance. The norepinephrine activity ensures the sympathomimetic effects: tachycardia, hypertension, mydriasis, sweating and hyperthermia. Cocaine also blocks sodium channels, which may explain its action as a local anesthetic. Cocaine leads to vasoconstriction and thus can affect almost every organ. Myocardial infarction, cerebral ischemia and bleeding, aortic dissection, intestinal ischemia and renal ischemia are potential sequelae. The onset of action of cocaine depends on the type of incorporation from: Intravenous injection and smoking: Immediate onset, peak after 3-5 minutes, stopping the effects of about 15-20 min intranasal use: Insert after about 3-5 minutes maximum effect at 20-30 min, and a duration of about 45-90 min Oral administration: inserting after about 10 min, maximal effect at approximately 60 min, and a duration of about 90 minutes, since the effect of cocaine only very short stops, the substance is often injected intravenously or smoked every 10-15 minutes. Pregnancy cocaine use during pregnancy can have an effect on the fetus; the risk of placental abruption and miscarriage is higher. Symptoms and signs Acute Effects The effect depends on the type of revenue. After intravenous injection or inhalation of cocaine leads to hyperexcitability, increased alertness, euphoria and feelings of power, strength and power. Arousal and “High” are similar after injection of amphetamines. If cocaine is sniffed as a powder, these feelings are less intense and incisive. Users who smoke the substance may develop a pneumothorax or pneumomediastinum, causing chest pain, shortness of breath, or both. Myocardial ischemia by cocaine use can also lead to chest pain, but cocaine can also cause chest pain without myocardial ischemia; the mechanism is unclear. Arrhythmias and conduction disturbances may occur. Cardiac effects can lead to sudden death. Excessive use, often over several days, leading to a fatigue syndrome or “Washed-out syndrome” which ist.Toxizität characterized by intense fatigue and need for sleep or overdose An overdose can cause severe anxiety, panic, agitation, aggression, insomnia, hallucinations, cause paranoid delusions, impaired judgment, tremors, convulsions and delirium. It comes to mydriasis and sweating. Heart rate and blood pressure are elevated. Death can be caused by a myocardial infarction or cardiac arrhythmias. A severe overdose causes a syndrome of acute psychosis (z. B. schizophrenia-like symptoms), hypertension, hyperthermia, rhabdomyolysis, coagulation disorders, kidney failure and seizures. People with extremely severe intoxication may have genetic (abnormally) low serum cholinesterase levels. This enzyme is required for the elimination of cocaine from the plasma. Patients who inhale cocaine, acute pulmonary syndrome can develop (crackles lung) with fever, coughing up blood and hypoxia, which may progress to respiratory failure. With simultaneous use of cocaine and alcohol condensation occurs and formation of Coca ethylene, has the stimulating properties and toxicity effects verstärkt.Chronische When heavily dependent users appear severe toxic effects. Myocardial fibrosis, left ventricular hypertrophy and cardiomyopathy can develop. In rare cases, repeated rhinitis causes a perforation of the nasal septum due to local ischemia. Cognitive impairment, including impaired attention and limitations of verbal memory, occurs in people who are highly dependent. People who inject cocaine, subject to the typical infectious Komplikationen.Entzug The main symptoms are depression, impaired concentration and drowsiness. The appetite is increased. Diagnosis Clinical evaluation Diagnosis is clinically usually. Blood values ??are not determined. The Cocaine Metabolite benzoylecgonine is part of the most routine urine tests for various substances. Treatment Intravenous benzodiazepines avoid beta blockers cooling for hyperthermia as required toxicity or overdose, the treatment of mild cocaine poisoning is generally not required because the substance only has an extremely short duration of action. Benzodiazepines are the preferred initial treatment for most toxic effects including CNS excitation, seizures, tachycardia and hypertension. Lorazepam 2-3 mg iv every 5 min titrated can be used. High doses and one continuous infusion may be necessary. An infusion of propofol during mechanical ventilatory support can be used in difficult cases. Hypertension that does not respond to treatment with benzodiazepines is, with i.v. Nitrates (. E.g., nitroprusside) or phentolamine treated; Beta-blockers are not recommended because they allow continued ?-adrenergic stimulation. Hyperthermia can be life threatening and should aggressively with sedation plus. Evaporative cooling, ice packs and control intravascular volume and urine flow with i.v. saline treatment. Phenothiazines lower the seizure threshold, and their anticholinergic effects can interfere with cooling measures, which is why they are not used for sedation. Occasionally very excited patients should be asked pharmacologically quiet and artificially ventilated to improve acidosis, rhabdomyolysis or multisystem dysfunction. Cocaine-induced chest pain be investigated like any other patients with potential myocardial ischemia or aortic dissection: by chest x-ray, serial ECG and cardiac serum markers. As mentioned above, beta-blockers are contraindicated, while benzodiazepines are the drug of choice. When a coronary vasodilation is required after benzodiazepines were added, nitrates or phentolamine can (1 to 5 mg, i.v., slow administration) weren.Missbrauch employed people who consume large amounts of cocaine, and people who substance i.v. inject or smoke, most likely to be dependent. For occasional use and a nasal or oral incorporation of the risk of dependency is low. Ending a prolonged cocaine use can only be done with considerable support; possibly resulting depression requires close monitoring and treatment. There are many outpatient treatment options such as addiction and self-help groups and cocaine hotlines. Inpatient treatment is then displayed in the first place if a physical or mental comorbidity or if outpatient therapy was unsuccessful again. To treat children cocaine-dependent mothers (prenatal drug exposure). For more information Cocaine Anonymous World Services