22 Cocaine and Amphetamines

Question 1

Enzyme which metabolizes cocaine to ecgonine methyl ester

Answer 1

Plasma Cholinesterase

Question 2

Lack of which enzyme may predispose patients to life-threatening toxicity of cocaine

Answer 2

Plasma Cholinesterase

Question 3

Target compound detected in routine urine toxicology screens

Answer 3

Benzoylecgonine

Question 4

ECG findings of cocaine toxicity

Answer 4

QRS prolongation (due to blockade of fast Na channels)
QTc prolongation (due to potassium channels)

Question 5

Cocaine users with acute MI are managed with

Answer 5

Aspirin and NTG

Question 6

Contraindication for Cocaine users

Answer 6

B-blockers

Carries the potential for unopposed stimulation of alpha adrenergic receptors that worsens coronary and peripheral vasoconstriction

Question 7

Primary treatment for IV rhabdomyolysis

Answer 7

Aggressive IV hydration

Question 8

Management for Sympathomimetic Toxicity

Answer 8

_VS and continuous cardiac monitoring
Supportive care and prevent self-harm
Benzodiazepines for sedation
Aggressive cooling for hyperthermia
IV fluid for rhabdomyolysis
Benzodiazepines for seizures
Evaluate chest pain and treat ACS
Phentolamine for uncontrolled hypertension
Targeted therapy for dysrhythmias

Question 9

A wide complex tachycardia with clinical evidence of cocaine toxicity can be assumed to be due to sodium channel blockade and can be treated with ________

Answer 9

Sodium bicarbonate 1-2 meq/L IV bolus followed by intermittent boluses or infusion