Cocaine

Question 1

cocaine is a three-fold drug:

Answer 1

CNS stimulant
local anesthetic
vasoconstriction

Question 2

positive effects of cocaine

Answer 2

Euphoria
Garrulousness
Decreased sleep
Decreased appetite
Sexual stimulation

Question 3

cocaine-incuded euphoria occurs as ____________

Answer 3

cocaine-incuded euphoria occurs as THE BLOOD LEVEL IS RISING

Question 4

negative effects of cocaine

Answer 4

Irritability
Anxiety
Restlessness
Paranoia

Question 5

cocaine-induced paranoia

Answer 5

Occurs in about 2/3 of heavy users

Not necessarily dose-related, but there may be kindling effect

Duration (hr-min), content (paranoid about police, dealers etc.) distinguish it from other causes of paranoia

Question 6

IN cocaine time course

Answer 6

onset of mood change: secs-2min

peak effects: 10 min

post-drug dysphoria: 45-60 mins

Question 7

IV cocaine time course

Answer 7

onset of mood change: 15 sec

peak effects: 3-5 mins

post-drug dysphoria: 20-30 mins

Question 8

smoking freebase (crack) cocaine time course

Answer 8

onset of mood change: 8 seconds

peak effects: 3-5 mins

post-drug dysphoria: 15 mins

Question 9

Intranasal Cocaine Response in Casual Users (MALES)

Answer 9

Higher peak plasma cocaine levels

Detected cocaine effects faster

Experienced more episodes of euphoria

Heart rate paralleled plasma levels

Question 10

Intranasal Cocaine Response in Casual Users (FEMALES)

Answer 10

Earlier onset of cocaine use

More rapid development of dependence

More frequent involvement with a drug dependent partner

More premorbid depression

Slower recovery from depressive sx during first month of abstinence

Question 11

Men or women may have a slightly better response to tx for cocaine abuse?

Answer 11

women

• to some extent may reflect reasons for use (escape from psychological pain vs. euphoria)
• may reflect overcoming of barriers to treatment

Question 12

cocaine metabolism and screening

Answer 12

To detect cocaine immediately after use (within 4 hours) you need a blood test, while metabolites can be screened in urine at least 4 hours past the drug administration and for the next 48 hours.

Question 13

cocaine abstinence sx

Answer 13

All abstinence sx are the OPPOSITE of intoxication sx

–> depression, increased sleep and appetite

Sx gradually fade over days to weeks

Question 14

cocaine is metabolized by…

major metabolite is…

Answer 14

Metabolized by plasma cholinesterases

Major metabolite is benzoylecgonine (BE), an inactive metabolite

Question 15

benzoylecgonine (BE) is present in urine for ~_______ post-use

Answer 15

benzoylecgonine (BE) is present in urine for ~48 hours post-use

Question 16

half-life of cocaine

Answer 16

Half-life of cocaine is 40-60 minutes

Question 17

Cocaine and Tolerance

Answer 17

Tolerance to DRUG EFFECTS, not the drug

Cocaine causes complete acute tolerance to euphoria, incomplete acute tolerance to increase in heart rate

Reverse tolerance (kindling) to some CNS effects, e.g., paranoia, seizures (a WITHDRAWAL SEIZURE)

Question 18

Local complications of cocaine

Answer 18

• Irritation/ulcers of nasal mucosa
• Rhinorrhea
• Nasal septal perforation
• Pulmonary dysfunction
• Dental/gum problems

Question 19

Cardiovascular Complications of Cocaine

Answer 19

• MI
• Ventricular dysrhythmias
• Cardiomyopathy
• Endocarditis

Question 20

Neuro Complications of Cocaine

Answer 20

• Hemorrhagic stroke
• Ischemic stroke
• Grand mal seizures (result of intoxication, not w/d)

Question 21

How does concomitant alcohol use affect cocaine metabolism?

Answer 21

If cocaine is administered while drinking alcohol, the by-product cocaethylene has a half-life of 2.5 hours (versus only 40-60 min for cocaine) in the blood.

Question 22

Cocaine is Used in 3 Major Ways:

Answer 22

1. IN (snorting) – peak 10 min, 30 sec onset
2. Injection, usually IV – peak 3-5 min, 15 sec onset
3. Smoking crack (freebase) – peak 3-5 min, 6-10 sec onset

Question 23

Cocaine OD: about as common in ______ as is heroin overdose in ______

Answer 23

Cocaine OD: about as common in African-Americans as is heroin overdose in Caucasians

Fentanyl and its analogs increasingly common in cocaine

Question 24

cocaine and pregnancy

Answer 24

Higher rate of:
Abruptio placentae
Genitourinary malformations
Low birthweight babies

*controversial (could be to poor prenatal care, other drugs, cigs, etc)

Question 25

Frequent Co-occurring Disorders with Cocaine Use Disorder

Answer 25

Other substance use disorders (EtOH –> lets users do more cocaine than usual and vice versa)
Mood Disorders
Attention Deficit Hyperactivity Disorder
Posttraumatic stress disorder
Personality Disorders, esp. antisocial,borderline

Question 26

Predictors of Outcome in Cocaine Use Disorder

Answer 26

Patients with initial positive urine were less than half as likely to complete tx or attain initial abstinence

Women may have better outcomes

Co-occurring psychiatric disorders do not consistently predict outcome

Question 27

Behavioral tx for cocaine use disorder

Answer 27

positive results have come from CONTINGENCY MANAGEMENT, e.g., REINFORCING patients for negative urine screens (giving vouchers)

Question 28

Pharmacotherapy of Cocaine Use Disorder

Answer 28

No reliably effective meds in general; none are FDA-approved (disulfiram)

High dropout rate, high placebo response rate both make it difficult to demonstrate efficacy

Question 29

Disulfiram for Cocaine Use Disorder

Answer 29

Inhibits aldehyde dehydrogenase, dopamine-beta-hydroxylase, and plasma esterases involved in metabolism of cocaine.

Cocaine use with disulfiram –> elevated CNS dopamine levels and increased cocaine blood levels, increased anxiety, paranoia, and dysphoria.
-> this may decrease cocaine and EtOH use

Question 30

cognitive behavioral therapy vs. disease-model 12-step counseling

Answer 30

Disease-Model 12-Step counseling had best outcomes: least cocaine use, most months of abstinence