Cocaine Flashcards
cocaine is a three-fold drug:
CNS stimulant
local anesthetic
vasoconstriction
positive effects of cocaine
Euphoria Garrulousness Decreased sleep Decreased appetite Sexual stimulation
cocaine-incuded euphoria occurs as ____________
cocaine-incuded euphoria occurs as THE BLOOD LEVEL IS RISING
negative effects of cocaine
Irritability
Anxiety
Restlessness
Paranoia
cocaine-induced paranoia
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
IN cocaine time course
onset of mood change: secs-2min
peak effects: 10 min
post-drug dysphoria: 45-60 mins
IV cocaine time course
onset of mood change: 15 sec
peak effects: 3-5 mins
post-drug dysphoria: 20-30 mins
smoking freebase (crack) cocaine time course
onset of mood change: 8 seconds
peak effects: 3-5 mins
post-drug dysphoria: 15 mins
Intranasal Cocaine Response in Casual Users (MALES)
Higher peak plasma cocaine levels
Detected cocaine effects faster
Experienced more episodes of euphoria
Heart rate paralleled plasma levels
Intranasal Cocaine Response in Casual Users (FEMALES)
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
Men or women may have a slightly better response to tx for cocaine abuse?
women
- to some extent may reflect reasons for use (escape from psychological pain vs. euphoria)
- may reflect overcoming of barriers to treatment
cocaine metabolism and screening
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.
cocaine abstinence sx
All abstinence sx are the OPPOSITE of intoxication sx
–> depression, increased sleep and appetite
Sx gradually fade over days to weeks
cocaine is metabolized by…
major metabolite is…
Metabolized by plasma cholinesterases
Major metabolite is benzoylecgonine (BE), an inactive metabolite
benzoylecgonine (BE) is present in urine for ~_______ post-use
benzoylecgonine (BE) is present in urine for ~48 hours post-use
half-life of cocaine
Half-life of cocaine is 40-60 minutes
Cocaine and Tolerance
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)
Local complications of cocaine
- Irritation/ulcers of nasal mucosa
- Rhinorrhea
- Nasal septal perforation
- Pulmonary dysfunction
- Dental/gum problems
Cardiovascular Complications of Cocaine
- MI
- Ventricular dysrhythmias
- Cardiomyopathy
- Endocarditis
Neuro Complications of Cocaine
- Hemorrhagic stroke
- Ischemic stroke
- Grand mal seizures (result of intoxication, not w/d)
How does concomitant alcohol use affect cocaine metabolism?
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.
Cocaine is Used in 3 Major Ways:
- IN (snorting) – peak 10 min, 30 sec onset
- Injection, usually IV – peak 3-5 min, 15 sec onset
- Smoking crack (freebase) – peak 3-5 min, 6-10 sec onset
Cocaine OD: about as common in ______ as is heroin overdose in ______
Cocaine OD: about as common in African-Americans as is heroin overdose in Caucasians
Fentanyl and its analogs increasingly common in cocaine
cocaine and pregnancy
Higher rate of:
Abruptio placentae
Genitourinary malformations
Low birthweight babies
*controversial (could be to poor prenatal care, other drugs, cigs, etc)
Frequent Co-occurring Disorders with Cocaine Use Disorder
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
Predictors of Outcome in Cocaine Use Disorder
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
Behavioral tx for cocaine use disorder
positive results have come from CONTINGENCY MANAGEMENT, e.g., REINFORCING patients for negative urine screens (giving vouchers)
Pharmacotherapy of Cocaine Use Disorder
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
Disulfiram for Cocaine Use Disorder
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 cocain and EtOH use
cognitive behavioral therapy vs. disease-model 12-step counseling
Disease-Model 12-Step counseling had best outcomes: least cocaine use, most months of abstinence
