Cocaine Flashcards
What is the toxic dose of cocaine?
> 1 gram
What are the symptoms that herald severe cocaine toxicity?
Headaches, hyperthermia, cardiac conduction abnormalities, focal neurology, chest pain
What is the safe local anaesthetic dose of cocaine?
1-3 mg/kg
What is the usual dose of a line of cocaine?
20-30 mg
What are the toxic mechanisms of cocaine?
Sympathomimetic (block of presynaptic catecholamine reuptake resulting in vascular dissection, ICH, acute cardiomyopathy). Acute coronary syndrome. Blockade of myocardial fast sodium channels –> ventricular dysrhythmias. CNS excitation results in psychomotor acceleration, seizures and hyperthermia.
How long can cocaine metabolites appear in the urine?
Up to 36 hours
What are the clinical features of cocaine intoxication?
CNS: euphoria, anxiety, aggression, paranoia, hyperthermia, rigidity, myoclonic movements, seziures. CVS: tachy/hypertension, dysrhythmias, ACS, QT prolongation, APO. Peripheral: hyperthermia, fasciculations, mydiasis, sweating, tremor.
What are the medical complications of cocaine intoxication?
Hyperthermia-rhabdo, renal failure, cerebral oedema. Aortic/carotid dissection. SAH/ICH, ischaemic colitis, pneumothorax, pneumomediastinum, ACS/APO
What are some ECG changes that may be noticable with cocaine intoxication?
Brugada-type pattern (RBBB with ST elevation in V1/V2/V3)
What are treatment priorities in acute cocaine intoxication?
Treat cardiac dysrhythmias, hypertension, hyperthermia, seizures, severe agitation
How would you treat VTach in cocaine intoxication?
IV bolus of 50-100 mmol of sodium bicarb. If refractory to sodium bicarb/shock then give lignocaine 1.5 mg/kg IV + infusion
How would you treat hypertension or sinus tachy in a patient with cocaine intoxication?
Benzos and NOT beta-blockers
With cocaine intoxication, what temperature requires external cooling?
> 39.5 degrees
Why are beta-blockers contraindicated in ACS or chest pain with cocaine intoxication?
Unopposed alpha-receptor stimulation
