Cocaine Misuse Flashcards
What are the three patterns of clinical effects dependent of frequency and use of cocaine?
Recreational user
Binge User
Chronic high-dose dependency
What clinical effects are seen in a recreational user of cocaine?
- euphoria
- increased alertness
- increased feelings of self-confidence
- pressured speech
- he ‘high’ is followed by plateau and then come down
When are the clinical effects more pronounced in recreational users of cocaine?
When cocaine is injected or smoke rather than intranasal use
What clinical effects are witnessed in a binge user of cocaine?
- tachycardia
- twitching
- insomnia
- anxiety
- hallucinations
- persecutory delusions (can result in dangerous aggression)
What clinical effects are witnessed in chronic high-dose dependency cocaine?
- perforated nasal septum
- severe psychiatric and medical complications
- fatalities
What is a risk factor in development of cocaine abuse?
Early childhood traumas
How may cocaine abuse present?
- Psychiatric emergency - may present with acute anxiety or paranoia
- Person discloses drug abuse and seeks help
- Patient using another drug discloses they are also doing cocaine
- Cocaine related medical problem e.g. asthma, chest pains and weight loss
How would you manage a cocaine user if they came in with severe anxiety/paranoia?
Sit pt down and clam them as a cocaine ‘high’ wears off rapidly and pt should soon become state enough for further assessment
If verbal and non-verbal methods do not work - may use rapid tranquillisation or benzodiazepines
What are acute medical complications of cocaine use?
- pulmonary oedema
- heart failure
- MI
- Stroke
- Hyperthermia
What psychological interventions may be used in cocaine users?
- Contingency management incentives are given for drug-free periods, which are confirmed by blood testing
- CBT
- Motivational Interviewing Involves helping the person think through what changes they need to make o their lives and focus on the need to stop/limit their drug use in order to reduce harm or prevent relapse
What medications may be used for helping symptoms of cocaine use?
Benzodiazepines
antidepressants
beta-blockers
Why would benzodiazepines e.g. diazepam be used in treating cocaine use
helps ‘come-down’ and treat insomnia
Why may antidepressants e.g. SSRIs be used in cocaine use?
useful if depression is a feature and other stimulant drug use has stopped.
What is there a risk of if SSRIs and cocaine used at same time?
Serotonin syndrome
Why may beta-blockers be used in cocaine users?
for anxiety, particularly during withdrawal and reduce relapse rate. However, be wary due to the fact it can be contra-indicated by asthma (and cocaine use is associated with asthma)
