Wk 26 - Cocaine

Question 1

What is cocaine?

Answer 1

• Psychoactive alkaloid of coca plant
• Addictive stimulant drug
• CNS effects similar to amphetamines
• Local anesthetic + vasoconstrictor

Question 2

What are the 2 forms of illegal cocaine?

Answer 2

• Cocaine base (crack): difficult to dissolve for injection, smoked bc low MP
• Cocaine salt: readily injected or snorted, highly water sol

Question 3

Give examples of inert fillers used as adulterants

Answer 3

• Dextrose
• Lactose
• Mannitol
• Starch

Question 4

Give examples of active chemicals used as adulterants

Answer 4

• Benzocaine
• Lidocaine
• Procaine
• Ephedrine
• Amphetamine
• Caffeine

Question 5

What are the contaminants found in street cocaine?

Answer 5

• Benzene
• Acetone
• Sodium carbonate

Question 6

What is the common cocaine adulterant + what are the side effects?

Answer 6

Levamisole:

• Leucopenia
• Agranulocytosis
• Cutaneous vasculitis

Question 7

What are the peak concentration of cocaine after smoking, injecting + intranasal?

Answer 7

• 5-10 mins: injection/smoking

- 60 mins: intranasal

Question 8

Which is shorter acting, cocaine or amphetamines?

Answer 8

Cocaine

Question 9

What are the major metabolites of cocaine?

Answer 9

• Benzoylecgonine

- Ecgonine methyl ester

Question 10

What are the minor metabolites of cocaine?

Answer 10

• Norcocaine
• P-hydroxycocaine
• M-hydroxycocaine

Question 11

How does cocaine produce anesthesia?

Answer 11

Inhibit excitation of nerve endings or blocking conduction in peripheral nerves

Question 12

What are the mechanism of action of cocaine?

Answer 12

• Vasoconstriction
• Reversibly binds + inactivates sodium channels
• Affects cardiac myocytes by blocking sodium channels

Question 13

What is the primary site of action of cocaine?

Answer 13

• Dopamine uptake transporter

- Block DAT, inc dopamine, mediates rewarding effect of cocaine

Question 14

What other site of action does cocaine act on?

Answer 14

• Inhibits VTA GABA neurons -. disinhibits VTA DA neurons
• DA binds to post synaptic D1 receptor + regulates Glue transmission via NMDA + AMPA receptors
• Cocaine activates pre/postsynaptic D1 receptor -> inc Glu transmission
• Glu: triggers relapse

Question 15

What are the short term effects of cocaine?

Answer 15

• Main: extreme happiness, alertness, hypersensitivity to sight + paranoia
• Other: constricted blood vessels, dilated pupils, nausea, raised temp + BP

Question 16

What are the long term effects of cocaine?

Answer 16

• Snorting: swallowing problems, hoarseness, nasal septum inflammation
• Smoking: worsen asthma + damages lungs
• Red blood flow to GIT (tears + ulceration)
• Lose appetite
• Toxic effect on heart + CV system (stroke, inability to contract)

Question 17

What are the neurological problems w/ long term cocaine use?

Answer 17

• Intracerebral hemorrhage or aneurysm rupture
• Movement disorder
• Impaired cognitive function

Question 18

Outline some withdrawal symptoms that come w/ cocaine

Answer 18

• Paranoia
• Depression
• Itching
• Irritability
• Schizo like symptoms

Question 19

What are the primary goals of managing addiction?

Answer 19

• Abstinence
• Relapse prevention
• Rehabilitation

Question 20

Outline some behavioural approaches that are used as primary interventions

Answer 20

• CBT
• Contingency management
• Motivational enhancement therapy

Question 21

Give examples of medication used to help cocaine addicts from drug use

Answer 21

• Propranolol: dec physical symptoms
• Vigabatrin: seizures
• Topiramate + citalopram: red relapse
• Disulfiram: treat alcoholism + red cocaine use
• Cocaine vaccine: stimulate immune system to create cocaine specific antibodies that bind to cocaine