Cocaine

Answers are from DSM-IV-TR or the Substance Abuse Practice Guideline, AJP

Supplement, August 2006.As of 9Sep08

Half-life

Q. Half-life of cocaine?

Half-life

Ans. 30 – 50 minutes [which helps explain the need for frequent dosing to maintain high].

Intoxication

Q. DSM-IV list 9 signs of cocaine intoxication. List.

Intoxication - 1

Ans.1. Tachycardia or bradycardia2. Pupillary dilation3. BP up or down4. Perspiration or chills5. Nausea or vomiting6. Weight loss7. See next slide

Intoxication - 2

7. Psychomotor agitation or retardation

8. Muscular weakness, R decreased, chest pain, or cardiac arrhythmias

9. Confusion, seizures, dyskinesias, dystonia, or coma.

With perceptual disturbance

Q. “With perceptual disturbance” is a specifier that is added to the dx of intoxication. What signs might be reported?

With perceptual disturbance

Ans.

-- paranoid ideation

-- auditory hallucinations

-- tinnitus

Withdrawal

Q. Signs of withdrawal? DSM list 5.

Withdrawal

Ans.

1] fatigue

2] vivid, unpleasant dreams

3] insomnia or hypersomnia

4] increased appetite

5] psychomotor retardation or agitation

Physical exam - snorters

Q. Physical examination of snorters finds?

Physical exam - sorters

Ans. Nose bleed and, with longer use, perforated nasal septum.

Babies

Q. Babies of mothers who have used cocaine a lot during pregnancy tend to be?

Babies

Ans. Low birth weight.

Prevalence - lifetime

Q. Lifetime prevalence?

Prevalence - lifetime

Ans. 2% of the US population.

Prevalence - gender

Q. Which gender predominates?

Prevalence - gender

Ans. Males

Urine +

Q. How long is the urine positive after use of cocaine?

Urine +

Ans.

One dose: 1 – 3 days

Lots of doses: 7 -12 days

Crack

Q. What is crack and how does it differ from natural cocaine?

Crack

Ans. Crack is a cocaine alkaloid that differs in that:

-- it is easily vaporized and inhaled which provides an extremely rapid onset.

Cocaine intoxication management

Q. Management of cocaine intoxication?

Cocaine intoxicationmanagement

Ans.1. Usually only requires supportive care2. Exceptions include providing the appropriate

med for specific symptoms:-- hypertension-- tachycardia-- seizures-- delusions-- very agitated

Cocaine withdrawalmanagement

Q. Meds for cocaine withdrawal?

Cocaine withdrawal

Ans. No meds have been proven to be helpful in controlled studies.

Psychosocial approaches

Q. Name psychosocial approaches for cocaine dependence.

Psychosocial approaches

Ans.

1. CBT

2. Behavior therapy

3. 12-step counseling

4. Self-help groups, e.g., Narcotic’s Anonymous

Meds

Q. If used with psychosocial approaches, what meds “show promise”?

Meds

Ans.

-- disulfiram

-- modafinil

-- topiramate