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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