Cocaine

Background

Cocaine chemical structure

• A sympathomimetic stimulant derived from an alkaloid paste made from the leaves of the coca plant
• Both a legitimate medical drug and a drug of abuse

Forms of Abuse

• Cocaine can be smoked, snorted, injected or ingested
• Smoked form is often in a free-base or crack form

Detection

• Unreliable in very acute intoxication
• Qualitative urine detection of cocaine metabolite benzoylecgonine at cut-off of 300 ng/ml
  • On average, shows up in urine 24-48 hrs after use
  • Up to 22 days in chronic users

Adverse effects

• Acute
  • Sympathomimetic qualities
    • Tachycardia
    • Fever
    • Agitation
    • Diaphoresis
• Chronic
  • Atherosclerosis
  • Cardiomyopathy
  • Nasal Septum damage
  • "Crack Lung"

Mechanism of action

• Blocks reuptake of serotonin, dopamine and norepinephrine
• Anesthetic effects achieved through sodium channel blockade

Differential Diagnosis

Sympathomimetics

• Cocaine
• Amphetamines
  • Synthetic cathinones (khat)
• Ketamine
• Ecstasy (MDMA)
• Synthetic cannabinoids
• Bath salts

See Also

• Sympathomimetic Toxicity
• Cocaine Intoxication
• Cocaine Chest Pain
• Cocaine Withdrawal
• Levamisole toxicity