|Drug Toxicity - clinical assessment
|Aspirin or Salicylates toxicity
|Ethylene glycol toxicity
|Carbon Tetrachloride Toxicity
|Renal Tubular Acidosis
|Tricyclic Antidepressant Toxicity
|Carbon monoxide Toxicity
|Paracetamol (Acetaminophen) toxicity
|Beta Blocker toxicity
|Calcium channel blockers toxicity
|Organophosphate (OP) Toxicity
|Toxin elimination by dialysis
|Drug Toxicity with Specific Antidotes
Commonly available and used drug. Ask about usage. Patients tend not to admit to it unless asked and may be relevant.
- Cocaine is a central nervous system stimulant derived from the leaves of the coca plant
- Effect is blockade of the reuptake of dopamine, serotonin and Norepinephrine
- This raises the levels of these substances.
- It is suggested that chronic usage may actually accelerate atherosclerosis.
- The pleasures of cocaine come from raising dopamine levels in the mesolimbic reward centres
- Cocaine can be snorted and absorbed via well-vascularised tissues (that normally heat and humidify air) lining the nose. Causes localised vasoconstriction and eventual damage to the nasal mucosa.
- It can be smoked or taken intravenously. The last two give a rapid response but a shorter high than snorting. Other methods include rubbing it on the gums or taking small amounts orally.
- It has also been taken as a suppository. It is still used as a local anaesthetic in some ophthalmic and ENT surgery particularly as it also reduces bleeding.
- Cocaine induced chest pain is usually due to spasm and is generally (there are exceptions) not treated with thrombolysis.
- Patients who take cocaine often have the coexisting atherosclerotic disease and these areas of disease are actually more prone to spasm.
- Chest pain, Neurological signs from ischaemic/haemorrhagic stroke, aortic dissection
- Hypertensive, tachycardia, hyperthermia, euphoric, psychotic
- Dilated pupils, Long term - myocarditis, atherosclerosis.
- FBC, U&E, Troponin at baseline and 12 hours
- ECG - ischaemia or look for STEMI, LVH. CXR - cardiomegaly. CT head if any neurology.
- Evidence of Persisting ST elevation due to STEMI necessitates Primary PCI.
- Thrombolysis is generally avoided especially where markedly hypertensive.
- Give Sublingual and then IV nitrates as a prelude to PPCI.
- Unselected Beta Blockade alone will cause hypertension due to unopposed alpha effects and should be avoided.
- Hyperthermia is a recognised side effect of cocaine and should be treated with fluids, cooling and dantrolene,
- Haloperidol (Haldol)and phenothiazines should be avoided as they lower fit threshold. Try Diazepam.