Adverse effects cocaine

Serious adverse effects of epinephrine potentially occur when it is given in an excessive dose, or too rapidly, for example, as an intravenous bolus or a rapid intravenous infusion. These include ventricular dysrhythmias, angina, myocardial infarction, pulmonary edema, sudden sharp increase in blood pressure, and cerebral hemorrhage. The risk of epinephrine adverse effects is also potentially increased in patients with hypertension or ischemic heart disease, and in those using (3-blockers (due to unopposed epinephrine action on vascular Ui-adrenergic receptors), monoamine oxidase inhibitors, tricyclic antidepressants, or cocaine. Even in these patients, there is no absolute contraindication for the use of epinephrine in the treatment of anaphylaxis [1,5,6]. 

The higher than expected frequencies of alcohol PCP - and heroin PCP-related deaths also would have occurred if the combinations were preferred by the users. The motivation may involve the injection of heroin to moderate the adverse effects of PCP, or the use of PCP to ease the pain of heroin withdrawal. Another explanation assumes a stimulant effect of PCP. The use of stimulants, especially cocaine, with heroin is increasingly popular among heroin users (Kozel et al. 1982). 

In another case involving alcohol and cocaine, the defendant shot three police officers and was charged with attempted murder. The defendant claims that he had no memory of the events. Urine analysis indicated the use of cocaine. Testimony at trial emphasized the adverse effects of cocaine on behavior and on the inability to form intent to kill. In this case, however, the man was found guilty and sentenced to 60 years to life. 

Adverse effects of cocaine include constricted peripheral blood vessels, dilated pupils, and increased body temperature, heart rate, and blood pressure. Cocaine induces several immediate euphoric effects, such as hyperstimulation, reduced fatigue, and mental clarity, all of which depend on the administration route. The faster the absorption of cocaine, the more severe the effects. In contrast, faster absorption limits the duration of action. For example, the effect from snorting cocaine may last 15 to 30 minutes, whereas effects from smoking may last 5 to 10 minutes. Increased use can reduce the period of stimulation, as addicted humans may develop tolerance. In rare instances, sudden death may occur on the first use of cocaine or unexpectedly thereafter. 

Adverse effects of catecholaminergic stimulants, such as amfetamine and cocaine, fall into several categories, based on dose, time after dose, chronicity of use, and pattern of use/abuse (for example 4-5 day bingeing episodes). Adverse effects include not only responses during the period of use but also intermediate and longterm residual effects after withdrawal. For example, in some abusers once an amfetamine psychosis has developed with chronic abuse, only one or two moderate doses are required to induce the full-blown psychosis in its original form, even long after withdrawal (1). This is also evidenced by the precipitous slide to severe re-addic-tion in former abusers who are re-introduced to stimulants. 

Cocaine was also the first aminoester local anesthetic, and its adverse effects differ from those of other local anesthetics. Owing to its rapid absorption by mucous membranes, cocaine applied topically can cause systemic toxic effects. There is a wide variation in the rate and amount of cocaine that is systemically absorbed. This variability can be affected by the type and concentration of vasoconstrictor used with cocaine and also accounts for the differences in cocaine pharmacokinetics in cocaine abusers (SEDA-20,128). 

Renal infarction is an uncommon adverse effect of cocaine (210). 

The prevalence rate of cocaine use during pregnancy is 10-45% in some centers in North America. As cocaine use is increasing and widespread, information on the possible adverse effects secondary to fetal cocaine exposure continues to amass in case reports and studies. 

The adverse effects of the combined use of alcohol and cocaine have been reviewed (385). There is little evidence that this combination acts synergistically or that either drug enhances the negative effects of the other. However, the combination leads to the formation of cocaethylene, which may potentiate cardiotoxic effects and the combination has a greater than additive effect on heart rate. Lastly, cocaine antagonizes the learning and psychomotor performance deficits and driving impairment caused by alcohol. 

In the second study there were 174 patients in two similar experimental groups in whom injectable rather than inhaled heroin was used (5). A response to treatment was defined as at least a 40% improvement in physical, mental, or social domains of quality of life, if not accompanied by a substantial (over 20%) increase in the use of another illicit drug, such as cocaine or amphetamines. After 12 months those who took methadone and heroin (smoked or injected) had significantly better outcomes. The incidences of adverse effects (constipation and drowsiness) were similar in all the groups. However, owing to the limitations of the study and the complex nature of drug dependence, the therapeutic outcomes could not be justifiably and solely attributed to the specific drug(s). 

Iontophoresis in the ear to relieve pain was reported by Albrecht in 1911 [47]. He used cocaine in high concentrations (20%-40%), copper electrodes, and uncontrolled high current (1.5-2 mA) on perforated tympanic membranes. Despite excellent anesthesia, many of his patients were vertiginous during and after treatment, with some patients suffering permanent loss of hearing. However, relatively recent studies have demonstrated that the use of lidocaine [48], A-acetylcysteine [49], or dexamethasone and fosfomycin [50] in iontophoresis to the ear has no adverse effects in either animal or clinical trials. Echols et al. [51] confirmed that lidocaine could be iontophoresed in the middle ear for at least 30 minutes at 1 mA without any adverse effects. 

Cocaine (alkaloid) is used medicinally solely as a surface anaesthetic (for abuse toxicity, see p. 192) usually as a 4% solution, because adverse effects are both common and dangerous when it is injected. Even as a surface anaesthetic sufficient absorption may take place to cause serious adverse effects and cases continue to be reported only specialists should use it and the dose must be checked and restricted. Cocaine prevents the uptake of catecholamines [adrenaline (epinephrine), noradrenaline (norepinephrine)] into S5nnpathetic nerve endings, thus increasing their concentration at receptor sites, so that cocaine has a built-in vasoconstrictor action, which is why it retains a (declining) place as a... 

Buprenorphine has been suggested to be useful for the treatment of cocaine and opiate dependence. In a study designed to assess its safety for this purpose (SEDA-18, 85) there were no adverse effects or serious interactions with a single dose of intravenous morphine or cocaine during daily maintenance on buprenorphine. 

Assays of neonatal meconium for cocaine metabolites along with mothers self-reports were used to evaluate the dose-response relation. There were no significant adverse effects due to cocaine exposure on scores in the major tests up to 24 months of age. Cocaine-exposed infants with the lowest 10th percentile birth weight and those placed with kinship caregivers had less optimal development. Cocaine-exposed infants who participated in child-focused early intervention programs scored higher than the others. 

Intranasal 4% lidocaine has been used for migraine and cluster headaches with success and few serious adverse effects a bitter taste was common and some patients complained of nasal burning and oropharyngeal numbness Unilateral mydriasis (anisocoria), suggesting serious neurological injury, has been attributed to topical cocaine (285). 

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