For cocaine overdose

Cocaine is a central nervous system (CNS) stimulant that causes a significant increase in heart rate, respiration, blood pressure, and body temperature. According to DAWN, one in thirteen cocaine users go to the hospital to be treated for severe reactions that could be life-threatening. Sudden death can result from heart failure, respiratory failure, seizures, strokes, and cerebral hemorrhage. There is no antidote for cocaine overdose. Even if the adverse reactions do not result in death, they can do permanent damage to the body. 

Zheng, F., Zhang, C.-G. (2008). Structure-and-mechanism-based design and discovery of therapeutics for cocaine overdose and addiction. Org. Biomol. Chem. 6 836-43. 

In the epidemiological tracking of agitated delirium victims in Metropolitan Dade County, men with preterminal delirium comprised approximately 10% of the annual number of cocaine overdose deaths. The demographic trends show that the proportion of these cases remains consistent throughout the epidemic of cocaine abuse and tends to track the annual frequency of cocaine-related sudden deaths. This observation suggests that a certain percentage of cocaine addicts may be at risk for cocaine delirium with chronic abuse. 

The clinical effects of amphetamine and its derivatives are very similar to those of cocaine, although the euphoria they produces may be less intense but last longer than that due to cocaine. Signs of amphetamine intoxication, toxicity, overdose, sensitization by production of an acute paranoid psychosis, and withdrawal syndrome are all similar to those described above for cocaine. 

Staley JK, Talbot JZ, Ciliax BJ, Miller GW, Levey AI, Kung M-P, Kung HF, Mash DC (1997) Radioligand binding and immunoautoradiographic evidence for a lack of toxicity to dopaminergic nerve terminals in human cocaine overdose victims. Brain Res 747 219-229. 

Aspects of non-fatal cocaine overdose among cocaine users have been studied in Australia in 200 current cocaine users (120 injecting users and 80 non-injecting users), who volunteered for a structured interview 13% had overdosed on cocaine, 7% in the preceding 12 months (379). Those who had overdosed were more likely to inject cocaine, to be female, to have longer cocaine habits,... 

Generally, the samples tested were head hair obtained from expertises or from subjects deceased from fatal heroin or cocaine overdose. Collection procedures have not been standardized, but hair is often collected from the area at the back of the head (vertex posterior), cut as close as possible to the scalp and stored in dry tubes. In this area, there is less variability in hair growth rate, the number of hairs in the growing phase is more constant, and the hair is less subject to age and sex-related influences. Occasionally, axiUaty or pubic hair have also been tested for cannabinoids. 

A 44-year-old black man developed priapism 2 hours after having overdosed on 30-40 trazodone tablets 50 mg and 10 Tylenol No. 3 (paracetamol plus codeine) tablets (162). Toxicology analysis was positive for cocaine and opiates. The priapism required detumescence twice, on initial presentation and then 6 hours later, and 8 hours after presentation he again developed painless priapism, which resolved spontaneously after 1.5 hours. 

Cocaine and other stimulant drugs are often taken in combination with other drugs, particularly alcohol and opiates. Laboratory studies in humans have shown that alcohol can enhance and prolong the subjective pleasure associated with cocaine, and this is likely the basis for their frequent association. Recent studies have revealed that when cocaine is taken with alcohol, a new compound called cocaethylene is formed in the body. Cocaethylene has pharmacological properties similar to cocaine, but it may be more toxic. Many cases of cocaine overdose may in fact involve cocaethylene toxicity caused by combining cocaine and alcohol (Raven, Necessary, Danluck, Ettenberg,... 

Rush, Roll, Higgins, 1998). The combination of cocaine (or amphetamine) and heroin (or other opiate) is called a speedbair and is particularly popular among heroin addicts. Morphine and cocaine combinations have been studied in the laboratory, and as with alcohol, morphine appeared to enhance the pleasurable effects of cocaine but also increased the cardiovascular effects. Combinations of cocaine and heroin have sometimes been blamed for drug overdose deaths (as in the deaths of comedian John Belushi and actor River Phoenix), and the synergistic effects on blood pressure and heart rate may be a factor (Foltin Fischman, 1992 Rush et al., 1998). 

Metabolism also plays a critical role in the pharmacology of cocaine. The rapid hydrolysis of cocaine via two different pathways leads to its rapid inactivation/detoxification. This rapid metabolism has been a major determinant in the methods and modes of cocaine abuse. Identification and characterization of these hydrolytic enzymes would be useful in that selective induction of these enzymes offers a potential treatment strategy for dealing with cocaine overdose. It is conceivable that long-term elevation of the enzyme or enzymatic activity could be used in conjunction with maintenance therapy for cocaine addicts. Hydrolases or esterases are also responsible for the transesterfication of cocaine. The pharmacological effect of cocaine is prolonged and enhanced when cocaine is used in conjunction with ethanol. A carboxylesterase catalyzes an ethyl transeterification of cocaine to cocaethylene, which is biologically active. 

Abuse of psychoactive chemicals can result in neurotoxic effects that are difficult to treat medically. Successful therapy is often hindered by the lack of useful antagonists for many of these chemicals and by the extensive distribution of these chemicals out of the bloodstream. Although there are treatments for opiate addiction and an antagonist for opiate overdose, there are no such medical treatments for most drugs of abuse such as phencyclidine (PCP) and cocaine. Therefore, this chapter focuses on recent advances in immunotherapy which suggest this novel approach could be beneficial in the treatment of drug abuse. 

The astute clinician understands the differences between the medications in the individual medication classes. All 3-blockers are not considered to be equally safe and effective in treating patients with peripheral arterial disease, reactive airway disease, heart failure, or a cocaine overdose. Not all calcium channel blockers and -blockers may be safely combined for angina treatment, and only certain antihypertensive agents may be used safely during... 

Respiratory distress, ataxia, hyperpyrexia, convulsions, coma, or stroke are signs and symptoms of cocaine overdose. This qnestion would be most appropriate for the nurse to ask based on the client s signs and symptoms. 

Vera CMP, Cohn AM, Arrojo GC, Garcia JMC. Acute aortoihac thrombosis due to cocaine intake. Ann Vase Surg 2013 27 239. el-239.e4. Arora NP, Berk WA, Aaron CK, Wilhams KA. Usefulness of intravenous lipid emulsion for cardiac toxicity from cocaine overdose. Am J Gardiol 2013 111 445-7. 

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