Hypertension cocaine abuse

Cardiovascular effects include tachycardia, hypertension, and increased cardiac irritability large intravenous doses can cause cardiac failure. Cardiac dysrhythmias have been ascribed to a direct toxic effect of cocaine and a secondary sensitization of ventricular tissue to catecholamines (17), along with slowed cardiac conduction secondary to local anesthetic effects. Myocardial infarction has increased as a complication of cocaine abuse (7,8). Dilated cardiomyopathies, with subsequent recurrent myocardial infarction, have been associated with long-term use of cocaine, raising the possibility of chronic effects on the heart (18). Many victims have evidence of pre-existing fixed coronary artery disease precipitated by cocaine (SEDA-9, 35) (19-21). However, myocardial infarction has been noted even in young intranasal users with no evidence of coronary disease (22), defined by autopsy or angiography (23,24). If applied to mucous membranes, cocaine causes local vasoconstriction, and, with chronic use, necrosis. 

A 44-year-old man with hepatitis C and cirrhosis, esophageal varices, and poorly controlled hypertension, who was also a chronic alcoholic and crack cocaine abuser, had his varices injected at endoscopy and... 

The association of cocaine abuse with progressive chronic renal failure has received increased attention in recent years [156-158]. Ward and co-workers have reported on the possibility of a progressive nephropathy with features of hypertension, azotemia... 

Finally, cocaine has been implicated as a risk factor for the development of ESRD in young dialysis patients with a shorter duration of hypertension by history [158]. The relative risk of developing ESRD with cocaine abuse was nearly 10 times higher than that of race and blood pressure matched controls. In summary, evidence for a progressive nephropathy associated with cocaine abuse is accumulating and could contribute to the increasing incidence of ESRD in the United States. 

Gu X, Flerrera GA. Thrombotic microangiopathy in cocaine abuse-associated malignant hypertension report of 2 cases with review ofthe literature. Arch Pathol Lab Med. 2007 31(12) 817-1820. 

Adverse effects include increased risk of seizures, myocardial infarction, rhabdomyolysis, renal failure, and stroke. Other life-threatening adverse effects include hyperthermia, hypertension, vasoconstriction, tachycardia, cardiac ischemia, and paranoia. Prolonged cocaine abuse has been shown to cause cardiomyopathy. 

B. Bromocriptine has been used experimentally to alleviate craving tor cocaine. Caution There is one case report of a severe adverse reaction (hypertension, seizures, and blindness) when bromocriptine was used in a cocaine abuser during the postpartum period. 

The treatment goals for withdrawal from ethanol, cocaine/ amphetamines, and opioids include (1) a determination if pharmacologic treatment of withdrawal symptoms is necessary, (2) management of medical manifestations of withdrawal such as hypertension, seizures, arthralgias, and nausea, and (3) referral to the appropriate program for substance abuse treatment. 

Cocaine differs from the other local anesthetics with respect to its cardiovascular effects. Cocaine s blockade of norepinephrine reuptake results in vasoconstriction and hypertension, as well as cardiac arrhythmias. The vasoconstriction produced by cocaine can lead to local ischemia and, in chronic abusers who use the nasal route, ulceration of the mucous membrane and damage to the nasal septum have been reported. The vasoconstrictor properties of cocaine can be used clinically to decrease bleeding from mucosal damage or surgical trauma in the nasopharyneal region. 

Amphetamines have also been associated with a syndrome of acute kidney injury and rhabdomyolysis. Several series have described patients following intravenous injection of methamphetamine or phenmetrazine who presented with hyperactivity, fever, chills, sweats, abdominal cramps, diarrhea, and hypotension [177,178]. The patients have developed acute kidney injury which is usually oliguric and associated with classic rhabdomyolysis, similar to cases of cocaine-induced rhabdomyolysis. Several patients have had disseminated intravascular coagulation and liver function abnormalities as well. Methamphetamine abuse has also been associated with accelerated hypertension, unexplained chronic renal failure, acute lead poisoning (a common reagent used in its production utilizes lead acetate) and at least one case of biopsy proven interstitial nephritis the latter patient responded to intravenous corticosteroids but whether the nephritis was truly due to amphetamines remains unproven [179]. 

Accidental local infiltration of potent alpha agonists such as norepinephrine may lead to tissue ischemia and necrosis if not promptly reversed infiltration of the ischemic area with phentolamine is sometimes used to prevent tissue damage. Overdose with drugs of abuse such as amphetamine, cocaine, or phenylpropanolamine may lead to severe hypertension because of their indirect sympathomimetic actions. This hypertension will usually respond well to alpha-blockers. Sudden cessation of clonidine therapy leads to rebound hypertension (Chapter 11) this phenomenon is often treated with phentolamine. 

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