Cocaine intoxication

Drug intoxication. Cocaine and amphetamine intoxication may cause an agitated paranoid psychotic episode. Physical signs include dilated pupils, slurred speech, ataxia, hyperreflexia, and nystagmus, as well as evidence of drug use (e.g., needle tracks, nasal septum erosion). Vital signs, if obtainable, include elevated blood pressure, pulse rate, and temperature (see also the section The Alcoholic Patient in Chapter 14). 

Glassification of Substance-Related Disorders. The DSM-IV classification system (1) divides substance-related disorders into two categories (/) substance use disorders, ie, abuse and dependence and (2) substance-induced disorders, intoxication, withdrawal, delirium, persisting dementia, persisting amnestic disorder, psychotic disorder, mood disorder, anxiety disorder, sexual dysfunction, and sleep disorder. The different classes of substances addressed herein are alcohol, amphetamines, caffeine, caimabis, cocaine, hallucinogens, inhalants, nicotine, opioids, phencyclidine, sedatives, hypnotics or anxiolytics, polysubstance, and others. On the basis of their significant socioeconomic impact, alcohol, nicotine, cocaine, and opioids have been selected for discussion herein. 

Segal DS, Kuczenski R Behavioral alterations induced by an escalating dose-binge pattern of cocaine administration. Behav Brain Res 88 251—260, 1997 Serper MR, Chou JC, Allen MH, et al Symptomatic overlap of cocaine intoxication and acute schizophrenia at emergency presentation. Schizophr Bull 25 387—394, 1999... 

Rumbaugh, C.L. Small vessel cerebral vascular changes following chronie amphetamine intoxication. In Ellinwood, E.H., Jr., and Kilbey, M.M., eds. Cocaine and Other Stimulants. Vol. 21. New York Plenum Press, 1977. pp. 251-252. 

Identify the typical signs and symptoms of intoxication associated with the use of alcohol, opioids, cocaine/amphetamines, and cannabis, and determine the appropriate treatment measures to produce a desired outcome following episodes of intoxication. 

The treatment goals for acute intoxication of ethanol, cocaine/amphetamines, and opioids include (1) management of psychological manifestations of intoxication, such as aggression, hostility, or psychosis, and (2) management of medical manifestations of intoxication such as respiratory depression, hyperthermia, hypertension, cardiac arrhythmias, or stroke. 

The treatment goals for acute intoxication due to ethanol, cocaine/amphetamines, and opioids include (1) management of... 

Cocaine or stimulant intoxication may require administration of a small dose of a short-acting benzodiazepine (e.g., lorazepam 1 to 2 mg) for agitation or severe anxiety. Antipsychotics (e.g., haloperidol 2 to 5 mg) should be used only if psychosis is present. If hyperthermia is present, initiate cooling measures. 

Cocaine intoxication is treated pharmacologically only if the patient is agitated and psychotic. Low-dose antipsychotics can be used short-term if necessary for psychotic symptoms. 

The mischief of civilisation is the intensive life, which demands intensive stimulation. Human nature requires pleasure. Wholesome pleasures require leisure. We must choose between intoxication and the siesta. There are no cocaine fiends in Log rune. 

GHB is currently extremely popular in the dance club and rave scene. It is also popular among the gay community as well as with exotic dancers and strippers. It is primarily used for its ability to produce euphoria, intoxication, and enhanced sexual feelings. Others use it as a sleep aid or to enhance bodybuilding. Still others use it intentionally as a date rape drug. Abusers of other drugs, such as cocaine or methamphetamine, often take GHB to reduce the withdrawal... 

Nanji AA, Filipenko JD. (1984). Asystole and ventricular fibrillation associated with cocaine intoxication. Chest. 85(1) 132-33. 

Psychiatric medications do not currently play a prominent role in the treatment of cocaine-dependent patients (see Table 6.4). Although researchers have labored to find medications to treat cocaine addiction, there have not been any notable breakthroughs. As with other substance use disorders, the presence of a psychiatric disorder for which medication is indicated (i.e., depression, anxiety disorders, bipolar affective disorder, or schizophrenia) should prompt appropriate treatment. Similar to the presence of alcohol intoxication, deferring a diagnosis for a day or two in a new patient with no past history is often the more prudent course. 

At higher doses, cocaine can produce undesirable effects, including tremor, emotional lability, restlessness, irritability, paranoia, panic, and repetitive stereotyped behavior. At even higher doses, it can induce intense anxiety, paranoia, and hallucinations, along with hypertension, tachycardia, ventricular irritability, hyperthermia, and respiratory depression. In overdose, cocaine can cause acute heart failure, stroke, and seizures. Acute intoxication with cocaine produces these various clinical effects, depending on the dose these effects are mediated by inhibition of the dopamine transporter and in turn by the effects of excessive dopamine activity in dopamine synapses, as well as by norepinephrine and serotonin in their respective synapses. 

Repeated intoxication with cocaine may produce complex adaptations of the dopamine neuronal system, including both tolerance and, indeed, the opposite phenomenon, called sensitization or reverse tolerance. One example of reverse tolerance may be what happens to some abusers on repeated intoxication with cocaine at doses that previously only induced euphoria. In these cases, cocaine causes a behavioral... 

In addition to the acute intoxicating effects and the chronic reverse tolerance effects of cocaine, all of which are mediated by increasing dopamine levels due to its release from dopamine synapses, there are also longer-term effects of cocaine, possibly due to other, more traditional desensitization types of adaptations of dopamine receptors. As abusers use cocaine for longer and longer periods of time, their dopamine receptors become desensitized (down-regulated) as they adapt to chronic... 

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