History and Epidemiology
Cocaine is found in the leaves of this plant, a shrub that grows abundantly in Colombia, Peru, Bolivia, the West Indies, and Indonesia.
What is the coca plant (Erythroxylum coca)?
The plasma protein that cocaine binds to
What is alpha1-acid glycoprotein?
This toxidrome is characteristic of cocaine toxicity.
Bonus points: This mnemonic may be used to remember the toxidrome.
What is the sympathomimetic toxidrome?
Bonus points: What is MATHS?
The metabolite of cocaine that can be detected in the urine for 2 - 3 days after the last use.
What is benzoylecgonine?
This depolarizing neuromuscular blocker is relatively contraindicated in patients presenting with cocaine toxicity
What is succinylcholine?
A type of surgical procedure that cocaine was extensively used for as a topical anesthetic in the 1800s
What is eye surgery?
A unique pharmacologic interaction with this substance produces ethylbenzoylecgonine, also known as "ethyl cocaine" or "cocaethylene".
What is ethanol?
The most critical vital sign abnormality in cocaine toxicity
What is hyperthermia?
What is chest pain?
Administration of this agent is needed due to volume depletion from poor oral intake, excessive fluid losses (from agitation, diaphoresis, and hyperthermia), and rhabdomyolysis
What is normal saline?
The year that cocaine was restricted for medical use only due to the passage of the Harrison Narcotics Act
What is 1912?
In addition to the catecholamines dopamine, norepinephrine, and epinephrine, the reuptake of this neurotransmitter is also blocked by cocaine.
What is serotonin?
The stimulation of the dilator fibers of the iris from cocaine use causes this effect on the eyes
What is mydriasis?
This marker is preferred over myoglobin or myocardial band enzymes of creatine phosphokinase (CPKMB) since cocaine use is associated with diffuse muscle injury
What are troponins?
Since hyperthermia is a critical vital sign abnormality, this treatment method is required to normalize core body temperature
What is ice water immersion?
The schedule/classification of cocaine based on the Controlled Substances Act.
What is Schedule II?
Cocaine increases the concentration of these amino acids, explaining the psychomotor agitation, seizures, and hyperthermia seen with cocaine use.
What are excitatory amino acids (glutamate or aspartate)?
This term is given to an acute pulmonary syndrome that occurs after inhalational use of crack cocaine. The syndrome is a poorly defined set of symptoms including fever, hemoptysis, hypoxia, ARDS, and respiratory failure.
What is "crack lung"?
What is computed tomography angiography?
The preferred sedative agents or mainstay of therapy in cocaine toxicity
What are benzodiazepines?
The percentage of drug overdose deaths associated with cocaine in 2021
What is 23%?
In addition to QRS complex prolongation, this ECG pattern is also associated with cocaine use due to its activity in blocking sodium channels.
What is the Brugada pattern?
This acute cardiomyopathy is a reversible form of left ventricular apical ballooning associated with myocardial ischemia in the absence of atherosclerotic lesions.
What is Takotsubo cardiomyopathy?
An imaging modality that excludes certain causes of chest discomfort or to identify free air under the diaphragm when GI perforation is suspected
What is chest radiography?
These antihypertensive agents are contraindicated in cocaine-associated chest pain since they potentiate coronary artery vasospasms
What are beta-blockers?