Acute effects
The effect of cocaine administration will vary depending on how it is used. The effects of cocaine administration can vary depending on whether it is smoked or injected. These highs are similar to the effects of injecting amphetamines. These feelings are less intense and devastating for addicts who inhale cocaine powder through the nose.
Smokers of the drug can develop pneumothorax and pneumomediastinum. This may cause chest pain, shortness or both. Cocaine use can cause chest problems (“cocaine heart pain”) as well as myocardial and cardiac ischemia. However, this mechanism remains elusive. A variety of conduction abnormalities and arrhythmias have been documented. Cardiac effects can lead to sudden death. “Marathon” (continuous usage), which can last for many days, can cause exhaustion, or “exhaustion”, which includes extreme fatigue and the need to sleep.
Toxicity or overdose
An overdose can cause severe anxiety, panic attacks, aggression, aggressiveness, hallucinations and paranoid delirium. Mydriasis and sweating are observed, and heart rate and blood pressure increase. Arrhythmia or myocardial damage can cause death.
Severe overdose causes acute psychosis syndrome (resembling symptoms of schizophrenia), hypertension, hyperthermia, rhabdomyolysis, coagulopathy, renal failure, and seizures. A person with severe clinical toxicities may have a reduced (or atypical) level of serum cholinesterase. This enzyme is required to remove cocaine from the body.
Patients who inhale cocaine could develop acute pulmonary symptoms (crack lung) which include fever, hemoptysis or hypoxia. It can also lead to respiratory problems.
The concomitant use of cocaine and alcohol creates a condensation product, cocaethylene. This has stimulant properties that can lead to toxicity.
Chronic effects.
Toxic effects can be severe for compulsive heavy cocaine use. Left ventricular hypertrophy, cardiomyopathy and myocardial fibrosis are all possible. Repeated nasal retractions of cocaine can lead to nasal septum perforation in rare cases. This is due to localized hyperemia. Some serious addicts may experience cognitive impairment such as impaired attention spans and verbal memory. The usual infectious complications may be experienced by addicts who inject cocaine.
Withdrawal Syndrome
Depression, difficulty concentrating and drowsiness, which are all symptoms of cocaine addiction, are the most common. Increased appetite.
Diagnosis
Clinical evaluation.
The clinical diagnosis of cocaine addiction is made most often by a physician. The drug’s levels are not measured. The cocaine metabolite, benzoylecgonine, is determined by most routine urine drug screening tests.
Treatment
Intravenous benzodiazepines.
Avoid beta-blockers
Refrigeration for hyperthermia if necessary
Toxicity or Overdose
Mild cocaine intoxication can be treated with very short acting drugs. Benzodiazepines are the preferred initial treatment for the most toxic effects, including central nervous system agitation and seizures, tachycardia, and hypertension. Lorazepam may be administered intravenously in a dose of 2-3 mg per 5 minutes. This dosage can be titrated until it has an effect. It is possible to require continuous infusion and higher doses. In persistent cases, propofol is used infusively, in combination with artificial lung ventilation.
For arterial hypertension that resists benzodiazepines such as arterial hypertension, intravenous (e.g. Nitroprusside, Phentolamine) is recommended. Beta-blockers, which allow for prolonged alpha adrenergic stimulation, are not recommended.
Hyperthermia may be fatal and should be treated aggressively using sedation with evaporative cool, ice bags and intravenous administrations with saline.
They are best not used for sedation because of the lower threshold of seizure activation of phenothiazines and their anticholinergic effect.
Patients suffering from severe agitation might need to receive pharmacologic Paralysis and Mechanical Ventilation. This will improve acidosis, acute Skeletal Muscle Necrosis, and multiorgan dysfunction.
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