Cocaine Intoxication

First Things First (assess & treat for the following)

• Assess for life-threatening complications.
  • Hypoxia, altered mental status: airway mgt, O2 supplementation
  • Hypotension, shock: vascular access, IV fluids
  • Arrhythmias: follow ACLS guidelines
  • Status epilepticus: IV benzodiazepines, correct structural defects
  • Severe hyperthermia: initiate cooling
• Control agitation w/ benzodiazepines IV/IM.
• Focused evaluation for specific complaints

Pharmacology

• Available forms of cocaine
  • Cocaine hydrochloride: snorted, injected or ingested
  • Crack cocaine (alkaloid form): inhaled
• Route of administration determines intensity & duration of action.
  • Inhalation has fastest onset & shortest duration.
  • Intranasal has slower onset, longer duration.
• Major pathophysiologic effects
  • Increases release of catecholamines: primarily norepinephrine, also dopamine & serotonin
  • Blocks reuptake of these catecholamines at preganglionic neurons
  • Catecholamines lead to profound sympathomimetic effects.
  • Local anesthetic effect due to blockade of fast sodium channels