0071643192.pdf

PSYCHOBEHAVIORAL DISORDERS

TABLE 16.3. Effects of Cocaine Intoxication

ORGANSYSTEM EFFECTS

Cardiovascular Has quinidine-like effectscausing QRS widening and QT prolongation

Large doses cause a direct toxic effect on the myocardium causing bradycardia, wide-complex

dysrhythmias, myocarditis, and hypotension.

α-Adrenergic—mediated coronary vasoconstrictionoccurs causing myocardial infarction and

cardiomyopathy.

Hypertension and tachycardia

Aortic rupture, aortic and coronary artery dissection

Neurological Hyperadrenergic state causes pupillary dilatation, hyperthermia, and psychomotor agitation.

Severe hypertension and cerebral vasoconstriction cause intracerebral hemorrhages (ICH), seizures,

CVAs, coma, confusion.

Muscle weakness, dystonias, and dyskinesias can occur from inhibition of nerve impulses.

Pulmonary Seen with crack cocaine use: pulmonary hemorrhage, pulmonary edema, pneumonitis, asthma,

barotrauma (pneumothorax, pneumomediastinum)

Gastrointestinal Toxicity seen with “body packers” (patient swallows multiple bags of well-concealed cocaine for

smuggling purposes) and “body stuffers” (patient swallows one hastily wrapped bag to avoid

police arrest); can also see mesenteric vasoconstriction resulting in ischemia

Renal Increased creatinine phosphokinase (CPK) can cause rhabdomyolysis and acute renal failure. Renal

infarction can also occur.

■ Avoid haldol, droperidol, chlorpromazine →can lower seizure thresh-
oldand cause dysrhythmias and hyperthermia.
■ Treat hyperthermia with rapid evaporative cooling.
■ Aggressive IV fluids to prevent/treat rhabdomyolysis
■ Avoid β-blockers in cocaine chest pain →can cause an unopposed
αadrenergic state, thus worsening vasoconstriction.
■ Treat wide complex tachydysrhythmias and QRS prolongation with
sodium bicarbonate.
■ Treat hypertension with phentolamineor sodium nitroprusside.

Amphetamines

■ Derivatives of phenylethylamine
■ Enhances the release and blocks the reuptake of catecholaminesand may
directly stimulate catecholamine receptors
■ Induces release of serotonin centrally,which accounts for the hallucino-
genic properties of MDMA (3,4-methylenedioxy-N-methylamphetamine) ie,
“ecstasy”
■ MDMA can cause hypertension, hyperthermia, and dehydration, which
can lead to excessive water drinking and profound hyponatremia.
■ MDMA can also cause seizures.
■ Treat MDMA toxicity with IV fluids, active cooling, and benzodiazepines.
■ Methylphenidate [Ritalin],a widely prescribed drug for Attention Deficit
Disorder (ADD), is an amphetamine derivative and is now becoming a
drug of abuse.

Body packers or stuffers

should receive activated

charcoal and polyethylene

glycol (Go-LYTELY) for

decontamination. If the

patient shows signs of

intoxication, immediate

surgical consultation should

be made!