special subjects
Cocaine
Introduction
Cocaineis a sympathomimetic drug with central nervous system stimulant and euphoriant properties. High doses can cause panic, schizophrenic-like symptoms, seizures, hyperthermia, hypertension, arrhythmias, stroke, aortic dissection, intestinal ischemia, and myocardial infarction. Toxicity is managed with supportive care, including IV benzodiazepines (for agitation, hypertension, and seizures) and cooling techniques (for hyperthermia). Withdrawal manifests primarily as depression, difficulty concentrating, and somnolence (cocainewashout syndrome). users are episodic recreational users. However, about 25% of users meet criteria for abuse or dependence. Use among adolescents has declined slightly since 2011 ( General reference ). Availability of highly biologically active forms, such as crack Mostcocainein the US is volatilized and inhaled, but it may be snorted, or injected IV. For inhalation, the powdered hydrochloride salt is converted into a more volatile form, usually by addingsodium bicarbonate, water, and heat. The resultant precipitate (crackcocaine) is volatilized by heating (it is not burned) and inhaled. Onset of effect is quick, and intensity of the high rivals that associated with IV injection. Tolerance tococaineoccurs, and withdrawal from heavy use is characterized by somnolence, difficulty concentrating, increased appetite, and depression. The tendency to continue taking the drug is strong after a period of withdrawal. 