1. Ihab Abdallah
Under Supervision: Dr. Mayada Wazaify

2. References
1- drugabuse.gov
2- Uptodate
3- National Institute of Drug Abuse (NIDA).

3. • Cocaine
(Benzoylmethylecgonine)
Is a crystalline alkaloid prepared from the leaves of the
Erythroxylon coca plant
.
Cocaine
Crystalline
Odorless
White
Bitter

4. NIDA
According to the National Institute of Drug Abuse
(NIDA)
Cocaine
A powerfully addictive drug that can be
Snorted
Injected
Chewed
Smoked

5. Cocaine ( Schedule II )
The 2nd Harmful Drug

6. COCAINE ( SCHEDULE I )

7. Form’s of Cocaine
Cocaine HCL (powder)
Prepared by dissolving the alkaloid in hydrochloric
acid, forming a water soluble salt.
Crack Cocaine
Produced when cocaine hydrochloride is mixed with
sodium bicarbonate and water, and then heated.

8. Must Watch
• Video

9. Route of Administration
Cocaine can be administered as a drug of abuse in
the following ways :
1. Cocaine hydrochloride:
 Snorting (intranasal)
 Intravenous injection

10. Route of Administration
2. Crack Cocaine:
Inhalation of vapor from heated foil or pipe. (Smoked)
3. Coca leaves:
Chewed or ingested.

11. Comparison
Route
Onset of Action
Duration of Action
Smoking
7 seconds
20 minutes
Intravenous injection
15 seconds
22-30 minutes
Snorting
3 minutes
45-90 minutes
Oral
10 minutes
60 minutes

12. Brain Storming
The most common cause of Recurrent
Epistaxis in young adult is ???
3
2
Cocaine use
Ref: USMLE
1

13. Mechanism of Action

14. Mouse Party

15. Clinical Usage
 Cocaine is used by health care professionals to
temporarily numb the lining of the mouth, nose, and
throat (mucous membranes) before certain medical
procedures (biopsy, stitches, wound cleaning).
 It is an anesthetic that works quickly to numb the
area about 1-2 minutes after application.

16. Cycle of Addiction
Reward System
Cocaine
Dependence
Cocaine Addiction
(Craving)
(Anhedonia)
Inability to feel
pleasure
Cocaine
Release of the impulses from NA to activate the reward system
Craving
This pathway activated also in the absence of cocaine

17. Metabolism
• Serum half life of 45-90 minutes.
• Only 1% of the drug is recovered in urine after ingestion.
•
Cocaine can be detected in blood or urine only for several
hours after its use.
• Cocaine metabolites are detectable for 2-5 days.
•
Hair analysis provides a very sensitive marker for cocaine
use within the preceding weeks to months.

18. Short Term Effect
Initial Dose
Physical Effect
Psychological Effect
Tachycardia
Euphoria
Dilated pupils
Sense of well being
Sweating
Impaired reaction time
Reduced appetite
Impaired attention span
Reduced need for sleep
Impaired learning of new skills
Reduced lung function

19. Short Term Effect
Increased Doses
Physical Effect
Psychological Effect
Seizures
Anxiety, Irritability, Insomnia
Cardiac arrhythmias
Depression, Paranoia
Myocardial infarction
Aggressiveness, Impulsivity
Stroke
Delusions
Respiratory arrest
Agitated, Excited delirium
Reduced psychomotor function

20. Long Term Effect
Physical Effect
Psychological Effect
Erosions, necrosis
Dependence
Rhinorrhea and nasal eczema
Disturbed eating
Chest pain, muscle spasms
Disturbed sleeping patterns
Sexual impotence
Weight loss
Malnutrition
Vascular disease

21. Specific Organ Systems

22. Central Nervous System
o Cocaine euphoria is associated with transient increases in
EEG activity.
o Seizures may occur in persons without a seizure history,
even with first time use of cocaine.
o These are usually single, generalized tonic-clonic seizures
occurring within 90 minutes of cocaine use.

23. Central Nervous System
o Cerebral vasoconstriction, cerebrovascular disease, and
hemorrhagic and ischemic stroke are increased in
cocaine users.
o MRI, PET imaging in chronic cocaine users demonstrate
structural and functional brain abnormalities.

24. Central Nervous System
o A pathologic study using melanin immunoreactivity found
cocaine users to have 16 percent fewer midbrain dopamine
neurons than non-using subjects.
This and related findings
o suggest that cocaine may have a neurotoxic effect on
dopamine neurons, contributing to development of cocaine
dependence in some users.

25. Central Nervous System
o Cocaine use is associated with a variety of movement
disorders:
Stereotyped Behaviors
Choreoathetosis
Buccolingual Dyskinesia
Tourette’s Syndrome
Acute Dystonic Reactions
Akathisia (Crack Dancers)
• Cocaine users are at increased risk of acute dystonic
reactions from neuroleptic (antipsychotic) medications.

26. PET
Brain images showing decreased dopamine2 receptors in the
brain of a person addicted to cocaine versus a nondrug user.
The dopamine system is important for conditioning and
motivation, and alterations such as this are likely
responsible, in part, for the diminished sensitivity to
natural rewards that develops with addiction.

27. Respiratory System
o The effects of cocaine on the respiratory system depend on
the route of administration.
o Intranasal cocaine use (snorting) may cause chronic rhinitis,
perforation of the nasal septum, oropharyngeal ulcers.
Why ??
Due to vasoconstriction and resulting ischemic
necrosis.

28. Respiratory System
o Smoked cocaine use produces acute respiratory symptoms in
up to half of users.
Including
Productive Cough
Shortness of Breath
Chest Pain
Hemoptysis
Wheezing
Exacerbation of
Asthma
These effects are probably due to direct damage to the alveolar-capillary
membrane by cocaine or inhaled micro particles.

29. Cardiovascular System
 Cardiopulmonary
symptoms
are
the
most
frequent
complaints in cocaine users who seek medical help, with
chest pain being the most frequent symptom.
Cocaine
By
increasing
adrenergic
activity in the heart, and
• Increase HR
• Increase BP
• Increase SVR
indirectly via the CNS.

30. Cardiovascular System
 The increased myocardial oxygen demand, coupled with
decreased
coronary
blood
flow
from
vasospasm
and
vasoconstriction, can cause acute myocardial infarction.
 Cocaine appears to enhance the progression of renal disease
in patients with hypertension.
 Cocaine use increases risk for cardiac arrhythmias and
sudden death.

31. Cardiovascular System
 Chronic use is associated with left ventricular hypertrophy,
cardiomyopathy, myocardial fibrosis, and myocarditis.

32. DSM V
1- Cocaine is often taken in larger amounts or over a longer
period than was intended.
2- There is a persistent desire or unsuccessful efforts to cut
down or control cocaine use
3- A great deal of time is spent in activities necessary to
obtain cocaine, use cocaine, or recover from its effects
4- Craving, or a strong desire or urge to use cocaine
5- Recurrent cocaine use resulting in a failure to fulfill major
role obligations at work, school, or home.

33. 6- Continued cocaine use despite having persistent or
recurrent
social
or
interpersonal
problems
caused
or
exacerbated by the effects of cocaine.
7- Important social, occupational, or recreational activities are
given up or reduced because of cocaine use.
8- Recurrent cocaine use in situations in which it is physically
hazardous.
9- Tolerance.
10- Withdrawal.
≥2
10

34. Cocaine Tolerance
Initially
o Cocaine produces an intense high and may not cause an
emotional depression when the drug wears off.
As a result
The user may conclude that cocaine is harmless.
With Repeated use
o A craving as well as a tolerance for the drug develops.

35. Cocaine Tolerance
• Over time, the high produced by a given amount of
cocaine decreases while the depression when the drug
wears off deepens.
• The addict ends up "chasing a high" by taking ever-
increasing
amounts
of
cocaine
more
and
more
frequently. When the supply of cocaine is gone, the
addict is left with an intense craving along with
severe depression that may reach a suicidal level.

36. Cocaine Frenzy
o As tolerance to cocaine develops, an increased susceptibility
to seizures and psychosis also develops.
• An extreme form of this reverse tolerance can be called
• The person in a cocaine frenzy displays psychotic and
violent behavior, panic, and superhuman strength.

37. HIV & Hepatitis B and C
o Cocaine abusers are at increased risk for contracting such
infectious diseases as
and
.
o This risk stems not only from sharing contaminated needles
and drug paraphernalia but also from engaging in risky
behaviors as a result of intoxication.
o Potentially lead to risky:
1-sexual encounters
2- Needle sharing
3-Trading sex for drugs—by both men and womens.

38. HIV & Hepatitis B and C
o Hepatitis C
has spread rapidly among injecting drug
users.
o Risk begins with the first injection, and within 2 years,
nearly 40% of injection drug users (IDUs) are exposed to
HCV.
o By the time IDUs have been injecting for 5 years, their
chances of being infected with HCV are between 50-80%.

39. Pregnancy
Common Adverse Effect of Cocaine use in Pregnancy!!
1- Restricts blood flow to the uterus, cause fetal hypoxia.
2- Uterine contractions, CNS infarction, Heart defects.
3- Persistent neonatal arterial hypertension.
4- Decreased neonatal weight and size ( head circumference).
5-sudden infant death syndrome, Mental retardation.
6- Babies may be irritable at birth and exhibit symptoms such as: tremor,
hypertension, abnormal reflexes, tachypnea, autonomic instability, vomiting,
diarrhea, seizures and poor feeding.

40. Brain Storming
Why baby look like this ???
3 2 1
Crack Baby !!!!
A baby who is not strong and healthy at
birth and whose mother used crack
cocaine while she was pregnant.

41. Treatment

42. Psychosocial Treatment
lead to small reductions in cocaine use
BY:
Motivational
interviewing
Psychodynamic
Cognitive
therapy
Behavioral
therapy
Supportive
therapy

43. o More intensive treatment.
o More frequent visits.
o Longer duration of treatment.
o Cocaine Anonymous.
Associated with better outcomes

44. Behavioral Treatment
o One of behavioral therapy that is showing positive results
in cocaine addicted population is contingency management
or motivational incentives (MI).
o MI: is particularly useful for helping patients achieve initial
abstinence from cocaine and for helping patients stay in
treatment.
o Cognitive behavioral therapy: is an effective approach for
preventing relapse.

45. Medications
1- Cocaine Vaccine:
Is composed of a cocaine hapten conjugated to inactivated
cholera toxin B, resulting in the creation of a molecule
capable of stimulating an antibody response.
Cocaine vaccine that prevents entry of cocaine into the brain
holds great promise for reducing the risk of relapse.

46. Medications
2- Others:
Disulfiram
Vigabtrin
Modafinil
Tiagabine
Topiramate
Show promise and have been reported to
reduce cocaine use in controlled clinical trials.