Cocaine/Amphetamines

Cocaine

*Blocks reuptake of dopamine [DAT]* Cocaine acts by blocking the reuptake of certain neurotransmitters such as dopamine, norepinephrine, and serotonin. By binding to the transporters that normally remove the excess of these neurotransmitters from the synaptic gap, cocaine prevents them from being reabsorbed by the neurons that released them and thus increases their concentration in the synapses

Withdrawal symptoms

- "Crash" - Exhaustion - Excessive sleep and fatigue [24 hour +] - Depression - Ravenous Appetite {withdrawing/Cannabis While intoxicated] - Unpleasant dreams (nightmares) - No vomiting or shaking [Vomiting = Opiate withdrawal]

A 28-year-old Hispanic man presents to his primary care practitioner complaining of depression. He has noted increased atypical chest pain radiating to his back on minimal exercise over the past several months. He denies using any drugs in the past month. An ECG shows evidence of right ventricular strain. Assays for cardiac enzymes are negative. An echo confirms right ventricular enlargement and an estimated mean pulmonary pressure of 55 mmHg. HIV and hepatitis B and C serologies are negative. The patient agrees to participate in a drug treatment program and is evaluated for medical treatment for pulmonary HTN.

He has smoked, snorted and used intravenous methamphetamine for 5 years except while in jail. A urine screen for drugs of misuse is positive for amphetamines.

Amphetamines

Stimulate the *release of and blocks reuptake of dopamine* - Inhibits DAT and VMAT Since amphetamine (Amph) is a substrate of the DAT, it competitively inhibits DA transport. In addition, once in the cell, amphetamine interferes with the *vesicular monoamine transporter (VMAT)* and impedes the filling of synaptic vesicles. As a consequence, vesicles are depleted and cytoplasmic DA increases.

Acutely you will experience the same symptoms as ______?

Schizophrenia

Cocaine and Amphetamine Intoxication

- Euphoric Mood - Excessive Talking - Grandiosity - Paranoia - Hypervigilance - Anxiety - *Tachycardia* - *Dilation of Pupils* - *Hallucinations and delusions*

Chronic Users

- Periods without eating or sleeping - *Weight Loss* - Dry Mouth - Itchy/Bleeding nose - Irritability

A 22-year-old man is brought from the airport with high fever and convulsions. No other history is available, other than that he started vomiting soon after the flight had left Jamaica. His abdomen is soft and nontender but he is tachycardiac with an elevated systolic BP. Abdominal x-ray reveals the presence of several foreign bodies in the GI tract.

Cocaine

A 28-year-old man presents to an emergency room with anxiety, complaining of a racing pulse and chest pain. He reports a history of 10 pack-years of cigarette smoking. He has recently begun smoking crack cocaine. His symptoms clear during observation, after reassurance and mild sedation.

Cocaine

Treatments

Cocaine Anonymous Contingency Management Intervention To Reduce Craving [Increase Dopamine] - Bromocriptine - Amatadine

A 32-year-old white man presents to the emergency room. On examination, the patient is agitated and has multiple skin excoriations and scars on his hands and upper arms. His pupils are dilated and he is grinding his teeth. He is hypertensive, mildly hyperthermic and tachycardic. An ECG shows sinus tachycardia with evidence of LVH.

after smoking methamphetamine. He was discovered by police ingesting (body stuffing) several packets of materials to prevent detection An initial urine drug toxicology screen is positive for amphetamines An abdominal flat-plate x-ray shows several metallic areas, indicating folded aluminum methamphetamine packets.