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Critical Review of Evidence for Neonatal Cocaine Intoxication and Withdrawal
Published in Richard J. Konkol, George D. Olsen, Prenatal Cocaine Exposure, 2020
Delia A. Dempsey, Donna M. Ferriero, Sarah N. Jacobson
Cocaine intoxication, withdrawal, and metabolism have been well delineated in adults; these data will first be briefly presented. The limited data in newborns, infants, and young children regarding the metabolism and acute effects of cocaine will be then reviewed in light of what is known in adults. Based on this review, probable signs of newborn cocaine intoxication and withdrawal will be discussed. Finally, new research regarding clinical signs of newborn cocaine intoxication, withdrawal, and fetopathology will be presented. Neonates prenatally exposed to cocaine have a host of confounders that may affect their pre- and postnatal development.9–21 Some confounders may even have a greater effect upon growth and development than cocaine.22,23 At this time, the confounders are not incorporated into the model of intoxication, withdrawal, and fetopathic effects. The goal of this review is to demonstrate that there are data to support this model and identify likely signs of intoxication, withdrawal, and fetopathology. When this model is tested, confounders will need to be identified.
Pharmacological interventions
Published in Ilana B. Crome, Richard Williams, Roger Bloor, Xenofon Sgouros, Substance Misuse and Young People, 2019
Amphetamines and other stimulants, including cocaine, create their rewarding and reinforcing effects by stimulating the mesolimbic and mesocortical dopaminergic pathways. The main stimulatory effect of most amphetamines is achieved by stimulating dopamine release from the presynaptic vesicles into the synaptic cleft and by inhibiting dopamine re-uptake. Amphetamine intoxication and withdrawal share many similarities with the symptoms of cocaine intoxication and withdrawal. Intoxicated people should be under careful cardiovascular and respiratory monitoring. Treatment options are aimed at decreasing the reward and reinforcing properties of amphetamines. There is no specific medication for amphetamine misuse, but selective serotonin re-uptake inhibitors (SSRIs) may be used to stabilise the ‘crash’ that results from stimulant use (e.g., due to weekend use of MDMA, ecstasy, etc.). SSRIs have the effect of increasing the availability of dopamine and decreasing the depletion of dopamine, which may, in turn, decrease self-administration of amphetamines.
Psychiatric Diagnosis: The State of the Art
Published in Mark S. Gold, R. Bruce Lydiard, John S. Carman, Advances in Psychopharmacology: Predicting and Improving Treatment Response, 2018
Robert Moreines, Irl Extein, Mark S. Gold
The diagnostic criteria for cocaine intoxication given by the AMA manual specifies cocaine levels in blood and/or urine.11 The only additional facts that matter are whether the person came to treatment before spouse, bank, employer, friend, professional society forced him/her. Since all drug and alcohol use is unhealthy (though some people have more acute or visible consequences than others) and no drug use is totally without problems, the existing DSM III system for drug abuse diagnosis is bankrupt.
Association between binge drug use and suicide attempt among people who inject drugs
Published in Substance Abuse, 2018
Charles Fournier, Maykel Farag Ghabrash, Adelina Artenie, Elise Roy, Geng Zang, Julie Bruneau, Didier Jutras-Aswad
In our study sample, binge remained associated with attempted suicide after controlling for a number of other factors. Binge episodes can have significant deleterious effects on many brain functions during both active drug use and in the days to follow. Chronic exposure to psychoactive drugs is associated with pathological modification of neuronal activity resulting in intrusive impulsivity.32 In addition, impulsivity secondary to reduced frontal lobe activation has been previously documented during acute cocaine intoxication.33 Through alteration of decision-making processes and failure of self-control mechanisms, sustained intoxication during binge episodes may increase risk of suicide attempt.5,32,34 Moreover, excessive use of neurodepressants such as opioids and sedative-hypnotics has been implicated in development of affective symptoms,35 which are directly associated with suicidal behavior.36 This is in line with our results that demonstrate that frequent or occasional use of cocaine and frequent use of sedative-hypnotics were both independently associated with suicide attempt among PWID.10,11
Recreational use of carfentanil – a case report with laboratory confirmation
Published in Clinical Toxicology, 2018
Sabine Müller, Susanne Nussbaumer, Gabriel Plitzko, Roger Ludwig, Wolfgang Weinmann, Stephan Krähenbühl, Evangelia Liakoni
A 16-year-old male patient was found unconscious (Glasgow Coma Scale 3), hypotensive (71/58 mmHg), tachycardic (126 bpm), hypopneic and cyanotic (peripheral oxygen saturation 70%, no signs of pulmonary edema) following the use of an unknown substance via unknown route. Body temperature was normal, pupils of normal size responding to light. After intubation, he was airlifted to the hospital, where, after intravenous administration of naloxone and flumazenil, he regained consciousness. The urine drug screening immunoassay (Triage® TOX Drug Screen, Alere, Cologne, Germany) was negative, the blood alcohol concentration below the limit of detection. Despite inconsistent clinical findings, cocaine intoxication was suspected when a white powder and a snorting tube were found in the patient’s belongings. However, using gas chromatography–mass spectrometry and liquid chromatography combined with high-resolution tandem mass spectrometry (LC-HR-MS/MS), the powder was identified as carfentanil. Analysis of samples collected approximately 1 h after use with LC-MS/MS showed a serum concentration of 0.6 ng/mL for carfentanil and 0.2 ng/mL for its main metabolite norcarfentanil (Figure 1); urine concentrations were 1.3 ng/mL and 0.5 ng/mL, respectively.
Cocaine induced heart failure: report and literature review
Published in Journal of Community Hospital Internal Medicine Perspectives, 2021
Sherif Elkattawy, Ramez Alyacoub, Abraham Al-Nassarei, Islam Younes, Sarah Ayad, Mirette Habib
Cocaine intoxication disrupts the homeostasis in nearly all organ systems throughout the human body; however, the cardiovascular system is responsible for most adverse effects. [8] The major cardiovascular complications associated with patients that use cocaine include myocardial infarction (MI), aortic dissection (AD), heart failure and cardiomyopathies, stroke, excessive hypertension, chest pain, and arrhythmia [9]. Cocaine can give rise to both acute and chronic cardiovascular disease, prompting adequate understanding of the pathophysiology so that prudent diagnostic and therapeutic action can be taken [10,11]