Cocaine Use and Nursing AssessmentThe US Food and Drug Administration has classified cocaine as a schedule II narcotic (controlled substance with a high potential for abuse). (Swinyard 1985) Cocaine has several approved medical uses, and is mostly used as a local anesthetic. Cocaine is also classified as a sympathomimetic agent (Gay 1982). However, cocaine today has become a highly abused drug, and there is not much known about its effects on humans. There have now been many reports published about its effects and yet there is still much controversy about the drug. Cocaine is a tropane alkaloid (benzoylmethylecogognine), of the evergreen shrub, Erythroxylon coca. It is extensively grown in Bolivia and Peru. The strong sympathomimetic effects of cocaine have been compared to amphetamines. It causes the “fight and flight” reaction; tachycardia, dilated pupils, increased muscle contractility, increased blood glucose, and peripheral vasoconstriction. Cocaine has been found to primarily block the uptake of neurotransmitters at the nerve terminals, thereby potentiating sympathetic stimulation and central nervous system effects of euphoria. This is due to the effects of dopamine and serotonin. (Langer 1974) (Gropetti 1976) of course, the response to cocaine is a phenomenon unique to each individual. Even the feelings of dysphoria experienced when the effects of the cocaine wearing off, are different for many individuals. When assessing patient who have taken cocaine, the nurse should remember that the drug has quite variable effects upon individuals. Physical tolerance and withdrawal symptoms do not occur with cocaine. However, it is still considered to be very addictive due to its effect as the drug is wearing off. During this time, the person experiences extreme dysphonic sensations, which leads to a craving of the drug. Therefore, the need for cocaine could be considered an obsession rather than a physical addiction. Many authorities consider this a psychological addiction rather than a physical additions. Cocaine will usually cause the following: Central Nervous System: euphoria, a sensation of “soaring”, elation, laughing, talkativeness, flighty, irritability, apprehensiveness, unable to sit still, nausea, vomiting, headaches, cold sweats, vertigo, twitching of small muscles especially of face, fingers, feet, tremors, generalized tics, possible psychosis, hallucinations, core body temperature rises. Advanced effects may be unresponsive, decreased responsiveness to all stimuli, incontinence. Cocaine may have the opposite effect: depression, flaccid paralysis of muscles, coma, pupils fixed and dilated, loss of reflexes, respiratory arrest, cocaine has also been known to precipitate CVA’s. Cardiovascular System: initially the pulse may be irregular, and then become very slow, later. Pulse may raise dramatically, hypertension, skin pallor caused by vasoconstriction, PVC’s, increased respiratory rate and depth. Advanced symptoms may include more increase in pulse and blood pressure, then blood pressure can fall due to ventricular arrhythmias that can occur, pulse becomes rapid, weak and irregular, peripheral and then central cyanosis, Cheyne-Stokes respirations, gross pulmonary edema, may lead to MI or ventricular fibrillation and death. Dosage and Absorption of Cocaine As with all other drugs, the dosage and the route of administration will greatly influence the effects of the cocaine. The maximum therapeutic dose of cocaine for local anesthesia is 200mg to 300mg. (Perman 1979) cocaine can be in the form of a powder, paste, liquid, or crystal and may be administered by oral, parenteral, intranasal routes. In fact, newer forms of abusing cocaine include the inhalation of concentrated forms of “street” cocaine, “freebasing” that can be “smoked” like a cigarette or just inhaled. Many street forms of cocaine will also contain other drugs such as amphetamines, caffeine and other stimulants or Lidocaine (Allred 1981). However, cocaine is not taken orally very frequently, because the effect is diminished due to the acidity of the stomach and the alkalinity of the small intestine; absorption is poor from these environments. Nurses today are most likely to encounter patients with cocaine toxicity in the intensive care unit of the hospital. However, it is certain that other patients, some of whom may be seriously ill, may be suffering from the effects of cocaine use. Every nurse will need to remember that there is a very wide prevalence of cocaine use today and be able to recognize and assess those signs and symptoms of the use of cocaine. Next: References |