Cocaine comes under a lot of names
and I'm sure you're very familiar with it already
"Blow", "Snow", "Snort", "Super-speed",
all kinds of names for cocaine.
It's a very commonly used drug in the older category
of people, around 40, 45 years old.
It's an inhibitor of CNS transporters,
so, dopamine, norepinepherine and serotonin.
It is a very short lived kind of product or drug.
It gives short lived euphoria, short lived self confidence
and actually does contribute to some mental alertness,
which is why it tends to be a performance enhancer in
those people who are in high risk (inaudible)
like stock brokers and business people who want
to stay awake for a long time.
Overdoses are very common with cocaine.
This results in seizures, respiratory depression.
Now, the reason why cocaine has such a variable effect
on people is because it is usually snorted.
When you snort cocaine,
you cause intense vasoconstriction of the blood vessels.
But in those patients who don't have a lot of vasoconstriction,
these people are going to have more toxic effects.
That's why cocaine is hard to predict in terms of
how you will get sick from it.
Cardiac toxicity is very common. And on more than one occasion,
I've had to treat an arrhythmia brought about by cocaine.
It blocks norepinepherine uptake, so that the norepinepherine
is in the synaptic cleft for a very long time,
which is why they tend to be very tachycardic, hypertensive
and they do have increased cardiac contractile function.
As I said before, it's a potent vasoconstrictor.
This can lead to peripheral hypertension. It can lead to MI's
and it can lead to strokes. In terms of cocaine use in pregnancy,
there's a significant increase in fetal mortality and morbidity.
And you'll also get fetal cortical cystic lesions.
We recently had a patient in my clinic whose child had
fetal cortical cystic lesion from maternal cocaine use.
And it is a lot more common than you think, so make sure
you're always asking your patients if they use cocaine.
Crack cocaine is a variation of cocaine. It's often called
"Crack" or "Rock" or "Work" or "Hard" or "Iron",
there's a whole bunch of names.
This is a picture of crack cocaine.
It is the most addictive form of cocaine. It is a very short,
very intense, and very significant high that they get.
There is a massive amount of dopamine release
with depletion and depression thereafter.
And its effect are essentially the same as cocaine,
but it is much faster acting,
where cocaine can take up to 30 seconds to have an effect,
crack will act under 8 seconds. It's also far more dangerous.
So, I mentioned to you before that with cocaine,
it's usually snorted. And when it's snorted,
you get significant vasoconstriction of the blood vessels
in the nose. That limits its absorption.
With crack, it's inhaled. And the pulmonary vasculatures
response to cocaine is actually to dilate.
So now, not only do you have that amount of cocaine
going in the lungs, but the blood vessels are dilated,
so the amount of absorption is much much greater.
"Crack lung" is a common side effect of crack cocaine usage,
especially if it's heavy use and if it's long term.
It's characterized with pulmonary fibrosis.
And it's often accompanied with fever and cough
and often misdiagnosed as a pneumonia.
"Crack babies", we sometimes see this in most communities.
They often have later cognitive and developmental issues.
Ekbom's syndrome is a parasitosis with secondary skin damage.
So, people who take crack cocaine think that their skin is
crawling with bugs. So they scratch so hard
that they actually damage the skin.
And it's a very typical kind of skin rash.
So, here you can see a person who had been using
crack cocaine and scratch themselves,
and he has got lesions all over his face.
And these two pictures are only three months apart.
So you can see how toxic and how horrible
this particular drug is.