1. Cocaine Answers are from DSM-IV-TR or the Substance Abuse Practice Guideline, AJP Supplement, August 2006. As of 9Sep08

2. Half-life Q. Half-life of cocaine?

3. Half-life Ans. 30 – 50 minutes [which helps explain the need for frequent dosing to maintain high].

4. Intoxication Q. DSM-IV list 9 signs of cocaine intoxication. List.

5. Intoxication - 1 Ans. 1.Tachycardia or bradycardia 2.Pupillary dilation 3.BP up or down 4.Perspiration or chills 5.Nausea or vomiting 6.Weight loss 7.See next slide

6. Intoxication - 2 7. Psychomotor agitation or retardation 8. Muscular weakness, R decreased, chest pain, or cardiac arrhythmias 9. Confusion, seizures, dyskinesias, dystonia, or coma.

7. With perceptual disturbance Q. “With perceptual disturbance” is a specifier that is added to the dx of intoxication. What signs might be reported?

8. With perceptual disturbance Ans. -- paranoid ideation -- auditory hallucinations -- tinnitus

9. Withdrawal Q. Signs of withdrawal? DSM list 5.

10. Withdrawal Ans. 1] fatigue 2] vivid, unpleasant dreams 3] insomnia or hypersomnia 4] increased appetite 5] psychomotor retardation or agitation

11. Physical exam - snorters Q. Physical examination of snorters finds?

12. Physical exam - sorters Ans. Nose bleed and, with longer use, perforated nasal septum.

13. Babies Q. Babies of mothers who have used cocaine a lot during pregnancy tend to be?

14. Babies Ans. Low birth weight.

15. Prevalence - lifetime Q. Lifetime prevalence?

16. Prevalence - lifetime Ans. 2% of the US population.

17. Prevalence - gender Q. Which gender predominates?

18. Prevalence - gender Ans. Males

19. Urine + Q. How long is the urine positive after use of cocaine?

20. Urine + Ans. One dose: 1 – 3 days Lots of doses: 7 -12 days

21. Crack Q. What is crack and how does it differ from natural cocaine?

22. Crack Ans. Crack is a cocaine alkaloid that differs in that: -- it is easily vaporized and inhaled which provides an extremely rapid onset.

23. Cocaine intoxication management Q. Management of cocaine intoxication?

24. Cocaine intoxication management Ans. 1.Usually only requires supportive care 2.Exceptions include providing the appropriate med for specific symptoms: -- hypertension -- tachycardia -- seizures -- delusions -- very agitated

25. Cocaine withdrawal management Q. Meds for cocaine withdrawal?

26. Cocaine withdrawal Ans. No meds have been proven to be helpful in controlled studies.

27. Psychosocial approaches Q. Name psychosocial approaches for cocaine dependence.

28. Psychosocial approaches Ans. 1.CBT 2.Behavior therapy 3.12-step counseling 4.Self-help groups, e.g., Narcotic’s Anonymous

29. Meds Q. If used with psychosocial approaches, what meds “show promise”?

30. Meds Ans. -- disulfiram -- modafinil -- topiramate