cocaine addiction

Question 1

cocaine:

____ stimulant

_____ anesthetic

and it works as a ______

Answer 1

CNS stimulant

local anesthetic

and it works as a vasoconstrictor

Question 2

cocaine induced euphoria occurs as the _______ is rising

Answer 2

blood level

Question 3

negative effects of cocaine

Answer 3

• irritability
• anxiety
• restlessness
• paranoia

Question 4

cocaine- induced paranoia

• occurs in about ____ of heavy users
• not necessarily dose-related, but there may be _____ effects
• _____ duration

Answer 4

• occurs in about 2/3 of heavy users
• not necessarily dose-related, but there may be kindling effects
• short duration

Question 5

fastest route of administration to see effects

Answer 5

smoking crack

Question 6

mandated a minimum sentence of 5 years without parole for possession of 5 gms crack or 500 gms of powder cocaine

Led to racial disparity in imprisonment, far more African-Americans imprisoned for crack offenses

Answer 6

Anti-Drug Abuse Act of 1986

Question 7

Mandatory minimum sentence now for 28 gms (1 oz) of crack

100:1 ratio of powder: crack changed to 18:1

Answer 7

Fair Sentencing Act of 2010

Question 8

sex differences in cocaine users:

Earlier onset of cocaine use

More rapid development of dependence

More frequent involvement with a drug dependent partner

More premorbid depression

Slower recovery from depressive sx during first month of abstinence

Women may have a slightly better response to treatment

To some extent may reflect reasons for use (escape from psychological pain vs. euphoria)

May reflect overcoming of barriers to treatment

Answer 8

females to chase away the bad feelings

Question 9

why do males use cocaine?

Answer 9

to enhance the good mood feeling

Question 10

cocaine is metabolized by

Answer 10

plasma cholinesterases

Question 11

major metabolite for cocaine?

is active or inactive?

how long is present?

half-life?

Answer 11

• benzoylecgonine (BE) which is an inactive metabolite
• present in urine for 48 hr.
• half life is 40-60 minutes

Question 12

cocaine tolerance due to the drug?

Answer 12

nope to the drug effects

Question 13

cocaine causes complete acute tolerance to _____ and incomplete acute tolerance to _____ in heart rate

Answer 13

cocaine causes complete acute tolerance to euphoria and incomplete acute tolerance to increase in heart rate

Question 14

kindling to some CNS effects such as paranoia and seizures

Answer 14

reverse tolerance (sensitization)

Question 15

local complications of cocaine

Answer 15

• irritation/ulcers of nasal mucosa
• rhinorrhea
• nasal septal perforation
• pulmonary dysfunction
• dental/gum problems

Question 16

Cardiovascular complications of cocaine

Answer 16

• MI
• ventricular dysrhythmias
• cardiomyopathy
• endocarditis

Question 17

neurological complications of cocaine

Answer 17

• hemorrhagic stroke
• ischemic stroke
• grand mal seizures

Question 18

psychiatric and lifestyle complications

Answer 18

• accidents
• homicide
• suicide

Question 19

cocaine overdose is common in ______ as is ________ overdose in Caucasians

Answer 19

cocaine: African Americans
heroine: caucasians

Question 20

what time analog is common in cocaine

Answer 20

fentanyl

Question 21

cocaine in pregnancy

• special note it is hard to distinguish cocaine effects from poor/no prenatal care, other drugs/alcohol use and smoking cigarettes

Answer 21

higher rate of :

• abruptio placentae
• genitourinary malformations
• low birthweight babies

Question 22

use of both cocaine and alcohol

Answer 22

allows one to use more of the other

Question 23

behavioral tx.

Answer 23

allows better tx. retention and better outcome

Question 24

relapse prevention tx. best for

Answer 24

higher severity pt/s

Question 25

potential drug med

Answer 25

• disulfiram

Question 26

disulfiram

Answer 26

inhibits aldehyde DH

Question 27

disulfiram allows for better Tx. in pts w.out _____ disorder

Answer 27

alcohol