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Rooney B, Sobiecka P, Rock K, Copeland C. From Bumps to Binges: Overview of Deaths Associated with Cocaine in England, Wales and Northern Ireland (2000-2019). J Anal Toxicol 2023; 47:207-215. [PMID: 36611264 PMCID: PMC10037635 DOI: 10.1093/jat/bkad002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Revised: 11/24/2022] [Accepted: 01/05/2023] [Indexed: 01/09/2023] Open
Abstract
The UK, as the "cocaine capital of Europe," currently accounts for ∼75% of all cocaine-related hospital admissions in Europe. This study aims to analyze the trends in cocaine-related deaths in England, Wales and Northern Ireland over 20 years (2000-2019). Cases reported to the National Programme on Substance Abuse Deaths (NPSAD) occurring between 2000 and 2019 where cocaine was detected at post-mortem (PM) were extracted for analysis. A total of 5,339 cases were retrieved, with an increase in the rate of reporting over time. Cocaine was deemed a cause of death and quantified in PM blood samples along with its major metabolite benzoylecgonine in 685 cases. Of these 685 cases, 25% (n = 170/685) occurred following acute use, 22% (n = 154/685) following chronic/binge use, 40% (n = 271/685) in combination with morphine, 4% (n = 29/685) in drug packer/swallower circumstances and 9% (n = 61/685) in a suicide context. Cardiac complications were evident in 22% of cases (n = 154/685). The average concentration of cocaine detected in cardiac cases (900 ng/mL) was considerably lower than that detected in cases where acute (19,100 ng/mL) or chronic/binge (6,200 ng/mL) dosing was evident. This is the first cocaine-related mortality study in these geographical areas. Deaths following cocaine use continue to rise despite its Class A drug listing in the UK. While underlying and external risk factors including polydrug use, cardiac complications and mental health can all contribute to the incidence of fatal drug toxicity following cocaine use, this study demonstrates that the risk of a cocaine overdose cannot be attributed to a specific blood concentration range.
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Affiliation(s)
- Brian Rooney
- School of Life Sciences, Pharmacy and Chemistry, Kingston University, Penrhyn Road, Kingston upon Thames, London KT1 2EE, UK
| | - Pola Sobiecka
- School of Life Sciences, Pharmacy and Chemistry, Kingston University, Penrhyn Road, Kingston upon Thames, London KT1 2EE, UK
| | - Kirsten Rock
- Institute of Pharmaceutical Sciences, King's College London, Stamford St., London SE1 9NQ, UK
- National Programme on Substance Abuse Deaths, St George's, University of London, Cranmer Terrace, London SW17 0RE, UK
| | - Caroline Copeland
- Institute of Pharmaceutical Sciences, King's College London, Stamford St., London SE1 9NQ, UK
- National Programme on Substance Abuse Deaths, St George's, University of London, Cranmer Terrace, London SW17 0RE, UK
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de Jong M, Sleegers N, Florea A, Van Loon J, van Nuijs ALN, Samyn N, De Wael K. Unraveling the Mechanisms Behind the Complete Suppression of Cocaine Electrochemical Signals by Chlorpromazine, Promethazine, Procaine, and Dextromethorphan. Anal Chem 2019; 91:15453-15460. [DOI: 10.1021/acs.analchem.9b03128] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Mats de Jong
- AXES Research Group, University of Antwerp, Groenenborgerlaan 171, 2020 Antwerp, Belgium
| | - Nick Sleegers
- AXES Research Group, University of Antwerp, Groenenborgerlaan 171, 2020 Antwerp, Belgium
| | - Anca Florea
- AXES Research Group, University of Antwerp, Groenenborgerlaan 171, 2020 Antwerp, Belgium
| | - Joren Van Loon
- AXES Research Group, University of Antwerp, Groenenborgerlaan 171, 2020 Antwerp, Belgium
- Product Development Research Group, University of Antwerp, Ambtmanstraat 1, 2000 Antwerp, Belgium
| | | | - Nele Samyn
- Drugs and Toxicology Department, National Institute for Criminalistics and Criminology, Vilvoordsesteenweg 100, 1120 Brussels, Belgium
| | - Karolien De Wael
- AXES Research Group, University of Antwerp, Groenenborgerlaan 171, 2020 Antwerp, Belgium
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Richards JR, Hollander JE, Ramoska EA, Fareed FN, Sand IC, Izquierdo Gómez MM, Lange RA. β-Blockers, Cocaine, and the Unopposed α-Stimulation Phenomenon. J Cardiovasc Pharmacol Ther 2016; 22:239-249. [PMID: 28399647 DOI: 10.1177/1074248416681644] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Cocaine abuse remains a significant worldwide health problem. Patients with cardiovascular toxicity from cocaine abuse frequently present to the emergency department for treatment. These patients may be tachycardic, hypertensive, agitated, and have chest pain. Several pharmacological options exist for treatment of cocaine-induced cardiovascular toxicity. For the past 3 decades, the phenomenon of unopposed α-stimulation after β-blocker use in cocaine-positive patients has been cited as an absolute contraindication, despite limited and inconsistent clinical evidence. In this review, the authors of the original studies, case reports, and systematic review in which unopposed α-stimulation was believed to be a factor investigate the pathophysiology, pharmacology, and published evidence behind the unopposed α-stimulation phenomenon. We also investigate other potential explanations for unopposed α-stimulation, including the unique and deleterious pharmacologic properties of cocaine in the absence of β-blockers. The safety and efficacy of the mixed β-/α-blockers labetalol and carvedilol are also discussed in relation to unopposed α-stimulation.
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Affiliation(s)
- John R Richards
- 1 Department of Emergency Medicine, University of California Davis Medical Center, Sacramento, CA, USA
| | - Judd E Hollander
- 2 Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, USA
| | - Edward A Ramoska
- 3 Department of Emergency Medicine, Drexel University, Philadelphia, PA, USA
| | - Fareed N Fareed
- 4 Emergency Medical Associates, EmCare Partners Group, Parsippany, NJ, USA
| | | | | | - Richard A Lange
- 7 Division of Cardiology, Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, TX, USA
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Richards JR, Garber D, Laurin EG, Albertson TE, Derlet RW, Amsterdam EA, Olson KR, Ramoska EA, Lange RA. Treatment of cocaine cardiovascular toxicity: a systematic review. Clin Toxicol (Phila) 2016; 54:345-64. [PMID: 26919414 DOI: 10.3109/15563650.2016.1142090] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Cocaine abuse is a major worldwide health problem. Patients with acute cocaine toxicity presenting to the emergency department may require urgent treatment for tachycardia, dysrhythmia, hypertension, and coronary vasospasm, leading to pathological sequelae such as acute coronary syndrome, stroke, and death. OBJECTIVE The objective of this study is to review the current evidence for pharmacological treatment of cardiovascular toxicity resulting from cocaine abuse. METHODS MEDLINE, PsycINFO, Database of Abstracts of Reviews of Effects (DARE), OpenGrey, Google Scholar, and the Cochrane Library were searched from inception to November 2015. Articles on pharmacological treatment involving human subjects and cocaine were selected and reviewed. Evidence was graded using Oxford Centre for Evidence-Based Medicine guidelines. Treatment recommendations were compared to current American College of Cardiology/American Heart Association guidelines. Special attention was given to adverse drug events or treatment failure. The search resulted in 2376 articles with 120 eligible involving 2358 human subjects. Benzodiazepines and other GABA-active agents: There were five high-quality (CEBM Level I/II) studies, three retrospective (Level III), and 25 case series/reports (Level IV/V) supporting the use of benzodiazepines and other GABA-active agents in 234 subjects with eight treatment failures. Benzodiazepines may not always effectively mitigate tachycardia, hypertension, and vasospasm from cocaine toxicity. Calcium channel blockers: There were seven Level I/II, one Level III, and seven Level IV/V studies involving 107 subjects and one treatment failure. Calcium channel blockers may decrease hypertension and coronary vasospasm, but not necessarily tachycardia. Nitric oxide-mediated vasodilators: There were six Level I/II, one Level III, and 25 Level IV/V studies conducted in 246 subjects with 11 treatment failures and two adverse drug events. Nitroglycerin may lead to severe hypotension and reflex tachycardia. Alpha-adrenoceptor blocking drugs: There were two Level I studies and three case reports. Alpha-1 blockers may improve hypertension and vasospasm, but not tachycardia, although evidence is limited. Alpha-2-adrenoceptor agonists: There were two high-quality studies and one case report detailing the successful use of dexmedetomidine. Beta-blockers and β/α-blockers: There were nine Level I/II, seven Level III, and 34 Level IV/V studies of β-blockers, with 1744 subjects, seven adverse drug events, and three treatment failures. No adverse events were reported for use of combined β/α-blockers such as labetalol and carvedilol, which were effective in attenuating both hypertension and tachycardia. Antipsychotics: Seven Level I/II studies, three Level III studies, and seven Level IV/V case series and reports involving 168 subjects have been published. Antipsychotics may improve agitation and psychosis, but with inconsistent reduction in tachycardia and hypertension and risk of extrapyramidal adverse effects. Other agents: There was only one high level study of morphine, which reversed cocaine-induced coronary vasoconstriction but increased heart rate. Other agents reviewed included lidocaine, sodium bicarbonate, amiodarone, procainamide, propofol, intravenous lipid emulsion, propofol, and ketamine. CONCLUSIONS High-quality evidence for pharmacological treatment of cocaine cardiovascular toxicity is limited but can guide acute management of associated tachycardia, dysrhythmia, hypertension, and coronary vasospasm. Future randomized prospective trials are needed to evaluate new agents and further define optimal treatment of cocaine-toxic patients.
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Affiliation(s)
- John R Richards
- a Department of Emergency Medicine , University of California Davis Medical Center , Sacramento , CA , USA
| | - Dariush Garber
- a Department of Emergency Medicine , University of California Davis Medical Center , Sacramento , CA , USA
| | - Erik G Laurin
- a Department of Emergency Medicine , University of California Davis Medical Center , Sacramento , CA , USA
| | - Timothy E Albertson
- b Department of Internal Medicine, Divisions of Toxicology, Pulmonary and Critical Care , University of California Davis Medical Center , Sacramento , CA , USA
| | - Robert W Derlet
- a Department of Emergency Medicine , University of California Davis Medical Center , Sacramento , CA , USA
| | - Ezra A Amsterdam
- c Department of Internal Medicine, Division of Cardiology , University of California Davis Medical Center , Sacramento , CA , USA
| | - Kent R Olson
- d Departments of Medicine and Clinical Pharmacy , University of California, San Francisco, Medical Director, California Poison Control System, San Francisco Division , San Francisco , CA , USA
| | - Edward A Ramoska
- e Department of Emergency Medicine , Drexel University , Philadelphia , PA , USA
| | - Richard A Lange
- f Department of Internal Medicine, Division of Cardiology , Texas Tech University Health Sciences Center , El Paso , TX , USA
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de Jong M, Sleegers N, Kim J, Van Durme F, Samyn N, Wang J, De Wael K. Electrochemical fingerprint of street samples for fast on-site screening of cocaine in seized drug powders. Chem Sci 2016; 7:2364-2370. [PMID: 29997780 PMCID: PMC6003614 DOI: 10.1039/c5sc04309c] [Citation(s) in RCA: 71] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Accepted: 01/06/2016] [Indexed: 11/21/2022] Open
Abstract
We report on a wearable fingertip sensor for on-the-spot identification of cocaine and its cutting agents in street samples. Traditionally, on-site screening is performed by means of colour tests which are difficult to interpret and lack selectivity. By presenting the distinct voltammetric response of cocaine, cutting agents, binary mixtures of cocaine and street samples in solution and powder street samples, we were able to elucidate the electrochemical fingerprint of all these compounds. The new electrochemical concept holds considerable promise as an on-site screening method.
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Affiliation(s)
- Mats de Jong
- AXES Research Group , Chemistry Department , Groenenborgerlaan 171 , 2020 Antwerp , Belgium . .,National Institute for Criminalistics and Criminology (NICC) , Vilvoordsesteenweg 100 , 1120 Brussels , Belgium
| | - Nick Sleegers
- AXES Research Group , Chemistry Department , Groenenborgerlaan 171 , 2020 Antwerp , Belgium .
| | - Jayoung Kim
- Department of Nanoengineering , University California San Diego , CA 92093 , USA
| | - Filip Van Durme
- National Institute for Criminalistics and Criminology (NICC) , Vilvoordsesteenweg 100 , 1120 Brussels , Belgium
| | - Nele Samyn
- National Institute for Criminalistics and Criminology (NICC) , Vilvoordsesteenweg 100 , 1120 Brussels , Belgium
| | - Joseph Wang
- Department of Nanoengineering , University California San Diego , CA 92093 , USA
| | - Karolien De Wael
- AXES Research Group , Chemistry Department , Groenenborgerlaan 171 , 2020 Antwerp , Belgium .
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Damodaran S. Cocaine and beta-blockers: the paradigm. Eur J Intern Med 2010; 21:84-6. [PMID: 20206876 DOI: 10.1016/j.ejim.2009.11.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2009] [Revised: 11/24/2009] [Accepted: 11/25/2009] [Indexed: 10/20/2022]
Abstract
Cocaine is one of the most commonly used substances of abuse. The use of beta-blockers in cocaine induced acute coronary syndrome has long been a matter of debate. While it is widely believed that beta-blockers are contraindicated in cocaine toxicity, there appears to be some recognizable role for certain beta-blockers in ameliorating the cardiovascular as well as central nervous system effects of cocaine. This article explores the role of beta-blockers in the management of cocaine toxicity.
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Affiliation(s)
- Senthilkumar Damodaran
- Department of Internal Medicine, University at Buffalo, Erie County Medical Center, 462 Grider Street, Buffalo, New York 14215, USA.
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van Nuijs ALN, Pecceu B, Theunis L, Dubois N, Charlier C, Jorens PG, Bervoets L, Blust R, Meulemans H, Neels H, Covaci A. Can cocaine use be evaluated through analysis of wastewater? A nation-wide approach conducted in Belgium. Addiction 2009; 104:734-41. [PMID: 19344443 DOI: 10.1111/j.1360-0443.2009.02523.x] [Citation(s) in RCA: 105] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
AIMS Cocaine is the second most-used illicit drug world-wide and its consumption is increasing significantly, especially in western Europe. Until now, the annual prevalence has been estimated indirectly by means of interviews. A recently introduced and direct nation-wide approach based on measurements of the major urinary excreted metabolite of cocaine, benzoylecgonine, in wastewater is proposed. DESIGN Wastewater samples from 41 wastewater treatment plants (WWTPs) in Belgium, covering approximately 3,700,000 residents, were collected. Each WWTP was sampled on Wednesdays and Sundays during two sampling campaigns in 2007-08. Samples were analysed for cocaine (COC) and its metabolites, benzoylecgonine (BE) and ecgonine methylester (EME) by a validated procedure based on liquid chromatography coupled with tandem mass spectrometry. Concentrations of BE were used to calculate cocaine consumption (g/day per 1000 inhabitants) for each WWTP region and for both sampling campaigns (g/year per 1000 inhabitants). FINDINGS Weekend days showed significantly higher cocaine consumption compared with weekdays. The highest cocaine consumption was observed for WWTPs receiving wastewater from large cities, such as Antwerp, Brussels and Charleroi. Results were extrapolated for the total Belgian population and an estimation of a yearly prevalence of cocaine use was made based on various assumptions. An amount of 1.88 tonnes (t) per year [standard error (SE) 0.05 t] cocaine is consumed in Belgium, corresponding to a yearly prevalence of 0.80% (SE 0.02%) for the Belgian population aged 15-64 years. This result is in agreement with an earlier reported estimate of the Belgian prevalence of cocaine use conducted through socio-epidemiological studies (0.9% for people aged 15-64 years). CONCLUSIONS Wastewater analysis is a promising tool to evaluate cocaine consumption at both local and national scale. This rapid and direct estimation of the prevalence of cocaine use in Belgium corresponds with socio-epidemiological data. However, the strategy needs to be refined further to allow a more exact calculation of cocaine consumption from concentrations of BE in wastewater.
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Affiliation(s)
- Alexander L N van Nuijs
- Toxicological Centre, Department of Pharmaceutical Sciences, University of Antwerp, Universiteitsplein, Antwerp, Belgium
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Krantz MJ, Rowan SB, Mehler PS. Cocaine-Related Torsade de Pointes in a Methadone Maintenance Patient. J Addict Dis 2008; 24:53-60. [PMID: 15774410 DOI: 10.1300/j069v24n01_05] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
A patient maintained on methadone for opioid-dependency developed recurrent syncope. Episodes occurred within hours after using cocaine, and were initially presumed secondary to seizure disorder. However, the patient subsequently suffered a cardiac arrest, and polymorphic ventricular tachycardia (torsade de pointes) was documented. Other than cocaine and methadone the patient was receiving no additional agents known to prolong the QT interval. Low serum methadone concentrations and marked reversible left ventricular systolic dysfunction were noted during the hospitalization. These findings, in conjunction with a history of torsade de pointes temporally related to cocaine abuse, suggest that cocaine was a major precipitant of arrhythmia. Recent experimental studies have shown that cocaine and methadone prolong the QT interval through the same mechanism. We examine the effects of cocaine and methadone on cardiac conduction in the context of the opioid-dependent population.
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Affiliation(s)
- Mori J Krantz
- Department of Internal Medicine, Denver Health Medical Center, Denver, CO 80204-4507, USA.
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Moritz F, Monteil C, Isabelle M, Mulder P, Henry JP, Derumeaux G, Richard V, Muller JM, Thuillez C. Selenium diet-supplementation improves cocaine-induced myocardial oxidative stress and prevents cardiac dysfunction in rats. Fundam Clin Pharmacol 2004; 18:431-6. [PMID: 15312149 DOI: 10.1111/j.1472-8206.2004.00255.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Chronic cocaine abuse causes cardiac dysfunction and induces oxidative stress. The goal of this study was to evaluate whether an enhanced antioxidant pool, induced by the administration of selenium, may prevent the myocardial dysfunction induced by cocaine. Cocaine was administered for 7 days (15 mg/kg/day, i.p.) to rats pretreated for 4 weeks with selenium (1.16 mg/L/day, p.o.). Cardiac function was evaluated by cardiac index and left ventricular (LV) fractional shortening (FS) measured by echocardiography. The redox ratio and enzymatic activities of glutathione peroxidase (GPX) and superoxide dismutase (SOD) were measured in the LV myocardium. Cocaine administration induced a cardiac dysfunction, as evidenced by a decrease in cardiac index and LV FS as well as by an increase in LV diameters. Moreover, antioxidant markers and redox ratio were altered in rats after cocaine exposure. Selenite supplementation induced a significant limitation of cardiac index and FS alterations observed after cocaine administration. This improvement in cardiac function was associated with a redox ratio recovery while SOD and GPX activities remained unchanged. Thus, selenite reversed both the oxidative stress and the contractile dysfunction induced by cocaine administration. These results suggest a major role of oxidative stress in the cocaine-induced cardiotoxicity.
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Affiliation(s)
- Fabienne Moritz
- INSERM E9920 (IFRMP n degrees 23) UFR de Médecine et de Pharmacie, 22 boulevard Gambetta, 76183 Rouen, France
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Moritz F, Monteil C, Mulder P, Derumeaux G, Bizet C, Renet S, Lallemand F, Richard V, Thuillez C. Prolonged Cardiac Dysfunction After Withdrawal of Chronic Cocaine Exposure in Rats. J Cardiovasc Pharmacol 2003; 42:642-7. [PMID: 14576513 DOI: 10.1097/00005344-200311000-00010] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Cocaine abuse causes myocardial dysfunction and induces oxidative stress. However, the reversibility of these effects is unknown. We evaluated myocardial function and oxidative stress after cocaine withdrawal, in a rat model of chronic cocaine exposure. Standard echocardiography and Doppler tissue imaging were performed after 4 weeks (W4) of cocaine administration (2 x 7.5 mg/kg/d, i.p.) and 4 weeks after interruption (W8). At these time points, redox state (reduced glutathione GSH, oxidized glutathione GSH, and GSH/GSSG) as well as activities of GSH peroxidase (GPX), superoxide dismutase (SOD), and catalase were determined in the left ventricle (LV). At W4, LV fractional shortening, posterior wall thickening, systolic myocardial ventricular gradient (SMVG), dP/dt(max), and dp/dt(min) were decreased, compared with control values while LV myocardial thickness was increased. At W8, even though dP/dtmax and dp/dt(min) were restored, myocardial function was still impaired as demonstrated by the decrease in posterior wall thickening, and systolic myocardial velocity gradient. At W4, CAT and GPX activities as well as GSH/GSSG ratio were reduced while SOD activity was increased. Antioxidant markers and redox ratio remained altered 4 weeks after the last injection. Thus, these data demonstrate the persistence of LV dysfunction after cocaine withdrawal, which occurs in a context of a deficit in antioxidant defenses.
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Affiliation(s)
- Fabienne Moritz
- INSERM E 9920, IFRMP no. 23, University Medical School, Rouen, France
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Frishman WH, Del Vecchio A, Sanal S, Ismail A. Cardiovascular manifestations of substance abuse part 1: cocaine. HEART DISEASE (HAGERSTOWN, MD.) 2003; 5:187-201. [PMID: 12783633 DOI: 10.1097/01.hdx.0000074519.43281.fa] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Substance abuse with cocaine is associated with multiple cardiovascular conditions, including myocardial infarction, dissection, left ventricular hypertrophy, arrhythmias, sudden death, and cardiomyopathy. Cocaine has effects to potentiate the physiologic actions of catecholamines and has direct effects on voltage-dependent sodium ion channels related to local anesthetic properties. The effects of cocaine can be augmented with concomitant alcohol consumption. Acute myocardial ischemia caused by cocaine may be related to in situ thromboisis and/or coronary vasospasm. Treatment strategies for cocaine-induced myocardial infarction would include antiplatelet therapy, thrombolysis, and vasodilators (eg, nitrates, nifedipine). Beta-adrenergic blockers should not be used unless concomitant vasodilator therapy is given.
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Affiliation(s)
- William H Frishman
- Departments of Medicine, The New York Medical College/Westchester Medical Center, Valhalla, NY 10595, USA
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Jones C, Parsonage M. Cocaine related chest pain: are we seeing the tip of an iceberg? ACCIDENT AND EMERGENCY NURSING 2002; 10:121-6. [PMID: 12443032 DOI: 10.1054/aaen.2002.0363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/19/2023]
Abstract
The recreational use of cocaine is on the increase. The emergency nurse ought to be familiar with some of the cardiovascular consequences of cocaine use. In particular, the tendency of cocaine to produce chest pain ought to be in the mind of the emergency nurse when faced with a young victim of chest pain who is otherwise at low risk. The mechanism of chest pain related to cocaine use is discussed and treatment dilemmas are discussed. Finally, moral issues relating to the testing of potential cocaine users will be addressed.
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Blackman BT. Cocaine use and acute coronary syndromes. Lancet 2001; 358:1367; author reply 1367-8. [PMID: 11684244 DOI: 10.1016/s0140-6736(01)06427-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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