Pediatric Cocaine Abuse Medication

  • Author: Anthony J Weekes, MD, RDMS, RDCS; Chief Editor: Caroly Pataki, MD   more...
 
Updated: Dec 6, 2011
 

Medication Summary

Sedative-hypnotics are used to treat seizures or anxiety in agitated patients. Antihypertensive agents may be required for hypertensive emergencies.

Cardiac resuscitation in cocaine-provoked ventricular fibrillation (VF) or unstable ventricular tachycardia (VT) may be required (see Ventricular Fibrillation). Use antiarrhythmic agents after preliminary defibrillation attempts fail. Follow current ACLS guidelines.

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Sedative-hypnotics

Class Summary

Increase release of gamma-aminobutyric acid (GABA), the main inhibitory neurotransmitter of the CNS. This category, which includes benzodiazepines and barbiturates, is useful for an agitated patient (eg, seizure control, anxiolytic, sedating). Use of these drugs is an important part of attenuating cocaine-induced chest pain, especially in patients with tachycardia and agitation.

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Diazepam (Valium, Diazemuls, Diastat rectal gel)

 

Depresses all levels of CNS (eg, limbic and reticular formation), possibly by increasing activity of GABA.

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Lorazepam (Ativan)

 

Sedative hypnotic with short onset of effects and relatively long half-life. May depress all levels of CNS, including limbic and reticular formation, by increasing action of GABA (a major inhibitory neurotransmitter in the brain).

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Phenobarbital (Luminal)

 

IV dose may require about 15 min to attain peak levels in the brain. If injected continuously until convulsions stop, brain concentrations may continue to rise and can exceed amount required to control seizures. Important to use minimal amount required and to wait for anticonvulsant effect to develop before administering a second dose.

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Antihypertensive agents

Class Summary

These agents are used to treat hypertensive emergencies.

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Nitroprusside (Nitropress)

 

Produces vasodilation and increases inotropic activity of the heart. At higher dosages, may exacerbate myocardial ischemia by increasing heart rate.

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Nitroglycerin (Nitro-Bid IV, Tridil)

 

Treats hypertension. DOC in coronary artery disease and/or vasospasm-related chest discomfort. Causes relaxation of vascular smooth muscle by stimulating intracellular cyclic guanosine monophosphate production.

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Phentolamine (Regitine)

 

Alpha1- and alpha2-adrenergic blocking agent that blocks circulating epinephrine and norepinephrine action, reducing hypertension that results from catecholamine effects on alpha receptors.

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Contributor Information and Disclosures
Author

Anthony J Weekes, MD, RDMS, RDCS  Ultrasound Fellowship Director, Associate Director of Emergency Ultrasound, Department of Emergency Medicine, Carolinas Medical Center

Anthony J Weekes, MD, RDMS, RDCS is a member of the following medical societies: American College of Emergency Physicians and Society for Academic Emergency Medicine

Disclosure: Nothing to disclose.

Coauthor(s)

Douglas S Lee, MD  Attending Physician, Department of Emergency Medicine, Naples Community Hospital

Douglas S Lee, MD is a member of the following medical societies: American Academy of Emergency Medicine

Disclosure: Nothing to disclose.

Specialty Editor Board

Chet Johnson  MD, Center for Child Health and Development, Shiefelbusch Institute for Life Span Studies, University of Kansas; Professor and Chair of Pediatrics, University of Kansas Medical Center

Chet Johnson is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Mary L Windle, PharmD  Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

Carrie Sylvester, MD, MPH  Senior Child and Adolescent Psychiatrist, Sound Mental Health

Carrie Sylvester, MD, MPH is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry

Disclosure: Nothing to disclose.

Chief Editor

Caroly Pataki, MD  Professor of Clinical Psychiatry and Behavioral Sciences, Department of Psychiatry, Division Chair, Child and Adolescent Psychiatry, Keck School of Medicine of the University of Southern California

Caroly Pataki, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, New York Academy of Sciences, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

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