Pediatric Cocaine Abuse Medication
- Author: Anthony J Weekes, MD, RDMS, RDCS; Chief Editor: Caroly Pataki, MD more...
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.
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.
Depresses all levels of CNS (eg, limbic and reticular formation), possibly by increasing activity of GABA.
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).
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.
These agents are used to treat hypertensive emergencies.
Produces vasodilation and increases inotropic activity of the heart. At higher dosages, may exacerbate myocardial ischemia by increasing heart rate.
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.
Alpha1- and alpha2-adrenergic blocking agent that blocks circulating epinephrine and norepinephrine action, reducing hypertension that results from catecholamine effects on alpha receptors.
Center for Behavioral Health Statistics and Quality. Behavioral Health Trends in the United States: Results from the 2014 National Survey on Drug Use and Health. SAMHSA. Available at http://www.samhsa.gov/data/sites/default/files/NSDUH-FRR1-2014/NSDUH-FRR1-2014.pdf. September 2015; Accessed: December 10, 2015.
NIDA. Cocaine abuse and addiction. National Institute on Drug Abuse: Research Report Series. 1999.
SAMHSA. Overview of Findings from the 2004 National Survey on Drug Use and Health. 2005.
Flórez-Salamanca L, Secades-Villa R, Hasin DS, Cottler L, Wang S, Grant BF, et al. Probability and predictors of transition from abuse to dependence on alcohol, cannabis, and cocaine: results from the National Epidemiologic Survey on Alcohol and Related Conditions. Am J Drug Alcohol Abuse. 2013 May. 39(3):168-79. [Medline]. [Full Text].
Delaney-Black V, Chiodo LM, Hannigan JH, Greenwald MK, Janisse J, Patterson G, et al. Prenatal and postnatal cocaine exposure predict teen cocaine use. Neurotoxicol Teratol. 2011 Jan-Feb. 33(1):110-9. [Medline].
Gerteis J, Chartrand M, Martin B, Cabral HJ, Rose-Jacobs R, Crooks D, et al. Are there effects of intrauterine cocaine exposure on delinquency during early adolescence? A preliminary report. J Dev Behav Pediatr. 2011 Jun. 32(5):393-401. [Medline]. [Full Text].
Boghdadi MS, Henning RJ. Cocaine: pathophysiology and clinical toxicology. Heart Lung. 1997 Nov-Dec. 26(6):466-83; quiz 484-5. [Medline].
Chasnoff IJ, Lewis DE, Griffith DR. Cocaine and pregnancy: clinical and toxicological implications for the neonate. Clin Chem. 1989 Jul. 35(7):1276-8. [Medline].
Chasnoff IJ, Burns WJ, Schnoll SH. Cocaine use in pregnancy. N Engl J Med. 1985 Sep 12. 313(11):666-9. [Medline].
Substance Abuse and Mental Health Services Administration, Center for Behavioral Health Statistics and Quality. The DAWN Report: Highlights of the 2011 Drug Abuse Warning Network (DAWN) Findings on Drug-Related Emergency Department Visits. SAMHSA. Available at http://www.samhsa.gov/data/sites/default/files/DAWN127/DAWN127/sr127-DAWN-highlights.htm. February 22, 2013; Accessed: December 10, 2015.
Kann L, Kinchen S, Shanklin SL, Flint KH, Kawkins J, Harris WA, et al. Youth risk behavior surveillance--United States, 2013. MMWR Surveill Summ. 2014 Jun 13. 63 Suppl 4:1-168. [Medline].
Wu LT, Woody GE, Yang C, Pan JJ, Blazer DG. Racial/Ethnic variations in substance-related disorders among adolescents in the United States. Arch Gen Psychiatry. 2011 Nov. 68(11):1176-85. [Medline].
Johnston, L. D., O’Malley, P. M., Miech, R. A., et al. Monitoring the Future national survey results on drug use: 1975-2014: Overview, key findings on adolescent drug use. monitoringthefuture.org. Available at http://www.monitoringthefuture.org/pubs/monographs/mtf-overview2014.pdf.. 2015; Accessed: December 10, 2015.
Wong SS, Zhou B, Goebert D, Hishinuma ES. The risk of adolescent suicide across patterns of drug use: a nationally representative study of high school students in the United States from 1999 to 2009. Soc Psychiatry Psychiatr Epidemiol. 2013 Oct. 48(10):1611-20. [Medline].
Aleksa K, Walasek P, Fulga N, Kappur B, Gareri J, Koren G. Simultaneous detection of seventeen drugs of abuse and metabolites in hair using solid phase micro extraction (SPME) with GC/MS. Forensic Sci Int. 2011 Oct 31. [Medline].
Warner TD, Behnke M, Eyler FD, Szabo NJ. Early adolescent cocaine use as determined by hair analysis in a prenatal cocaine exposure cohort. Neurotoxicol Teratol. 2011 Jan-Feb. 33(1):88-99. [Medline].
Weekes AJ, Quirke DP. Emergency echocardiography. Emerg Med Clin North Am. 2011 Nov. 29(4):759-87. [Medline].
Lundqvist T. Imaging cognitive deficits in drug abuse. Curr Top Behav Neurosci. 2010. 3:247-75. [Medline].
Cummings JR, Wen H, Druss BG. Racial/Ethnic differences in treatment for substance use disorders among u.s. Adolescents. J Am Acad Child Adolesc Psychiatry. 2011 Dec. 50(12):1265-74. [Medline].
Bracken BK, Rodolico J, Hill KP. Sex, age, and progression of drug use in adolescents admitted for substance use disorder treatment in the northeastern United States: comparison with a national survey. Subst Abus. 2013. 34(3):263-72. [Medline]. [Full Text].
Bukstein O. Practice parameters for the assessment and treatment of children and adolescents with substance use disorders. American Academy of Child and Adolescent Psychiatry. J Am Acad Child Adolesc Psychiatry. 1997 Oct. 36(10 Suppl):140S-56S. [Medline].
Das G, Laddu A. Cocaine: friend or foe? (Part 2). Int J Clin Pharmacol Ther Toxicol. 1993 Oct. 31(10):489-96. [Medline].
Dressler FA, Malekzadeh S, Roberts WC. Quantitative analysis of amounts of coronary arterial narrowing in cocaine addicts. Am J Cardiol. 1990 Feb 1. 65(5):303-8. [Medline].
Green RM, Kelly KM, Gabrielsen T. Multiple intracerebral hemorrhages after smoking "crack" cocaine. Stroke. 1990 Jun. 21(6):957-62. [Medline].
Marzuk PM, Tardiff K, Leon AC. Fatal injuries after cocaine use as a leading cause of death among young adults in New York City. N Engl J Med. 1995 Jun 29. 332(26):1753-7. [Medline].
Miller NS, Brady KT. Addictive disorders. Psychiatr Clin North Am. 2004 Dec. 27(4):[Medline].
Ross SM, Chappel JN. Substance use disorders. Difficulties in diagnoses. Psychiatr Clin North Am. 1998 Dec. 21(4):803-28. [Medline].
Schuler ME, Nair P, Kettinger L. Drug-exposed infants and developmental outcome: effects of a home intervention and ongoing maternal drug use. Arch Pediatr Adolesc Med. 2003 Feb. 157(2):133-8. [Medline].