Pediatric Cocaine Abuse Medication

Updated: Apr 14, 2016
  • Author: Anthony J Weekes, MD, RDMS, RDCS; Chief Editor: Caroly Pataki, MD  more...
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Medication

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.

Diazepam (Valium, Diazemuls, Diastat rectal gel)

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

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).

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.

Nitroprusside (Nitropress)

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

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.

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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