Review Question - QID 107040

This patient is most likely snorting (nose bleeds) and injecting (covering up track marks with long sleeves in the summer) cocaine. A potential consequence of cocaine abuse is sudden cardiac death.

Cocaine is a recreational drug that blocks the reuptake of dopamine, norepinephrine, and serotonin. The increase in dopamine in the nucleus accumbens is the mechanism of reward pathway activation, and the increase in norepinephrine activates the sympathetic nervous system. Cocaine can be consumed in many ways, including smoking "crack cocaine," snorting, and injecting. Typical physical signs of cocaine use are dilated pupils, nose bleeds, runny nose (snorting), track marks, and burned lips (smoking). Psychiatric signs include overconfidence, euphoria, paranoia, aggressiveness, poor judgment, delusions, and hallucinations.

Bunn and Giannini review the cardiovascular complications that can occur in cocaine abuse. Complications include myocardial infarction, dilated cardiomyopathy, cardiac arrhythmias, and ischemia.

Schwartz et al. review the pathophysiology of the cardiovascular effects of cocaine. Cocaine promotes a hypercoagulable state, which results in platelet activation and intracoronary thrombosis.

Illustration A summarizes the cardiac effects of cocaine abuse.

Incorrect Answers:
Answer 1: Serotonin syndrome is a serious side effect of MDMA (ecstasy).
Answer 3: White matter lesions in the CNS are a side effect of inhaling toluene.
Answer 4: Irreversible schizophrenia-like psychosis is a serious side effect of PCP.
Answer 5: Marijuana use has been associated with an increased risk of schizophrenia in those that are predisposed to it.