A 21-year-old man is brought to the emergency room after suffering a seizure. He is tachycardic and hypertensive and has a temperature of 38.6°C. Physical examination shows that the patient is in a postictal state and has a nasal septum perforation. Electrocardiogram (ECG) findings suggest acute MI. Friends of the patient report recent cocaine use. Which of the following drugs is indicated?
A) Elumazenil
B) Diazepam
C) Dexfenfluramine
D) Propranolol
E) Phenytoin
Answer and Discussion
The answer is B (Diazepam).
Cocaine is a strong narcotic stimulant that is often abused. Its mechanism of action involves the increased release of norepinephrine and the blockage of its reuptake. Effects of cocaine begin
within 3 to 5 minutes (within 8 to 10 seconds with smoking “crack”cocaine), and peak effects occur at 10 to 20 minutes. The effects rarely last more than 1 hour. Cocaine toxicity is characterized by seizures; hyperpyrexia; tachycardia; mental status changes, including paranoid behavior; hypertension; cerebrovascular accidents; MIs; and rhabdomyolysis. Nasal septum perforation may also occur in most cases,
Treatment involves the use of diazepam for aggitation, hypertension, and tachycardia. Nitroprusside or CCBs can be used for hypertensive crisis. β-Blockers should be avoided given the risk of coronary vasoconstriction and paradoxical hypertension. Other complications, such as cerebrovascular accidents, rhabdomyolysis, and MIs, should be managed in a conventional manner. Fortunately, cocaine has a short half-life and symptoms are usually self-limited. Individuals who use cocaine may become rapidly addicted.
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