cocaine forensic medicine and toxicology

cocaine Cocaine is a tropane alkaloid obtained from leaves of the South American shrub Erythroxylon coca. It has a role as a local anaesthetic, a central nervous system stimulant, a sodium channel blocker, an adrenergic uptake inhibitor, a dopamine uptake inhibitor, a serotonin uptake inhibitor, a sympathomimetic agent, a vasoconstrictor agent, a xenobiotic, an environmental contaminant, a plant metabolite and a mouse metabolite. It is a methyl ester, a benzoate ester, a tertiary amino compound and a tropane alkaloid. It is a conjugate base of a cocaine(1+).
ChEBI
An alkaloid ester extracted from the leaves of plants including coca. It is a local anesthetic and vasoconstrictor and is clinically used for that purpose, particularly in the eye, ear, nose, and throat. It also has powerful central nervous system effects similar to the amphetamines and is a drug of abuse. Cocaine, like amphetamines, acts by multiple mechanisms on brain catecholaminergic neurons; the mechanism of its reinforcing effects is thought to involve inhibition of dopamine uptake.
DrugBank
Cocaine is a benzoid acid ester that that was originally used as a local anesthetic, but is no longer used because of its potent addictive qualities. When given in high doses systemically, cocaine has mood elevating effects that have led to its widescale abuse. High doses of cocaine can be associated with toxic reactions including hyperthermia, rhabdomyolysis, shock and acute liver injury which can be severe and even fatal. Cocaine is a tropane alkaloid obtained from leaves of the South American shrub Erythroxylon coca. It has a role as a local anaesthetic, a central nervous system stimulant, a sodium channel blocker, an adrenergic uptake inhibitor, a dopamine uptake inhibitor, a serotonin uptake inhibitor, a sympathomimetic agent, a vasoconstrictor agent, a xenobiotic, an environmental contaminant, a plant metabolite and a mouse metabolite. It is a methyl ester, a benzoate ester, a tertiary amino compound and a tropane alkaloid. It is a conjugate base of a cocaine(1+).
ChEBI
An alkaloid ester extracted from the leaves of plants including coca. It is a local anesthetic and vasoconstrictor and is clinically used for that purpose, particularly in the eye, ear, nose, and throat. It also has powerful central nervous system effects similar to the amphetamines and is a drug of abuse. Cocaine, like amphetamines, acts by multiple mechanisms on brain catecholaminergic neurons; the mechanism of its reinforcing effects is thought to involve inhibition of dopamine uptake.
DrugBank
Cocaine is a benzoid acid ester that that was originally used as a local anesthetic, but is no longer used because of its potent addictive qualities. When given in high doses systemically, cocaine has mood elevating effects that have led to its widescale abuse. High doses of cocaine can be associated with toxic reactions including hyperthermia, rhabdomyolysis, shock and acute liver injury which can be severe and even fatal. coca

1. COCAINE
Roll no-56 to 60

2. Introduction
◦Cocaine is a colourless, odourless, crystalline substance with bitter taste
◦Street names ~ coke , crack , Charlie , snow , white lady
◦It is slightly soluble in water , but freely soluble in alcohol
◦It is obtained from the dried leaves of ‘Erythroxylumcoca’

3. Action
◦Cocaine produces a hyperadrenergicstate
◦It inhibits reuptakeof noradrenaline, dopamine, serotonin from synaptic cleft which
results in increased sympathomimetic activities
◦It is also a local anaesthetic as it blocks initiation and conduction of nerve impulse

4. Absorption & Excretion
◦Cocaine is rapidly absorbed from mucous membrane and subcutaneous tissue.
◦30 to 35% to cocaine is metabolised by hepatic esterasesand plasma
pseudocholinesterase.
◦Only 1-5% of cocaine is excreted unaltered through the kidney within 6 hours of
use.

5. Routes of administration
◦Chewing
◦Application to nasal mucous membrane/ Snorting
◦Smoking (free basing)
◦IV

6. Signs & Symptoms
◦It elevates the pulse, Blood pressure , respiration and temperature
◦Stages of Depression
CNS Coma , pupils fixed and dilated, areflexia,
flaccid paralysis
CVS Ventricular dysrhythmias results in weak ,rapid
and irregular pulse and hypotension
RS Cheyne-Stokesrespiration, apnea , pulmonary
edema

7. ◦Stages of excitement
local feeling of numbness or tingling
Face flushed
Skin pale
GIT Bitter taste, dryness of mouth
Temperature hyperthermia
RS Tachypnea, dyspnea
CVS Tachycardia, HTN

8. ◦Cause of death-respiratory failure, cerebral haemorrhage, cardiac failure, convulsions etc
◦Fatal dose –cocaine (20mg IV) or (500mg to 1.2g orally)
◦Fatal period-few minutes to 1-2 hours
◦Differential diagnosis-lithium toxicity, malignant syndrome, thyroid storm, cycle
antidepressants toxicity etc
◦Diagnosis -qualitative toxicological analysis of blood and urine.