Central Sympatholysis as a Novel Countermeasure for Cocaine-Induced Sympathetic Activation and Vasoconstriction in Humans

Menon, Dileep V.; Wang, Zhongyun; Fadel, Paul J.; Arbique, Debbie; Léonard, David; Li, Jia Ling; Victor, Ronald G.; Vongpatanasin, Wanpen

doi:10.1016/j.jacc.2007.03.060

Cited by 51 publications

(42 citation statements)

References 32 publications

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“…Recently, the FDA has approved to examine the use of dexmedetomidine in treating cancer patients at the end of life who are suffering from intractable pain, agitation or delirium [54]. It has significant opioid sparing effect and is useful in intractable neuropathic pain [55].…”

Section: Pain and Palliative Carementioning

confidence: 99%

Dexmedetomidine in Current Anaesthesia Practice- A Review

NAAz

Ozair

2014

JCDR

122

124

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Section: Pain and Palliative Carementioning

confidence: 99%

Dexmedetomidine in Current Anaesthesia Practice- A Review

NAAz

Ozair

2014

JCDR

122

124

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“…Dexmedetomidine, an α-2 agonist with sympatholytic effects, may also provide additional sedative and analgesic benefits. In healthy subjects naïve to cocaine [39], dexmedetomidine prevented increases in heart rate, skin resistance and sympathetic nervous system activity following intranasal cocaine administration. These properties of dexmedetomidine may be advantageous to counteract cocaine's sympathomimetic cardiovascular effects.…”

Section: Premedication and Sedationmentioning

confidence: 91%

“…Patients presenting with a SAH after cocaine use have a 4.2 times risk of a poor Hunt and Hess grade [35] with the higher Hunt and Hess grade independent of cocaine's effect on blood pressure [38]. Patients with cocaine associated SAH have been shown to have worse clinical outcomes than other SAH patients [39]. The knowledge and early recognition of the complications from cocaine use are essential for perioperative management.…”

Section: Doi: 107243/2049-9752-2-12mentioning

confidence: 99%

Perioperative care of the cocaine-dependent neurosurgical patient

Dwarakanath¹,

Cook²,

Fahy³

2013

J Anesthesiol Clin Sci

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Purpose: Cocaine, a commonly abused drug, can cause life-threatening complications, significantly impacting patient management. Cocaine is associated with an increased risk of stroke including subarachnoid hemorrhage (SAH) that may require expectant surgical management. Patients presenting for anesthesia with acute cocaine toxicity pose additional concerns. Clinical Features: A 48 year old woman presented with a seizure, acute cocaine intoxication, and was diagnosed with a SAH. Further diagnostic evaluation revealed a bleeding cerebral aneurysm requiring urgent surgical aneurysm clipping. Her perioperative course was complicated by hypertension requiring treatment to minimize further aneurysm bleeding before clipping. Cocaine-associated cardiac complications impacting management included a non-ST elevation myocardial infarction and severe anteroseptal hypokinesis on echocardiogram. Conclusion: Hemodynamic management with a recent SAH and acute cocaine intoxication required special considerations. Perioperative SAH management initially focused to prevent additional bleeding before clipping and then after clipping to minimize cerebral ischemia. Benzodiazepines were used early in this case to treat seizures and cocaine-associated hemodynamic effects. Specific treatments for life-threatening ventricular arrhythmias are discussed including sodium bicarbonate as a first line treatment and potential benefits of magnesium administration. With prolongation of a QT interval secondary to cocaine and/ or SAH, medications that often are utilized during the perioperative period may further prolong the QT interval and should be avoided.

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“…Usos lícito e ilícito dos fármacos, Acta Med Port 2014 Nov-Dec;27(6):755-766 monoaminas. 45 A redução da transmissão monoaminérgica resulta em numerosos sintomas e desordens psiquiátricas como depressão, ansiedade, insónia, anedonia, impulsividade, sintomas de agressividade e síndrome de abstinên-cia. 46 A nível periférico, a cocaína também atua como um anestésico local, devido à sua capacidade de bloquear canais de sódio dependentes da voltagem em células neuronais, bloqueando assim a propagação do potencial de ação.…”

Section: Cocaínaunclassified

Usos Lícito e Ilícito dos Fármacos

Dinis-Oliveira

2014

Acta Med Port

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Acta Med Port 2014 Nov-Dec;27(6):755-766 RESUMOAs drogas de abuso são um grupo heterogéneo de xenobióticos ou endobióticos que alteram a organização sináptica no sistema nervoso central, de modo transitório ou permanente, conduzindo frequentemente ao consumo da droga de forma compulsiva. O que une os seus membros é o facto de conferirem prazer (hedonismo) a quem consome, nomeadamente por influência no sistema mesolímbico da dopamina. Para exercerem os seus efeitos, as diferentes drogas de abuso vão atuar sobre recetores e transportadores de neurotransmissores, modelando a libertação destes para a fenda sináptica. Além de atuar em neurónios pré-sinápticos, também atuam nos recetores de neurotransmissores e canais iónicos nos neurónios pós-sinápticos, ocorrendo desta forma, uma modificação das vias de sinalização. Nesta revisão é discutido a farmacodinâmica de algumas substâncias psicoativas que são alvo de consumo abusivo em Portugal. Com esta abordagem é também possível uma discussão das drogas de abuso que exibem efeitos toxicológicos tão diversos como estimulantes, depressores e alucinogénios. Nomeadamente é discutido o potencial dos (i.e. depressores do sistema nervoso central, estimulantes, antiparkinsónicos anticolinérgicos, opioides, alucinogénios e dos canabinoides) para desenvolverem adição e dependência, bem como serem alvo de utilizações lícitas e ilícitas. Palavras-chave: Antiparkinsonianos; Depressores do Sistema Nervoso Central; Opioides; Antagonistas Colinérgicos; Analgésicos Opioides; Alucinogénios; Estimulantes do Sistema Nervoso Central. ABSTRACTDrugs of abuse are a heterogeneous group of xenobiotics or endobiotics that alter synaptic organization in the central nervous system in a transient or permanent basis, often leading to a compulsively use. What unites its members is that they confer pleasure (hedonism) to the abusers, namely by their action in the mesolimbic dopamine system. To exert its effects, different drugs of abuse will act on receptors and neurotransmitter transporters, modeling neurotransmitter release into the synaptic cleft. Besides acting on presynaptic neurons also function in neurotransmitter receptors and ion channels in postsynaptic neurons, thereby modifying the signaling pathways. In this work, the pharmacodynamic and the potential of some psychoactive substances that are typically subjected to abuse in Portugal, is reviewed. With this approach it was also possible a discussion of drugs of abuse that exhibit very different toxicological effects such as stimulants, depressants and hallucinogens. Particularly, the potential to induce dependence and addition, as well as to undergo illicit and licit uses, of central nervous system depressants, stimulants, anticholinergic antiparkinson drugs, opioids, cannabinoids and hallucinogens, is discussed. Keywords: Antiparkinson Agents; Central Nervous System Depressants; Cholinergic Antagonists; Analgesics, Opioid; Hallucinogens; Central Nervous System Stimulants. INTRODUÇÃOO abuso de drogas e medicamentos continua a ser um important...

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Central Sympatholysis as a Novel Countermeasure for Cocaine-Induced Sympathetic Activation and Vasoconstriction in Humans

Cited by 51 publications

References 32 publications

Dexmedetomidine in Current Anaesthesia Practice- A Review

Dexmedetomidine in Current Anaesthesia Practice- A Review

Perioperative care of the cocaine-dependent neurosurgical patient

Usos Lícito e Ilícito dos Fármacos

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