Cocaine dependence

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Cocaine dependence

Psychological disorders

Psychological disorders

Psychological disorders


Cocaine dependence


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USMLE® Step 1 questions

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High Yield Notes

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Cocaine dependence

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USMLE® Step 1 style questions USMLE

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A 29-year-old primigravid woman at 34 weeks gestation comes to the clinic for a routine prenatal examination. She has noticed regular fetal movements and does not have complaints of vaginal bleeding, leaking or abdominal pain. She had an upper respiratory infection and hyperemesis in the first trimester that have since resolved. The patient uses illicit drugs including heroin, cocaine and marijuana. She does not use tobacco. Prior to conceiving, she would consume alcohol with her friends on the weekends. Temperature is 98°F (36.6°C), pulse is 110 bpm, blood pressure is 100/70 mmHg. Ultrasound reveals a biparietal diameter of 32 weeks and abdominal circumference of 28 weeks. Which of the following complications should be anticipated at the time of delivery? 

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Cocaine, sometimes called coke, is a powerful psychoactive stimulant that alters how the brain functions—specifically, how we perceive our surroundings.

Cocaine comes from the leaves of the South American coca plant, and has been used for over a thousand years.

In modern times, it’s become a popular “party drug” because cocaine reduces inhibitions and creates a feeling of euphoria or pleasure; this feeling lasts between fifteen and ninety minutes, depending on how the drug’s it’s administered.

Around 18 million people worldwide use cocaine, and because of its strong potential for addiction and overdose, the drug is heavily regulated in many countries.

To understand how cocaine works, let’s zoom into one of the synapses of the brain.

Normally, electrical signals, or action potentials, travel down the axon to the axon terminal, where they trigger the release of chemical messengers called neurotransmitters from synaptic vesicles into the synapse.

The neurotransmitters travel across the synapse and bind to receptors on the postsynaptic neuron, where they give the cell a message.

After the neurotransmitters have done their job, they unbind from the receptors, and can just diffuse away, get degraded by enzymes, or get picked up by proteins and returned to their release site in a process called reuptake.

Cocaine increases the release of certain neurotransmitters, but it’s biggest effect is blocking reuptake receptors on presynaptic axon terminals.

Both of these actions keep neurotransmitters like dopamine, norepinephrine, and serotonin in the synapse longer, increasing their effects.

For example, increased concentrations of dopamine in the brain’s reward pathway (which includes the nucleus accumbens, ventral tegmentum, and prefrontal cortex) produce intense feelings of euphoria, pleasure, and the emotional “high” associated with cocaine.


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