Cocaine hydrochloride remains useful primarily because of the vasoconstriction it provides with topical use. Toxicity prohibits its use for other than topical anesthesia.

Cocaine has a rapid onset of action (1 minute) and a duration of up to 2 hours, depending on the dose or concentration. Lower concentrations are used for the eye, while the higher ones are used on the nasal and pha-

ryngeal mucosa. Epinephrine plus cocaine, although still used occasionally, is hazardous because the cate-cholamine potentiates the cardiovascular toxicity (e.g., arrhythmia, ventricular fibrillation) of cocaine.

Cardiovascular effects are related to both central and peripheral sympathetic stimulation. Initial brady-cardia appears to be related to vagal stimulation; this is followed by tachycardia and hypertension. Larger doses are directly depressant to the myocardium, and death results from cardiac failure.

Cocaine is readily absorbed from mucous membranes, so the potential for systemic toxicity is great. The CNS is stimulated, and euphoria and cortical stimulation (e.g., restlessness, excitement) frequently result. Overdosage leads to convulsions followed by CNS depression. The cortical stimulation it produces is responsible for the drug's abuse (see Chapter 35).

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