Cocaina
La cocaina si ricava dalle foglie di un arbusto sudamericano la coca. I conquistatori europei osservavano gli indigeni mangiare tali foglie per ridurre i sintomi della fatica durante i lavori pesanti ed inoltre le cospargevano sulle ferite. Freud la sperimentò ampiamente sui suoi pazienti (affermava che rafforzava lo spirito umano debole) e il suo collega oculista Koller ne scoprì le proprietà anestetiche locali.
ASPETTI FARMACOCINETICI
La durata d’azione della cocaina è di circa 30′, molto meno delle anfetamine. L’assorbimento è in genere rapido per ogni via di somministrazione. La somministrazione e.v. (endovenosa) produce un’ euforia intensa ed immediata, mentre l’inalazione nasale produce sensazioni meno forti e tende a causare atrofia e necrosi della mucosa nasale e del setto. Se fumata, l’effetto è intenso e rapido simile alla somministrazione e.v.
MECCANISMO D’AZIONE
La cocaina agisce inibendo la captazione delle catecolamine (noradrenalina e specialmente la dopamina) dalle terminazioni nervose. Gli effetti comportamentali della cocaina sono molto simili a quelli dell’ anfetamina, sebbene gli effetti simil-psicotici siano più rari. In caso di dosaggi eccessivi può subentrare un vero e proprio stato paranoico simil-schizofrenico: le allucinazioni sono molto particolari, ad esempio la sensazione che la pelle venga invasa dagli insetti e nel tentativo di liberarsene si possono provocare caratteristiche escoriazioni. In linea di massima la cocaina determina:
- eccitazione ed euforia;
- riduce la sensazione di fatica e della fame;
- aumenta l’attività motoria;
In periferia l’azione simpaticomimetica si traduce in:Â
- tachicardia;
- vasocostrizione importante anche a livello coronarico;
- aumento della pressione arteriosa.
Questa è una componente molto pericolosa della cocaina e rende il soggetto a rischio di infarto, aritmie, dissezione aortica, ictus ed emorragia.
RISCHI IN ACUTO
Overdose: con dosaggi eccessivi si può avere depressione vasomotoria e respiratoria. La morte per overdose viene rapidamente: le vittime giungono all’ exitus entro pochi minuti per aritmia, paralisi respiratoria o crisi convulsive. Il miglior trattamento è la somministrazione endovenosa di diazepam, Ca antagonisti e propanololo.
Postumi dell’utilizzo: l’uso protratto porta ad uno stato di esaurimento fisico totale, al quale contribuisce la mancanza di sonno e di cibo.
Rischi dovuti all’uso cronico: scompenso cardiaco cronico.
La cocaina usata durante la gravidanza compromette lo sviluppo fetale e può determinare malformazioni nel feto. In particolar modo le dimensioni del cervello sono significativamente ridotte.
Dipendenza: analogamente alle anfetamine la cocaina non possiede una chiara sindrome da dipendenza fisica ma la dipendenza psicologica è marcata. Il soggetto aumenta in maniera scalare la dose e il quadro di dipendenza evolve da uso occasionale a frenesia compulsiva ed è identico a quello osservato per le anfetamine. Il paziente può arrivare a consumare anche 4 grammi di cocaina in un giorno.
Controlli: un metabolita della cocaina si deposita nei capelli e l’analisi del suo contenuto, distribuito lungo la lunghezza del capello permette di monitorare il quadro temporale del consumo di cocaina.
Usi clinici: saltuariamente la cocaina viene usata come anestetico locale topico, soprattutto in oftalmologia ed interventi chirurgici minori del naso e della gola.
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