Prevatence of cocaine use in ED patients with severe hypertension
ABSTRACT We prospectively evaluated the prevalence of cocaine use in emergency department patients with elevated diastolic blood pressure greater than 120 mm Hg.
Urine was collected on adult patients with diastolic blood pressure greater than 120 mm Hg. The Institutional Review Board granted a waiver of informed consent based on complete deidentification of the data to prevent selection bias. Spontaneously voided urine specimens were analyzed for the presence of the benzoylecgonine.
Of 107 eligible patients with a diastolic blood pressure equal to or greater than 120 mm Hg, 99 were tested. Of the 99, 13 (13%) tested positive, and of which, 6 (46%) presented with a request for medication refill. Five patients (39%) had cardiovascular and/or pulmonary complaints.
Emergency department patients with hypertension who have recently used cocaine may be difficult to differentiate from those who have not. Consideration should be given to the potential for cocaine use when making treatment decisions in patients with hypertension.
SourceAvailable from: Gianfranco Cervellin[Show abstract] [Hide abstract]
ABSTRACT: Cocaine, a crystalline tropane alkaloid which is obtained from the leaves of the coca plant, acts a powerfully addictive stimulant that directly targets the central nervous system. The effects of the drug appear almost immediately after a single dose (intravenous, intranasal, or inhaled), and disappear within a few minutes or hours. Although the free commercialization of the drug is illicit and severely penalized in virtually all countries, its use remains widespread in many social, cultural, and personal settings. There is a variety of well-recognized side effects of cocaine abuse, which involve virtually every organ system. There is also emerging evidence, however, that cocaine abuse might trigger a variety of cardiac disorders, ranging from arrhythmias to acute myocardial infarction (AMI), heart failure and even sudden cardiac death, especially in relatively young male patients (e.g., those in the mid-1930s), in those who concomitantly use tobacco and alcohol, in those having experienced a trauma or a car accident and lack traditional risk factors for atherosclerosis. Since the use of cocaine may influence the treatment strategies of patients being evaluated for possible acute coronary syndrome (ACS) as well as the prognosis of an AMI, it might be advisable to introduce cocaine screening in patients admitted with chest pain at the emergence department, especially in high-risk patients (i.e., young males with concurrent use of tobacco or alcohol, suffering from a recent accident and with no traditional atherosclerotic risk factors), or in those who are unresponsive and unreliable. This strategy might be helpful to adopt the best therapeutic approach for reducing the risks associated with cardiovascular disease in these patients, and also to deter relapse.Advances in clinical chemistry 01/2010; 51:53-70. · 4.30 Impact Factor
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ABSTRACT: The benzene and triisopropylbenzene sorption capacity and rates of adsorption for several samples of MCM-41 and MCM-48 were compared. The results indicate that for samples with similar pore diameters, MCM-41 has approximately 30% more total capacity for the two hydrocarbons than MCM-48. Pore sizes estimated from the benzene capacity measurements agree well with those calculated from argon adsorption. Estimates made from benzene capacity measurements indicate that for the MCM-41, samples the thickness of the pore walls is approximately 8 and is independent of pore diameter; the pore wall thickness of the MCM-48 sample is estimated to be slightly larger, approximately 10. Sorption rates for all samples were found to be indicative of macropore diffusion limitations rather than mesopore diffusion, hence, no conclusions can be drawn concerning the relative rates of diffusion of benzene through the mesoporous channels characteristic of these samples.
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ABSTRACT: Over the past decade, the prevalence of hypertension (HTN) in the United States has escalated, and today's acute care advance practice nurses (APNs) are likely to encounter more patients experiencing a hypertensive crisis. In this article, we highlight the rising prevalence and financial burden of HTN. Causes of hypertensive crisis, the clinical differences between HTN emergency and HTN urgency, and current recommendations for crisis management are discussed. Managing primary HTN is critical to preventing the development of hypertensive crisis.The Journal for Nurse Practitioners 05/2010; DOI:10.1016/j.nurpra.2010.02.024