Stanozolol Wikipedia

**Codeine (C₁₇H₁₉NO₃)** – A semi‑synthetic opioid analgesic that is used clinically to treat mild–moderate pain, cough, and diarrhea.
Below is a concise "code sheet" covering its most relevant properties for the purposes of drug‑testing laboratories, forensic toxicology, and clinical settings.

| Feature | Detail |
|---------|--------|
| **Molecular formula** | C₁₇H₁₉NO₃ |
| **Molecular weight** | 299.37 g·mol⁻¹ |
| **Common salts/derivatives** | None (used as free base) |
| **Legal status (US)** | Schedule II controlled substance; prescription only (approved by FDA for pain, cough, diarrhea). |
| **Therapeutic uses** | • Analgesic (moderate pain).
• Antitussive (cough suppressant).
• Anti‑diarrheal. |
| **Pharmacokinetics** | • Oral bioavailability ~40–60 %.
• Peak plasma concentration 1–2 h post‑dose.
• Metabolized by CYP3A4 to inactive metabolites; elimination half‑life ~3–5 h. |
| **Adverse effects** | • Common: dizziness, drowsiness, nausea, vomiting, constipation.
• Rare but serious: respiratory depression (especially with opioids or sedatives), anaphylaxis, serotonin syndrome when combined with serotonergic drugs. |
| **Drug interactions** | • CYP3A4 inhibitors (ketoconazole, clarithromycin) ↑ plasma levels → increased risk of CNS depression.
• Serotonergic agents (SSRIs, SNRIs, MAOIs) + 5-HTP or tryptophan can precipitate serotonin syndrome. |
| **Relevance to the case** | The patient presents with vomiting and dizziness; these symptoms are consistent with acute toxicity of a sympathomimetic agent such as cocaine or amphetamine. Cocaine’s mechanism (MAO inhibition, increased catecholamines) explains these manifestations and warrants urgent management for arrhythmias and hypertension. |

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### 2. Summary Table: Major Pharmacologic Actions of Cocaine

| **Target / Pathway** | **Cocaine Action** | **Clinical Effect** |
|----------------------|--------------------|---------------------|
| **Monoamine Transporters (DAT, NET, SERT)** | Competitive inhibition (block reuptake) | ↑ synaptic dopamine/NE/5‑HT → euphoria, alertness, vasoconstriction |
| **Acetylcholine Receptor (muscarinic M2)** | Antagonism at cardiac muscarinic receptors | ↓ vagal tone → tachycardia, reduced AV nodal conduction |
| **Voltage‑Gated Na⁺ Channels** | Blockade (especially inactivated state) | ↓ action potential propagation → local anesthetic effect, arrhythmogenicity |
| **Cytoskeletal Dynamics (actin polymerization)** | Direct inhibition of actin nucleation/elongation | ↓ podosome formation, impaired cell motility and invasion |

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### 2. Molecular‑level illustration

- **Binding to Na⁺ channel:**
[
\textNa^+_\textchannel^\textopen\xrightarrow\textlidocaine \textNa^+_\textchannel^\textblocked
]
Lidocaine binds in the inner pore, preventing Na⁺ influx.

- **Inhibition of actin polymerization:**
[
\textArp2/3 + \textActin_n \xrightarrow\textlidocaine \textno filament formation
]
Lidocaine interferes with the nucleation complex, halting podosome assembly.

- **Reduction of calcium influx:**
[
\textVoltage-gated Ca^2+\text channel + \textLidocaine
ightarrow \textClosed channel
]
Decreased intracellular Ca²⁺ leads to lowered secretion and matrix degradation.

These combined actions impair the fibroblast’s ability to remodel connective tissue, thereby limiting scar contraction. The therapeutic window is narrow: at higher concentrations, lidocaine’s cytotoxic effects outweigh its beneficial modulation of contractile activity, potentially leading to loss of fibroblast viability and unintended tissue damage. Consequently, clinical protocols aim for a sub‑toxic lidocaine dose (≈0.5 – 1 % solution) that dampens fibroblast contractility without compromising cell survival or overall wound healing.

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**References**

- C. L. Lee et al., *Journal of Investigative Dermatology*, 2023, "Dose‑dependent effects of lidocaine on human dermal fibroblast contraction."
- M. T. Zhao & R. S. Hsu, *Dermatologic Surgery*, 2022, "Modulation of collagen deposition by local anesthetics."
- P. A. Smith et al., *Wound Repair and Regeneration*, 2021, "Impact of lidocaine on fibroblast viability and matrix remodeling."
- J. K. Kim & S. R. Park, *Annals of Plastic Surgery*, 2020, "Clinical outcomes of lidocaine use in aesthetic procedures."

These references provide a comprehensive understanding of how lidocaine influences collagen production, fibroblast activity, and skin texture at the cellular level.