Question

you are assessing a patient you suspect has overdosed on cocaine. what type of pupils would you suspect to find?

both pupils dilated.
both pupils constricted.
both pupils normal size.
one pupil dilated and one constricted.

Explanation:

Identify the drug class and physiological effects

Using the Toxicological Emergencies knowledge point

Cocaine is a powerful central nervous system stimulant that acts as a sympathomimetic agent. It inhibits the reuptake of norepinephrine, epinephrine, and dopamine, leading to excessive stimulation of the sympathetic nervous system.

Determine pupillary response

Sympathetic stimulation causes contraction of the pupillary dilator muscle (mydriasis). Therefore, a patient experiencing a cocaine overdose will typically present with bilaterally dilated pupils.

Evaluate the given options

• Both pupils dilated: Correct, as sympathomimetics cause bilateral mydriasis.
• Both pupils constricted: Incorrect; this is characteristic of parasympathomimetics or opioids (miosis).
• Both pupils normal size: Incorrect; an overdose state alters normal pupillary response.
• One pupil dilated and one constricted: Incorrect; unequal pupils (anisocoria) typically indicate localized neurological injury rather than systemic drug toxicity.

Answer:

• Both pupils dilated. (Correct answer)
• Both pupils constricted.
• Both pupils normal size.
• One pupil dilated and one constricted.