Which signs are commonly observed during acute cocaine intoxication?

• A. Hypotension, miosis, and bradycardia
• B. Elevated mood, restlessness, pressured speech; tachycardia and hypertension; dilated pupils
• C. Sedation, hypotension
• D. Euphoria with cool extremities

Answer: (B)

Acute cocaine intoxication produces sympathetic nervous system–driven stimulation, due to blockade of monoamine reuptake (norepinephrine, dopamine, serotonin). This leads to heightened arousal and external signs of arousal: elevated mood or euphoria, restlessness, rapid or pressured speech, along with physical signs like tachycardia, hypertension, and dilated pupils. These are classic indicators of stimulant intoxication, reflecting increased alertness, energy, and aggressive sympathetic activity.

The option describing elevated mood with restlessness and pressured speech, plus tachycardia, hypertension, and dilated pupils best fits this pattern. The other options either describe a depressant picture (sedation with hypotension) or pair mismatched signs (hypotension with miosis and bradycardia, which points away from stimulant use), or include signs not typical of acute cocaine intoxication (such as cool extremities in a context where vasoconstriction and sweating are more common).