Cocaine Abuse Cocaine is a CNS stimulant which facilitates peripheral and CNS catecholamine neurotransmission by reuptake inhibition.
Cocaine also activates the mesocortical and mesolimbic dopaminergic pathways.
Dopaminergic pathways are implicated in the reward mechanism as well as in the production of psychotic symptoms. Regular cocaine with its attendant repeated periods of brief CNS stimulation results in lasting changes in brain excitability - a phenomenon known as cortical kindling. Clinical correlate of cortical kindling is reverse tolerance - less drug is needed to produce a particular effect on the brain. Because cocaine use produces a sympathomimetic state via facilitation of peripheral and CNS bioamine neurotransmission, medical complications of cocaine use affect catecholamine sensitive tissues. Vasospasm-mediated cardiac arrhythmias and MI's, hypertension, strokes, and seizures result from direct effect of cocaine on vessels and nerve tissues.