Cocaine is a topic covered in the Washington Manual of Medical Therapeutics.

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General Principles

  • Cocaine exerts its effects by inhibiting the reuptake of norepinephrine, serotonin, epinephrine, and dopamine. Excess adrenergic tone in the setting of toxicity is reflected by the development of hypertension and tachycardia. Drug-seeking behavior is likely modulated by dopaminergic effects in the ventral tegmental area of the brain.
  • Cocaine has also been implicated in the development of early cardiovascular disease,1 likely due to a combination of vasospastic,2 prothrombotic,3 and atherogenic effects.4

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