Increased alertness and decreased fatigue may lead to feelings of euphoria. The individual may become hyperactive, restless, and talkative. They may develop insomnia and increased motor activity, such as tremors.
Cocaine use may create subjective feelings of great mental ability and muscular power. The individual may develop delusions and experience paranoid ideations related to excessive CNS stimulation.
Cocaine may overstimulate the sympathetic and parasympathetic nervous systems and activate the muscles to initiate the fight-or-flight response. Mydriasis, or pupil dilation, is a manifestation of this response related to cocaine abuse.
Chronic use of cocaine overstimulates the CNS and may result in auditory or visual hallucinations. Cocaine-induced psychoses include paranoid delusions of constantly being followed and watched.
Excessive CNS stimulation caused by cocaine abuse causes the individual to become easily agitated and demonstrate impaired judgment.
Since cocaine increases the myocardial oxygen demand, the individual abusing cocaine may develop tachycardia as the body attempts to supply enough oxygen to the heart. Severe vasoconstriction may occur and cause hypertension as the blood tries to flow through the constricted blood vessels.
Cocaine may induce chest angina and cardiac arrhythmias such as ventricular fibrillation. Since cardiac arrhythmias disrupt the flow of oxygen-rich blood to the heart and the body, cocaine overdose may lead to sudden cardiac death.
Compared with other amphetamines, chronic use of cocaine leads to hyperthermia/hyperpyrexia, or extreme elevation of body temperature exceeding 106°F. The body's temperature regulation mechanism sets the body temperature above normal. As a result, the body generates heat to achieve this temperature, and diaphoresis commonly occurs.
The individual abusing cocaine may experience seizure activity related to increased body temperature. Although most seizures associated with cocaine abuse are self-limiting, they may lead to complications such as myocardial infarction and intracranial hemorrhage.
Snorting is a common mode of ingesting cocaine. Chronic cocaine-snorting disrupts the nasal mucous membranes and causes nasal rhinitis. Individuals consistently snorting cocaine may develop pulmonary hemorrhage, nasal septum ulceration and perforation, and loss of the sense of smell.
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