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27 Cards in this Set
- Front
- Back
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What type of drug is nicotine?
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Highly addictive psychoactive drug
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What three methods have the strongest evidence of effect for smoking cessation?
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1. Advise to quit/avoid second-hand smoke
2. OFFER NICOTINE REPLACEMENT THERAPY and/or NON-NICOTINE MEDICATIONS 3. Recommending a smoking cessation program |
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What is the leading cause of preventable death in the US today?
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Smoking
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Do cigarettes or non-cigarette products show more sustained levels of nicotine?
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Non-cigarette
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What is responsible for triggering the physiological changes in the brain associated with addiction?
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The rapid increase in nicotine in the brain
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What does the speed of decline in nicotine dictate?
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Time of onset and severity of nicotine withdrawal symptoms
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Where are the nicotine acetylcholine receptor subtypes that we focused on located? What were the names?
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Ventral tegmental area
alpha-7, alpha-4, beta-2 |
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Describe the acute stage of nicotine exposure.
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Activation of GABA
Rewarding effects though GABA-dependent system that projects into the TPP (alpha-7 subunit) Also, direct action on nAChRs with beta-2 subunit on GABA or DOPAMINE neurons. |
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Describe the chronic stage of nicotine exposure.
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GABA becomes desensitized.
Leads to net shift in action of nicotine to DA neurons. Mediated by increase in glutamatergic input to the DA system. Responsible to aversive nicotine craving/withdrawal and sensitized incentive salience signal to nucleus accumbens. |
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What three processes do addictive drugs work through to modulate drug levels?
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Ion channel modulation
G-protein coupled receptors Amine transporter process |
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What do all addictive drugs significantly increase?
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Dopamine concentration in target structures of the mesolimbic projection.
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What is nicotine more addictive than?
Less addictive than? On par with? |
Alcohol or benzodiazepines
Amphetamine or cocaine Opiates |
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What is the most effect single drug for smoking cessation?
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VARENICLINE (Chantix)
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What is its mechanism?
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Partial agonist of a-4,b-2 nicotinic receptor
Blocks effect of additional nicotine challenge while causing release of mesolimbic dopamine |
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What is a serious side effect of non-nicotine replacement therapy?
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Psychiatric (from nicotine withdrawal and from drug induced action)
SUICIDE Common adverse effect is nausea |
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What drug is better than nicotine replacement but less effective than varenicline?
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BUPROPION (Wellbutrin SR)
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What is its mechanism?
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Nori and dopa re-uptake inhibitor
Decreases cravings and withdrawal symptoms May reduce depressive symptoms of withdrawal |
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What is an oral antihypertensive drug used for smoking cessation?
What does it do? What patients should take it? |
CLONIDINE (catapres) --oral or patch
Blocks cravings, anxiety, restlessness, tension, and hunger Agitated ex-smokers (has a sedative effect) Some side effects = sedation, dry mouth, dizziness |
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Which drug is a nicotine antagonist (ganglionic blocker)?
What patients should not take it? What are some common AEs? What is it best used in combination with? |
MECAMYLAMINE (Inversine)
Coronary or renal problems, glaucoma, uremia patients Orthostatic hypotension, sedation, N/V, dry mouth In combination with nicotine replacement therapy |
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Which drug is an opiate antagonist?
What else is it used to treat for? What does recent research say? |
NALTREXONE (ReVia)
Alcoholism Not effective for smoking cessation |
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What is the goal of nicotine therapy?
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To produced a sustained plasma nicotine level that can be tapered off gradually (avoid symptoms of withdrawal)
Slower accumulation to peak levels to avoid dopamine release. |
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What produces the most constant nicotine blood level?
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The patch
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Who should not take patches?
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*Stimulates both branches of autonomic nervous system
CV disease, diabetics, hepatic problems, peptic ulcers, pheochromocytoma, and uncontrolled hyperthyroidism DO NOT SMOKE WHILE ON PATCH! |
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What is a problem with nicotine gum?
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Patients may transfer addiction from cigarettes to gum.
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Which NRTs are the best?
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Spray > inhaler (less data), then patch > gum (much more data)
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What are the potential harms of quitting smoking?
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Withdrawal symptoms, depression, changes in metabolism can affect PKs of certain psychiatric drugs.
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If patient refuses to quit smoking (give up nicotine), what is an option?
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Oral nicotine replacement therapy (not the best choice, but better than smoking cigarettes).
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