10-28 L3 Nicotine dependence

Question 1

What is the #1 nicotine-related mortality in US (1990)?

Answer 1

Cardiovascular (180k)
Lung Cancer (120k)
Other causes (31k)
Respiratory disease (84k)

Question 2

Name the 7 criteria seen in nicotine use disorder (dependence)? FIST-WUC

How many do you need to diagnosis as dependence?

Answer 2

• Forgoing activities in order to smoke
• Increase time looking for and using nicotine
• Smoke more than intended
• Tolerance
• Withdrawal
• Unsuccessful attempts at quitting
• Continued use (despite medical problems)

> 3 of the following criteria w/I last 12 months

Question 3

Name the 8 criteria seen in nicotine use disorder (withdraw)? ‘DI-DI-RAID’

How many do you need to diagnosis as withdrawal?

Answer 3

• Dysphoria (increase in mood)
• Insomnia
• Decreased heart rate
• Increased appetite or weight gain
• Restlessness
• Anxiety
• Irritability (no drugs)
• Difficult concentrating

Question 4

What is seen with tobacco withdrawal associated laboratory findings?

Answer 4

• Decrease catecholamine and cortisol levels
• Decrease metabolic rate
• EEG slowing
• Increase in certain serum drug concentration
• Neurophsychological testing impairment
• Changes in (REM) rapid eye movement in sleep

Question 5

Why does nicotine reach the brain quickly?

Answer 5

reaches the brain in ten seconds
due to inhalation
lungs->heart>brain

Question 6

What happens in acute tolerance vs. chronic tolerance?

Answer 6

Acute tolerance: result of activation and desensitization of nicotinic acetylcholine receptors (NAChRs) in CNS

Chronic tolerance: results in NAChRs up-regulation

Question 7

What happens physiologically when Activation of NAChRs occurs? (DeG IN)

Answer 7

decrease GABA tonic inhibition of dopamine release

increase NMDA activity in the mesocorticolimbic system

Question 8

What are the 5 A;s for brief intervention in nicotine users? (As-Ad-As-As-Ar)

Answer 8

• Ask: identify all nicotine users at every visit
• Advise: urge all nicotine users to quit
• Assess: determine willingness to make a quit attempt
• Assist: aid the patient in quitting
• Arrange: schedule a follow-up contact

Repeated use –> double quit rate

Question 9

What are the 5 R’s to motivate nicotine users to quite?

Answer 9

• Relevance: encourage pt. why quitting is relevant
• Risk: id potential neg consequences of nic use
• Rewards: Id potential pos. consequences of nic use
• Roadblocks: id barriers or impediments
• Repetition: this should be done every time you see an unmotivated pt.

Question 10

Name the types of nicotine replacement therapy (5 PIG LN)

Answer 10

• Patch
• Inhaler
• Gum
• Lozenge
• Nasal spray

Question 11

What is a precaution of Pregnancy and cardiovascular disease? (BuNNG NC)

Answer 11

• Buproprion SR
• Nicotine patch
• Nicotine Nasal spray
• Gum
• Nortriptyline
• Clonidine

Question 12

Buproprion SR (treatment of nicotine use disorder)

• when is it used
• contraindications
• side effects

Answer 12

First line pharmacotherapy
Contraindicated in: pts. w/seizure disorder, eating disorder, and MAOI use w/i the past 14 days.
Side effects: Insomina, dry mouth

Question 13

Varenicline tartate (AgoW, AntaR)

Answer 13

Partial agonism: nAChRs occupation –> amelioration of withdrawal symptoms

Partial antagonism: nicotine cannot bind to nAChRs thus blocking nicotine rewarding effects

Question 14

Name the therapies/treatment that ‘double the quit rate’

Answer 14

all NRT double quit rate

• Buproprion
• Nortriptyline
• Clonidine