Chapter 34: Substance Use Disorders III

Question 1

cig smoking

Answer 1

Cigarette smoking remains the greatest single cause of preventable illness and premature death​

In the United States, smoking kills more than 443,000 adults each year; this is about 1 of every 5 deaths

Question 2

nicotine MOA

Answer 2

Effects of nicotine result from actions at nicotinic receptors​
Can activate nicotinic receptors found in the autonomic ganglia, the adrenal medulla, the carotid body, the aortic arch, and the central nervous system​

Actions in the central nervous system mimic those of cocaine and other highly addictive substances

90-99% if nicotine from inhaled cigs get to brain in 10s

most of cigar smoke is absorbed in the mouth

half life of 2 hr

Question 3

nicotine pharm effects CV

Answer 3

Constricts blood vessels, accelerates the heart, and increases the force of ventricular contraction ​

Net result is elevation of blood pressure and increased cardiac work

Question 4

nicotine pharm effects GI

Answer 4

Increases secretion of gastric acid​

Augments tone and motility of gastrointestinal smooth muscle​

Can promote vomiting

Question 5

nicotine pharm effects CNS

Answer 5

Stimulates respiration and produces an arousal pattern on an electroencephalograph​

Moderate doses can cause tremors; high doses can cause convulsions​

Psychological effect

Question 6

nicotine pharm effects preg and lactation

Answer 6

Exposure during gestation can harm fetus​

Nicotine in breast milk can harm nursing infant​

Pharmaceutical nicotine is safer than tobacco smoke​

Reasonable to consider using nicotine therapy during pregnancy to help a patient quit smoking​

Question 7

nicotine and smoking

Answer 7

Tolerance​

Dependence​

Acute poisoning​
Treatment: Reducing nicotine absorption and supporting respiration​
Activated charcoal​
Ventilatory assistance​

Chronic toxicity from smoking

Question 8

smoking cessation: nicotine replacement therapy

Answer 8

hewing gum [Nicorette]​

Lozenges [Commit, Thrive C]​

Transdermal patches [NicoDerm C, NicoDerm CQ, Nicotrol]​

Nasal spray [Nicotrol NS]​

Inhaler [Nicotrol Inhaler, Nicorette Inhaler C]​

41% of Americans try to stop smokin without formal help -4-7% success rate ​

Counseling and meds -24% success ​

If individual quits for a year, 15% chance they’ll smoke again​

Quits for 5 years, 3% chance of relapse

Question 9

smoking cessation other non-nicotine drug tx

Answer 9

Bupropion [Zyban]​

Varenicline [Chantix]

No not have nicotine ​

Most are successes

Question 10

“5 A’s” Model for Treating ​
Tobacco Use and Dependence

Answer 10

Ask (screen all patients for tobacco use)​

Advise tobacco users to quit​

Assess willingness to make a quit attempt​

Assist with quitting (offer medication and provide or refer to counseling)​

Arrange follow-up contacts, beginning within the first week after the quit date​

Question 11

nicotine chewing gum

Answer 11

Doubles the cessation success rate​

Adverse effects: Mouth and throat soreness, jaw muscle ache, eructation (belching), and hiccups ​

Chew the gum slowly and intermittently for about 30 minutes​

Avoid eating or drinking while chewing and for 15 minutes before chewing

After 3mon without cig dc

Withdrawal gradually ​

Shouldn’t be using longer than 5 mon​

Initial dosing is base on number of cigs smoked

Question 12

nicotine lozenges

Answer 12

Doubles the cessation success rate​

Adverse effects: Mouth irritation, dyspepsia, nausea, and hiccups​

Allow lozenge to dissolve in mouth over 20 to 30 minutes​

No eating or drinking for 15 minutes before dosing and while the lozenge is in the mouth​

Do not chew or swallow the lozenge

Initial dosing based on cigs per day and how soon they smoke after waking ​

Dc slowly over 12 weeks then stop

Question 13

NicoDerm CQ and Nicotrol

Answer 13

Doubles the cessation success rate​

Adverse effects: Short-lived erythema, itching, and burning occur under the patch​

Applied once a day to clean, dry, nonhairy skin of the upper body or upper arm​

Application site should be changed daily and not reused for at least 1 week

Question 14

nicotine inhaler

Answer 14

Doubles the cessation success rate​

Adverse effects: Dyspepsia, coughing, throat irritation, oral burning, and rhinitis​

Frequent puffing over 20 minutes​

Should not be used by patients with asthma

1-2 per hour ​

No more than 40 doses per day​

Decreased after 4-6 weeks

Question 15

Nicotine Nasal Spray

Answer 15

Doubles the cessation success rate​

Adverse effects: Rhinitis, sneezing, coughing, watering eyes, and nasal and throat irritation​

Nicotine levels rise rapidly​

Spray provides some of the subjective pleasure associated with cigarettes

Dosing 6-12 cart daily then after 3 months taper to complete cessation over an additional 2-3 mon​

Question 16

Bupropion SR [Zyban, Buproban]

Answer 16

Atypical antidepressant​

Reduces the urge to smoke and some symptoms of nicotine withdrawal, such as irritability and anxiety​

Adverse effects: Dry mouth and insomnia

Begin 8-35 days before trying to quit smoking ​

Dc after 12 weeks

Question 17

Varenicline [Chantix, Champix]

Answer 17

Partial agonist at nicotinic receptors​

Most effective aid for smoking cessation​

Atypical antidepressant​

Adverse effects: Nausea, sleep disturbances, headaches, abnormal dreams, constipation, dry mouth, flatulence, vomiting, and altered sense of taste ​

Serious neuropsychiatric effects​

Cardiovascular events ​

U.S. authorities have banned the use of varenicline by truck drivers, bus drivers, airplane pilots, and air traffic controllers

Being 1-2 wk before smoking cessation and dc after 7-12 wek

Question 18

products not reocommended

Answer 18

Naltrexone​

Silver acetate​

Beta blockers​

Benzodiazepines​

Antidepressants other than bupropion SR and nortriptyline​

Electronic cigarettes (e-cigarettes)