Nicotine Flashcards
Why are cigarettes more addictive than chewing tobacco, snuff, and nicotine gum?
Absorption, and thus speed of onset, is much quicker when the drug is delivered via lungs.
What’s nicotine’s MoA?
Nicotinic AchR agonist.
What specific effects does nicotine have on dopamine? How does this relate to its addictiveness?
Increases phasic dopamine signaling (dopamine spikes).
Decreases tonic dopamine signaling.
Result: High contrast in DA signaling between presence and absence of nicotine -> highly addictive.
How well does quitting cold-turkey on one’s own work?
5% success rate (“long-term abstinence”), with increases when educational resources are used.
Do brief interventions, i.e. education and recommendations during routine doctor’s visits, work?
Yeah. Not that dramatic, but they’re easy, and they do help.
4 aspects of a brief intervention?
Negotiate a quit date (usu. 2 weeks from visit).
Help prep for quit date (discuss why last attempt failed, etc.)
Emphasize abstinence is the goal.
Prescribe pharmacotherapy to help.
What is added in intensive counseling?
More CBT-like stuff. Works better, but obviously hard to give to as many people.
3 groups for which efficacy/safety data make us not recommend pharmacotherapy for nicotine addiction?
Those smoking < 10 cigarettes a day.
Pregnant/breastfeeding women.
Adolescent smokers.
3 first-line pharmacotherapies for nicotine dependence?
Nicotine replacement.
Buproprion SR. (an atypical antidepressant)
Varenicline.
Is nicotine replacement better than placebo? By about how much?
About 30-80% better.
What kind of nicotine replacement can one do if one form of nicotine replacement doesn’t work?
Try a different kind, or do combo Tx.
the replacement often isn’t as satisfying as smoking because it doesn’t have as rapid an onset
Can buproprion be used in combination with nicotine replacement?
Yes, and it seems to produce better results.
Varenicline MoA? What are its 2 effects on smoking?
Partial agonist of the alpha 4 beta 2 nicotinic Ach receptor.
As agonist, reduces craving / withdrawal symptoms.
As competitor, reduces positive effects of smoking.
(highly analogous to buprenorphine for opioid dependence)
Which is more effective, buproprion or Varenicline?
Varenicline
What are the serious risks associated with Varenicline?
CV disease, even in patient with no Hx of it.
Suicidality.
(professor opines that benefit of getting people off of smoking far outweighs the small risk of Varenicline)
