Nicotine Dependence

Question 1

What is the typical history associated with nicotine dependence?

Answer 1

• History of regular tobacco use (e.g., cigarettes, cigars, smokeless tobacco)
• Difficulty quitting despite multiple attempts
• Experience of withdrawal symptoms (e.g., irritability, anxiety, craving) when not using

Question 2

What are the key physical examination findings in nicotine dependence?

Answer 2

• Signs of tobacco use: yellowed fingers, stained teeth
• Possible chronic cough or other respiratory symptoms
• Increased heart rate and blood pressure

Question 3

What investigations are necessary for diagnosing nicotine dependence?

Answer 3

• Clinical diagnosis based on history
• Fagerström Test for Nicotine Dependence to assess severity
• Consider screening for comorbid conditions (e.g., COPD, cardiovascular disease)

Question 4

What are the non-pharmacological management strategies for nicotine dependence?

Answer 4

• Behavioral therapy and counseling
• Support groups (e.g., Nicotine Anonymous)
• Use of quitlines and mobile health apps for support

Question 5

What are the pharmacological management options for nicotine dependence?

Answer 5

• Nicotine replacement therapy (e.g., patches, gum, lozenges)
• Prescription medications: varenicline (Chantix), bupropion (Zyban)
• Combination therapy often more effective

Question 6

What are the red flags to look for in nicotine dependence patients?

Answer 6

• Persistent tobacco use despite health problems
• Severe withdrawal symptoms
• Development of tobacco-related diseases (e.g., COPD, cancer)

Question 7

When should a patient with nicotine dependence be referred to a specialist?

Answer 7

• Refractory nicotine dependence not responding to initial treatments
• Need for specialized addiction treatment or multidisciplinary approach
• Complex cases with significant comorbidities

Question 8

What is one key piece of pathophysiology related to nicotine dependence?

Answer 8

• Nicotine activates the mesolimbic dopamine system in the brain
• Leads to release of dopamine and reinforcement of addictive behaviors
• Chronic use results in tolerance, dependence, and withdrawal symptoms