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Pharmacology CP > Pharmacology of Smoking > Flashcards

Pharmacology of Smoking Flashcards

1
Q

What are the dangers of cigarette smoking?

A
  • Lung cancer
  • Chronic obstructive pulmonary disease
  • Cardiovascular disease
  • Other cancers
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2
Q

What are the components of cigarette smoke?

A
  • Nicotine (10-20mg per cigarette and addictive)
  • Carcinogens (cancer causing)
  • Particulates (10 micrometers to nanoparticles)
  • Carbon monoxide (6-20x higher levels of carboxyhemoglobin in smokers than non-smokers)
  • Free radicals
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3
Q

What are the different types of nicotinic receptors?

A
  • N1 (ganglionic) receptors
  • N2 (muscle type) receptors
  • CNS type receptors
  • CNS, ANS and NMJ
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4
Q

What are the peripheral effects of activating nicotinic receptors?

A
  • Tachycardia
  • Nausea
  • Reduction of GI motility
  • Sweating
  • Decline with repeated dosage
  • Central effects of nicotine
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5
Q

What does nicotine act on and what does it lead to?

A
  • α-4-β-2 AChR in the CNS
  • Release of neurotransmitters
  • Dopamine, noradrenaline, acetylcholine, serotonin, glutamate, B-endorphin, GABA
  • Effects produced by these Its tend to wear off in habitual smokers
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6
Q

What does the release of dopamine lead to?

A
  • Pleasure and appetite suppression
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7
Q

What does the release of noradrenaline lead to?

A
  • Appetite suppression and arousal
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8
Q

What does the release of acetylcholine lead to?

A
  • Arousal and cognitive
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9
Q

What does the release of serotonin lead to?

A

– Appetite suppression and mood modulation

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10
Q

What does the release of glutamate lead to?

A
  • Memory enhancement and learning
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11
Q

What does the release of β-endorphin and GABA lead to?

A
  • Reduction in anxiety and tension
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12
Q

What is the effect of smoking on nicotinic receptors in the CNS?

A
  • Nicotine in cigarette smoke rapidly taken up by pulmonary circulation
  • Diffuses into CNS within 10-20 seconds
  • Chronic nicotine administration increases number of AChR in CNS and also leads to desensitisation of receptors
  • Reactivation of receptors is thought to be involved in craving and withdrawal
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13
Q

What other cancers can cigarette smoke lead to?

A
  • Bladder, kidney and pancreas
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14
Q

What is COPD?

A
  • Chronic obstructive pulmonary disease
  • Umbrella term for chronic bronchitis, bronchiolitis and emphysema
  • Conditions common in smokers
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15
Q

Describe the relationship between smoking and chronic bronchitis

A
  • Mucus gland hypertrophy and hyperplasia
  • Excess mucus (100-150 ml leads to smoker’s cough)
  • Cilia damaged by oxidants and mucociliary escalator does not work efficient.y
  • Patients tend to get frequent airways infection
  • Optimum for pathogens (warm, moist and glucose rich)
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16
Q

Describe the relationship between smoking and bronchiolitis

A
  • Inflammation of bronchioles
  • Increased neutrophils, macrophages, and CD8 T cells
  • Fibrosis and an increase in airway resistance
  • Bronchiolitis can be seen in young smokers
  • no evidence of aieqaay obstruction
17
Q

Describe the relationship between smoking and emphysema

A
  • Permanent enlargement of distal alveoli
  • SA rescued, gas exchange compromised
  • Elastin damaged–> premature closing of airways and air trapping
  • Heterogenous disease- affects particular airways in lungs
  • VQ mismatch
18
Q

What are the systemic effects of smoking?

A
  • Persistent, low-grade, systemic inflammation
  • Endothelial dysfunction
  • Activation of clotting pathways
  • Increased carboxyhemoglobin levels (less oxygen delivery)
  • Raised cholesterol levels (high and increased oxidised LDL)
  • Raised blood pressure
19
Q

What occurs in a persistent, low grade, systemic inflammation?

A
  • Increased C reactive protein in plasma
  • Increased plasma cytokines (TNF-α and IL-6)
  • Increased fibrinogen leading to increased blood visit, platelet aggregation and fibrin formation
20
Q

How does smoking lead to endothelial dysfunction?

A
  • Decrease in NO production, therefore vasodilation
21
Q

Outline some of the psychological aspects of smoking

A
  • Cues for smoking
  • Condition may maintain smoking behaviours, even after nicotine receptor desensitisation
  • Peer pressure type influences
  • Psychological factors are a major factor in relapse
22
Q

What are the different methods of smoking cessation?

A
  • Nicotine replacement therapy
  • Anti-depressants- bupropion (Zyban)
  • Nicotinic receptor partial agonist varenicline (CHampix)
  • Nicotinic receptor antagonist- Mecamylamine (Inversine) associated with ANS-type side effects
  • Behavioural support
23
Q

What are the different forms of nicotine replacement therapy?

A
  • Patches
  • Gum
  • Sublingual tablets
  • Nasal spray
  • Inhalators
24
Q

What are the different types of behavioural support available for smokers?

A
  • Nurse-led clinics
  • Telephone support lines
  • Hypnotherapy
25
Q

What is the mechanism of action for bupropion (antidepressant)?

A
  • Atypical tricyclic antidepressant
  • Acts as an inhibitor of dopamine uptake
  • Generally safe, but contradicted in patients with history of seizures
26
Q

What is the mechanism of action for Varenicline (nicotinic receptor partial agonist)?

A
  • Varenicline is a partial agonist at central nicotinic receptors
  • Reduces cravings for nicotine and enjoyable effects of smoking- Binds to a receptor
27
Q

What are the problems faced with smoking cessation?

A
  • 80% of smokers who try to quit on their own relapse within 1 month
  • Most smokers require several attempts
  • Need pharmalcological and behavioural support
28
Q

Describe cannabis smoking

A
  • Around 20% of 16-24 year olds smoke cannabis in UK
  • Carcinogens in cannabis are similar to those in tobacco
  • Cannabis smokers also exposed to particulates
29
Q

What are the dangers of cannabis smoking?

A
  • Inhale for longer to draw smoke deeper- increased exposure to tar
  • Inhalation pattern may also be carried over to tobacco smoking
  • Cannabis smokers may deny smoking history
  • may not ‘count as smoking’
30
Q

What are e-cigarettes?

A
  • Designed to mimic effects of smoking but without tobacco consumption
  • E-liquid containing nicotine, flavourings and glycerine is vaporised and inhaled
  • Originally marketed to aid smoking cessation
31
Q

What is the concern with e-cigarettes?

A
  • Concern about nicotine addiction if used by non-smokers

- Long term effects unknown

Pharmacology CP (11 decks)

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