Tobacco Related Disorders Flashcards
what is nicotine? what are some of its properties
stimulant
potent parasympathomimetic alkaloid
naturally produced in the nightshade family of plants
what is the prevalence of tobacco use disorder
20% in US adults (around 15% in canada)
what is the heritability of tobacco use disorder
about 50%, similar to other SUDs
how does nicotine work? where does it work in the brain?
AGONIST that binds to selectively to nicotinic cholinergic receptors
nicotine increases activity in the PREFRONTAL CORTEX, THALAMUS and VISUAL SYSTEM
risk factors for tobacco use disorder
externalizing traits
other MH disorders
low SES
low education
when do the medical consequences of tobacco use disorder typically begin
in 40s then worsen over time
list some of the medical complications of tobacco use disorder
cancers (lung, other)
cardiac + pulmonary disease, cough, SOB
perinatal problems (LBW, miscarriage)
accelerated skin aging
among those with continuing tobacco use, what % die early from related illness
50%
mostly due to carbon monoxide, tars, non nicotine parts
does nicotine medication appear to cause long term harm
no
those with SCZ are how much more likely to use tobacco
2-4x more likely
is pharmacotherapy, nonpharm therapy or both the best approach to treating tobacco use disorder
both together is best
rank the most effective to least effective medications for tobacco use disorder
most: varenicline
buproprion
least: NRT
when should you consider adding another medication on top of NRT to treat tobacco use disorder
if withdrawal symptoms persist despite NRT
*combo or varenicline and NRT is better than either alone
what is the mechanism of action of varenicline
both a partial agonist and antagonist at the alpha-4-beta-2 NICOTINE receptor
because its a partial agonist–> get release of dopamine and reduce craving, withdrawal
because its an antagonist–> reduces reinforcing effects of the nicotine with is no longer able to bind
*cigarettes are thus less euphoric and have less + reinforcement
side effects of varenicline
nausea
insomnia
constipation
GI
abnormal dreams
*there are some post market reports of SERIOUS NEUROPSYCH symptoms, anxiety and SI but a study showed no such increases
