Tobacco Use Treatment Flashcards
So if relapse isn’t driven by nicotine withdrawal, why does nicotine replacement therapy (NRT) work?
Well, we don’t really know… but it seems to have a lot to do with reducing impulsivity.
Is tobacco relapse driven by nicotine withdrawal symptoms?
Not as much as you’d think… it seems to have a lot to do with impulsivity generated by a dopamine-deprived ventral tegmental area.
What’s the normal function of the ventral tegmental area?
What effect does nicotine have on the signaling coming from this area?
It gets you to pay attention to the train coming down the tracks.
Nicotine tells the ventral tegmental area, “okay, we see the train coming down the tracks.”
What does the nucleus accumbens have to do with the ventral tegmental area (VTA) and nicotine addiction?
The nucleus accumbens receives dopamine from the VTA when the VTA is placated (the stimulus it’s worried about has been given attention).
The nucleus accumbens associates this placation of the VTA with cigarette smoking.
In terms of therapy for tobacco cessation, what is the goal in terms of changing the odds of quitting?
The goal is to reduce the odds of lapsing and relapsing - even just a little bit. You might not help the patient in front of you, but at a population level, it will make a large impact.
Cigarettes vs. gum vs. the patch in terms of speed of nicotine delivery?
Cigarettes deliver nicotine fast, and it reaches high concentrations.
The patch won’t kill a craving, but what is it good for?
Reducing impulsivity.
Forms of NRT that are effective for sudden cravings?
Inhaler, and particularly nasal spray.
the nasal spray has modest addictive potential
2 drugs to help tobacco abstinence?
MoAs?
Buproprion - antidepressant, “stabilizes dopamine” in nucleus accumbens?
Varenicline - nicotine partial agonist
Can a NRT long-term patch and quick-acting NRT be use in combination?
Yep. And this produces better success rates.
Is it harmful to smoke while on an NRT patch?
No. - but this is a common misconception that you should address.
What’s the deal with NRT in pregnancy?
Pregnancy category C (adverse effects on animal fetuses, no studies in women OR no studies in either).
But, nicotine levels are higher with continued smoking vs. NRT gum.
