15.4 Nicotine Use Disorder Drugs
4 min read•june 18, 2024
Nicotine is a complex issue that affects millions worldwide. It's not just about —it's a physical and psychological dependence that can be tough to break. Understanding how nicotine works in the body and its effects is key to tackling this addiction.
Luckily, there are many treatment options available. From to prescription medications and behavioral support, a comprehensive approach can significantly increase the chances of successfully quitting. As nurses, we play a crucial role in helping patients overcome this challenging addiction.
Nicotine Addiction and Its Effects
Physiological effects of nicotine addiction
Top images from around the web for Physiological effects of nicotine addiction
Frontiers | Updated Role of Neuropeptide Y in Nicotine-Induced Endothelial Dysfunction and ... View original
Is this image relevant?
Frontiers | Multidimensional Intersection of Nicotine, Gene Expression, and Behavior View original
Is this image relevant?
Frontiers | Multifactorial Etiology of Adolescent Nicotine Addiction: A Review of the ... View original
Is this image relevant?
Frontiers | Updated Role of Neuropeptide Y in Nicotine-Induced Endothelial Dysfunction and ... View original
Is this image relevant?
Frontiers | Multidimensional Intersection of Nicotine, Gene Expression, and Behavior View original
Is this image relevant?
1 of 3
Top images from around the web for Physiological effects of nicotine addiction
Frontiers | Updated Role of Neuropeptide Y in Nicotine-Induced Endothelial Dysfunction and ... View original
Is this image relevant?
Frontiers | Multidimensional Intersection of Nicotine, Gene Expression, and Behavior View original
Is this image relevant?
Frontiers | Multifactorial Etiology of Adolescent Nicotine Addiction: A Review of the ... View original
Is this image relevant?
Frontiers | Updated Role of Neuropeptide Y in Nicotine-Induced Endothelial Dysfunction and ... View original
Is this image relevant?
Frontiers | Multidimensional Intersection of Nicotine, Gene Expression, and Behavior View original
Is this image relevant?
1 of 3
- Nicotine binds to () in the brain triggers release of () producing feelings of pleasure and reward
- Chronic nicotine exposure increases number of nAChRs resulting in and need for higher doses to achieve same effect
- Increases heart rate, blood pressure, and respiratory rate
- Constricts blood vessels reducing blood flow to skin and extremities
- Stimulates release of glucose from liver and increases insulin resistance potentially contributing to development of type 2 diabetes
- Suppresses appetite and increases metabolic rate may lead to weight loss
- Impairs immune system function increasing risk of respiratory infections and delayed wound healing
Signs of nicotine use disorder
- Strong for nicotine
- Difficulty controlling nicotine use despite negative consequences
- when attempting to quit or reduce nicotine intake:
- , anxiety, and
- Difficulty concentrating
- Sleep disturbances
- Increased appetite and weight gain
- Continued use despite physical or psychological problems caused or exacerbated by nicotine
- Neglecting social, occupational, or recreational activities due to nicotine use
- Developing tolerance to nicotine requiring higher doses to achieve desired effect
- Persistent engagement in smoking despite awareness of its harmful effects
Treatment of Nicotine Dependence
Medications for nicotine dependence
- Nicotine replacement therapies ():
- () antidepressant reduces nicotine cravings and withdrawal symptoms
- () of nAChRs reduces nicotine cravings and rewarding effects of smoking
Mechanism of nicotine replacement therapies
- NRTs deliver controlled doses of nicotine to body reducing withdrawal symptoms and cravings associated with
- Provide lower, slower, and more stable release of nicotine compared to cigarettes allowing user to gradually wean off nicotine
- By reducing cravings and withdrawal symptoms, NRTs increase likelihood of successful smoking cessation
Benefits vs risks of cessation medications
- NRTs:
- Benefits: Reduce cravings and withdrawal symptoms, available over-the-counter (except inhalers and nasal sprays), can be used in combination with other smoking cessation methods
- Risks: Potential side effects such as skin irritation (patches), mouth or throat irritation (gum, lozenges, inhalers), nasal irritation (nasal sprays)
- Bupropion:
- Benefits: Reduces nicotine cravings and withdrawal symptoms, may help prevent weight gain, can be used in combination with NRTs
- Risks: Potential side effects such as dry mouth, , seizures (rare)
- Varenicline:
- Benefits: Reduces nicotine cravings and rewarding effects of smoking, has higher success rate compared to other medications
- Risks: Potential side effects such as nausea, abnormal dreams, changes in mood or behavior (rare)
Comprehensive Approach to Nicotine Addiction Treatment
Pharmacological interventions
- Medications for nicotine dependence as discussed above
Behavioral therapy
- Cognitive- to address thought patterns and behaviors associated with smoking
- Motivational interviewing to enhance motivation for quitting
- Stress management techniques to cope with triggers and cravings
Relapse prevention strategies
- Identifying high-risk situations and developing coping strategies
- Building a support network of family, friends, and healthcare professionals
- Implementing lifestyle changes to support a smoke-free life
Nursing Considerations and Patient Education
Nursing considerations for cessation drugs
- Assess patient's nicotine dependence, smoking history, and readiness to quit
- Educate patients on proper use, dosage, and potential side effects of prescribed medication
- Monitor patients for adverse reactions and adjust treatment plan as needed
- Encourage patients to set quit date and provide support throughout cessation process
- Assess and address any underlying mental health conditions that may impact smoking cessation success
- Collaborate with other healthcare professionals (physicians, behavioral therapists) to provide comprehensive care
Patient education for smoking cessation
- Provide information on health benefits of quitting smoking and risks associated with continued nicotine use
- Teach patients about symptoms and coping strategies (deep breathing, exercise, stress management techniques)
- Encourage patients to identify and avoid triggers that may lead to smoking, develop alternative coping mechanisms
- Emphasize importance of adhering to prescribed medication regimen and attending follow-up appointments
- Provide resources for additional support (smoking cessation helplines, support groups, online communities)
- Reinforce message that quitting smoking is a process, setbacks are common but do not indicate failure
- Celebrate milestones and successes throughout cessation process to maintain motivation and commitment to quitting
Key Terms to Review (43)
Addiction: Addiction is a chronic, relapsing disorder characterized by compulsive drug-seeking and use, despite harmful consequences. It is a complex brain disease that involves changes in brain structure and function, leading to a loss of control and an inability to abstain from the addictive substance or behavior. Addiction can occur in the context of various substances, including opioids, nicotine, and other drugs of abuse, as well as certain behaviors, such as gambling or internet use.
Addiction is a central concept in the understanding of substance use disorders, as described in the topics 14.3 Opioid Agonists and Antagonists, 15.1 Introduction to Substance Use Disorders, and 15.4 Nicotine Use Disorder Drugs. It is a critical factor in the development, maintenance, and treatment of these conditions.
Adolescents: Adolescents are individuals in the transitional stage of development between childhood and adulthood, typically ranging from ages 10 to 19. This period is marked by significant physical, emotional, and psychological changes.
Behavioral Therapy: Behavioral therapy is a type of psychotherapy that focuses on modifying an individual's behaviors and actions to improve their overall well-being. It is based on the principle that our thoughts, feelings, and behaviors are interconnected, and by changing our behaviors, we can positively impact our thoughts and emotions. In the context of 15.4 Nicotine Use Disorder Drugs, behavioral therapy is an important component of treatment for individuals struggling with nicotine addiction.
Bupropion: Bupropion is a medication primarily used for smoking cessation and to treat depression. It works by inhibiting the reuptake of norepinephrine and dopamine in the brain.
Chantix: Chantix, also known as varenicline, is a prescription medication used to help people quit smoking by reducing cravings and withdrawal symptoms. It works by blocking nicotine from binding to its receptors in the brain.
Children: Children are individuals in the developmental stage between infancy and adolescence. Their physiological and psychological characteristics impact how they respond to various pharmacological treatments.
Combination Therapy: Combination therapy refers to the use of two or more medications or treatments simultaneously to manage a health condition. This approach is commonly employed in the treatment of various diseases, including sexually transmitted infections and nicotine use disorder, to enhance efficacy, reduce side effects, and prevent the development of drug resistance.
Cravings: Cravings refer to an intense, persistent desire or urge to consume a specific substance, such as a drug or food. They are a hallmark symptom of addiction and can significantly impact an individual's ability to abstain from the desired substance.
Donepezil transdermal: Donepezil transdermal is a medication used to manage symptoms of Alzheimer's disease by delivering the drug through a skin patch. It inhibits acetylcholinesterase, thereby increasing acetylcholine levels in the brain.
Dopamine: Dopamine is a neurotransmitter that plays a crucial role in the brain's reward and pleasure centers, as well as in the regulation of various physiological processes. It is involved in a wide range of functions, from motor control and cognition to emotional and behavioral responses, making it a key player in understanding and treating numerous nervous system disorders.
Half-life: Half-life is the time required for the concentration of a drug in the bloodstream to reduce by half. It helps determine dosing intervals and duration of drug effects.
Half-Life: Half-life is a fundamental concept in pharmacology that describes the time it takes for the concentration or amount of a drug in the body to be reduced by half. It is a crucial factor in understanding the pharmacokinetics and pharmacodynamics of drugs, as well as their dosing and administration.
Insomnia: Insomnia is a sleep disorder characterized by difficulty falling asleep, staying asleep, or waking up too early and not being able to go back to sleep. It can have a significant impact on an individual's overall health and quality of life.
Irritability: Irritability refers to a heightened state of emotional sensitivity and reactivity, characterized by a low tolerance for frustration, annoyance, and difficulty in regulating one's emotional responses. This term is particularly relevant in the context of Nicotine Use Disorder Drugs, as it is a common symptom experienced during nicotine withdrawal and can contribute to the challenges of quitting smoking.
NAChRs: nAChRs, or nicotinic acetylcholine receptors, are a class of neurotransmitter receptors that are activated by the binding of the neurotransmitter acetylcholine. These receptors are found in the central and peripheral nervous systems and play a crucial role in the context of nicotine use disorder drugs.
Neurotransmitters: Neurotransmitters are chemical messengers that transmit signals between neurons and target cells in the nervous system. They are responsible for the communication and coordination of various physiological and psychological processes in the body, and their imbalance or dysfunction can contribute to the development of various neurological and psychiatric disorders.
NicoDerm/Nicorette: NicoDerm and Nicorette are nicotine replacement therapies (NRTs) used to help individuals quit smoking by reducing withdrawal symptoms and cravings. NicoDerm is a transdermal patch, while Nicorette is available as gum or lozenges.
Nicotine Gum: Nicotine gum is a form of nicotine replacement therapy used to help people quit smoking. It provides a controlled dose of nicotine to alleviate withdrawal symptoms and cravings, while breaking the behavioral habit of smoking.
Nicotine Inhalers: Nicotine inhalers are a type of nicotine replacement therapy (NRT) used to help people quit smoking. They deliver nicotine directly to the lungs, providing a rapid absorption of nicotine into the bloodstream, similar to the experience of smoking a cigarette.
Nicotine Lozenges: Nicotine lozenges are a type of nicotine replacement therapy (NRT) used to help individuals quit smoking or reduce nicotine cravings. They are small, dissolvable tablets that release nicotine into the bloodstream, providing a controlled dose of nicotine to ease withdrawal symptoms and cravings.
Nicotine Nasal Sprays: Nicotine nasal sprays are a form of nicotine replacement therapy (NRT) used to help individuals quit smoking. These sprays deliver a measured dose of nicotine directly into the nasal passages, providing a rapid absorption of nicotine to alleviate withdrawal symptoms and cravings associated with nicotine use disorder.
Nicotine Patches: Nicotine patches are a type of nicotine replacement therapy (NRT) used to help people quit smoking. They deliver a steady, controlled dose of nicotine through the skin, reducing cravings and withdrawal symptoms associated with nicotine addiction.
Nicotine receptor agonist: A nicotine receptor agonist is a substance that mimics the action of nicotine by binding to and activating nicotinic acetylcholine receptors in the brain, leading to effects such as increased dopamine release. These drugs are often used in smoking cessation therapies.
Nicotine Replacement Therapies: Nicotine replacement therapies (NRTs) are a type of medication used to help people quit smoking by providing a safer, controlled source of nicotine to alleviate withdrawal symptoms and cravings. These therapies aim to break the physical addiction to nicotine while the individual works on the psychological aspects of quitting smoking.
Nicotine Use Disorder: Nicotine use disorder is a condition characterized by a problematic pattern of nicotine use that leads to clinically significant impairment or distress. It involves a strong craving for nicotine, an inability to control or reduce nicotine use, and continued use despite negative consequences.
Nicotine withdrawal: Nicotine withdrawal is the physical and psychological symptoms experienced when a person reduces or stops nicotine intake after prolonged use. Symptoms can include irritability, anxiety, difficulty concentrating, and cravings.
Nicotinic Acetylcholine Receptors: Nicotinic acetylcholine receptors (nAChRs) are a class of cholinergic receptors that are activated by the neurotransmitter acetylcholine as well as the drug nicotine. These receptors are found in the central and peripheral nervous systems and play a crucial role in various physiological processes, including neurotransmission, muscle contraction, and the development of nicotine use disorder.
NRTs: NRTs, or Nicotine Replacement Therapies, are a class of medications used to help individuals quit smoking by providing a safer, controlled source of nicotine to alleviate withdrawal symptoms and cravings. These therapies aim to break the physical dependence on nicotine while supporting the behavioral and psychological aspects of nicotine addiction.
Partial Agonist: A partial agonist is a type of receptor ligand that binds to and activates a receptor, but only partially activates the receptor's response compared to a full agonist. This partial activation is an important concept in the context of opioid use disorder drugs and nicotine use disorder drugs.
Pediatric exposures: Pediatric exposures refer to incidents where children come into contact with harmful substances, such as nicotine or other drugs, either accidentally or intentionally. These exposures can lead to serious health consequences and require prompt medical attention.
Pharmacokinetics: Pharmacokinetics is the study of how the body affects a drug, including the processes of absorption, distribution, metabolism, and elimination. It examines the movement of drugs within the body and how these processes impact the drug's concentration and duration of action.
Relapse Prevention: Relapse prevention refers to the strategies and techniques used to help individuals with substance use disorders maintain long-term recovery and prevent a return to problematic substance use. It is a crucial component in the management of various substance use disorders, including opioid, alcohol, and nicotine use disorders.
Restlessness: Restlessness is a feeling of unease, discomfort, or inability to remain still or calm. It is often associated with a strong desire to move or change one's position, and can be a symptom of various physical, mental, or emotional conditions, including nicotine use disorder.
Smoking: Smoking refers to the act of inhaling and exhaling the fumes or vapor produced by burning tobacco or other substances. It is a prevalent behavior that can lead to the development of nicotine use disorder, a chronic and relapsing condition characterized by a strong craving for nicotine and continued use despite negative consequences.
Smoking Cessation: Smoking cessation refers to the process of quitting the use of tobacco products, particularly cigarettes, in order to improve one's health and well-being. It is a critical component in the treatment of nicotine use disorder, which is the focus of the 15.4 Nicotine Use Disorder Drugs chapter.
Sublingual: Sublingual refers to the administration of a drug or medication by placing it under the tongue, allowing it to be absorbed directly into the bloodstream through the mucous membranes in the sublingual area. This route of administration bypasses the digestive system and liver, leading to faster onset of action compared to oral dosing.
Tapering: Tapering refers to the gradual reduction in the dose or frequency of a medication or substance, typically done to minimize withdrawal symptoms and facilitate a safe and comfortable discontinuation of use. This term is particularly relevant in the context of nicotine use disorder drugs, where tapering strategies are often employed to help individuals quit smoking or using other nicotine-containing products.
Tolerance: Tolerance refers to the diminished response to a drug or substance that occurs with repeated exposure, requiring higher doses to achieve the same effect. This phenomenon is observed across various drug classes and substance use disorders, and is a key factor in the development and progression of addiction.
Transdermal: Transdermal refers to the administration of medication through the skin, allowing the active ingredients to be absorbed into the bloodstream. This method of drug delivery bypasses the gastrointestinal tract and liver, providing a direct route for the drug to reach the systemic circulation.
Varenicline: Varenicline is a prescription medication used to help people quit smoking. It works by partially activating the nicotine receptors in the brain, reducing cravings and withdrawal symptoms associated with nicotine addiction.
Withdrawal Symptoms: Withdrawal symptoms refer to the physical and psychological disturbances experienced when an individual abruptly stops or reduces the use of a substance they have become dependent on. These symptoms can range from mild discomfort to severe, life-threatening conditions, and they are a hallmark of substance use disorders.
Young adults: Young adults are individuals typically aged 18-25 years who are transitioning from adolescence to full-fledged adulthood. They often experience significant physical, psychological, and social changes during this period.
Zyban: Zyban is a prescription medication used to help people quit smoking by reducing cravings and withdrawal effects. It is an atypical antidepressant that works on brain neurotransmitters.