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Chapter 39

Chapter 39. Drug Abuse III: Nicotine and Smoking. Basic Pharmacology of Nicotine. Mechanism of action Pharmacokinetics Pharmacologic effects. Nicotine and Smoking. Main source: tobacco Nicotine is the most dangerous compound in cigarettes

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Chapter 39

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  1. Chapter 39 Drug Abuse III: Nicotine and Smoking

  2. Basic Pharmacology of Nicotine • Mechanism of action • Pharmacokinetics • Pharmacologic effects

  3. Nicotine and Smoking • Main source:tobacco • Nicotine is the most dangerous compound in cigarettes • Also carbon monoxide, hydrogen cyanide, ammonia, nitrosamines, and tar • Activates nicotinic receptors • Cardiovascular effects • GI effects • CNS effects • Pregnancy and lactation

  4. Nicotine and Smoking • Tolerance • Dependence • Acute poisoning • Treatment • Chronic toxicity from smoking

  5. Smoking Cessation • Nicotine replacement therapy • Chewing gum (Nicorette) • Lozenges (Commit, Thrive C) • Transdermal patches (NicoDerm C, NicoDerm CQ, Nicotrol) • Nasal spray (Nicotrol NS) • Inhaler (Nicotrol Inhaler, Nicorette Inhaler C)

  6. Smoking Cessation • Other non-nicotine drug treatments • Bupropion (Zyban) • Varenicline (Chantix) • Nortriptyline and clonidine (second-line drugs) • Nicotine Conjugate Vaccine

  7. “5 A’s” Model for Treating Tobacco Use and Dependence • Ask (screen all patients for tobacco use) • Advise tobacco users to quit • Assess willingness to make a quit attempt • Assist with quitting (offer medication and provide or refer to counseling) • Arrange follow-up contacts, beginning within the first week after the quit date

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