Table Of Contents
Nicotine
Nicotine is derived from the tobacco plant. It stimulates nicotinic receptors in autonomic ganglia and is highly addictive due to its effects on the dopaminergic system. It also has prominent withdrawal symptoms. Nicotine use is not an acute problem. The patient either presents willing to quit or with significant complications related tobacco e.g. coronary artery disease. Treatment is by quitting and managing withdrawal symptoms. Relapse after abstinence is common.
Classifying pack years
| Pack years | Severity |
|---|---|
| 0 | Non-smoker |
| 1 – 20 | Light smoker |
| 1 – 40 | Moderate smoker |
| > 40 | Heavy smoker |
- Signs and symptoms of nicotine withdrawal
- Intense craving
- Dysphoria
- Irritability
- Anxiety
- Increased appetite
- Poor concentration
- Treatment of nicotine dependence
- Varenicline (Chantix): A nicotinic cholinergic receptor partial agonist that mimics the action of nicotine. Its side effects include psychosis, and suicidal and homicidal ideation
- Bupropion (Zyban): Works very well for patients with refractory addiction. It inhibits DA and NE reuptake to reduce craving.
- Nicotine Replacement therapy: available as ttransdermal patches, gums, lozenge, nasal spray and inhaler
- Behavioural counselling
- Complications of smoking
- COPD
- Lung cancer
- Leukoplakia (especially. with chewing tobacco)
- Atherosclerosis and cardiovascular disease
- Other cancers e.g. bladder cancer, esophageal cancer, laryngeal cancer, and pancreatic cancer
