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Nicotine addiction Nicotine addiction Presentation Transcript

  • ARTICLE ON NICOTINE ADDICTION- QUITTING FOR GOOD TAKEN FROM JOURNAL PHARMA TIMES VOL.44-No .06.JUNE 2012 By Saugandha Das, MN Purohit, Manen patel and H.G Shivakumar
  • INTRODUCTION • Nicotine is a colourless, toxic alkaloid made up of carbon,hydrogen and nitrogen. • The primary reason why nicotine use has turned into worldwide concern is because of its ability to induce a state of euphoria in the brain of the smoker thus leading to addiction. • When a person smokes and inhales nicotine,the active substances are absorbed through alveoli into the lungs which initiate
  • • Chemical reactions in the nerve endings which increasesheartrate,memory,alertness and reaction time. • Neurotransmitters called dopamine and later endorphins are released in the brain producing feelings of pleasure and satisfaction. • As an addictive drug, nicotine has two very potent issues –it is a stimulant as well as depressant.
  • ADDICTION STATISTICS Tobacco addiction is the leading preventable cause of death in the U.S And is the second leading cause of death in the world. The WHO estimates that there are 1.3 billion smokers worldwide today and contributes to approximately 5 million deaths each year. With the present smoking trends,tobacco will kill 10 million people people each year by 2020.
  • • Non smokers exposed to environmental tobacco smoke have a significantly higher risk of developing cancers and pulmonary diseases. • Children exposed to second hand smoke develop a variety of respiratory disorders and morbidity.
  • TIME PHYSIOLOGICAL EFFECT 20 minutes Heart rate returns to normal 12 hours Carbon monoxide level in the blood returns to normal 2 weeks to 3 months Heart attack risks begins to drop and lung function improves 1 year Risk of coronary heart disease is half that of someone who smokes 10 years Risk of developing several types of cancer is decreased 15 years Risk of coronary heart disease is the same as a non smoker. PHYSIOLOGICAL CHANGES AFTER A PERSON QUITS SMOKING
  • SYMPTOMS OF NICOTINE ADDICTION SI. No SYMPTOMS 1 Tolerance to nicotine with decreased effect and increasing dose to obtain same effect 2 Withdrawal symptoms after cessation 3 Smoking more than usual 4 Persistent desire to smoke despite efforts to decrease intake 5 Extensive time spent smoking or purchasing tobacco 6 Postponing work,social or recreational events in order to smoke 7 Continuing to smoke despite health hazards.
  • PHYSICAL STATUS EXAMINATION 1. Physical effects of nicotine use include increased heart rate,accelerated blood pressure and weight loss 2. Physical effects of nicotine withdrawal and smoking cessation include weight gain due to increase in appetite,decreased heart rate,and improvement in the senses of taste and smell 3. 4. Patient commonly discloses the odour of smoke,tarstained teeth and premature skin aging. Symptoms of nicotine toxicity,otherwise known as acute nicotine poisoning,include nausea,vomitting,salivation,pallor,abdominal pain,diarrhoea and cold sweat
  • Mental status examination 1. Nicotine may enhance an individual’s level of alertness 2. Tobacco abuse and dependence may stimulate a frantic,almost manic picture 3. The speech may also be accelerated in line with the behaviour 4. Tobacco use can contribute to irritability often soothened by a dose of nicotine.
  • SL.No Types i Nicotine replacement therapy 1. Nicotine transdermal patch systems 2. Nicotine nasal spray 3. Nicotine delivery through the oral mucosa Common adverse events common to NRT products include dizziness,nausea and headache ii Non-nicotine therapies (medications) 1. Bupropion(Zyban),GlaxoSmithKline 2. Varenicline,pfizer 3. Nortriptyline 4. Clonidine METHODS TO QUIT NICOTINE ADDICTION
  • iii Novel therapies 1. Anti smoking vaccine(Nic VAX) 2. Green smoke electronic cigarette iv Behavioral Treatments v Diet vi Activity vii Hypnosis viii Acupuncture ix Motivational Therapies
  • NICOTINE REPLACEMENT THERAPY Nicotine was the first pharmacological agent approved by the Food and Drug Administration FDA for use in smoking cessation therapy. Nicotine replacement therapy (NRT) worksby making it easier to abstain from tobacco by partially replacing the nicotine previously obtained from tobacco. TRANSDERMAL NICOTINE PATCHES Nicotine patches deliver nicotine through skin at a relatively steady rate. Smokers who use more than 10 ciggarettes per day should use 21mg/d patch for the first 6 weeks,move to the 14 mg/d strength for 2 weeks and then use the 7mg dose for the final 2 weeks. Marketed products are NicoDerm,Nicotrol and Habitrol
  • NASAL SPRAY They are marketed as individualised prescription medication.The nasal spray delivers nicotine more rapidly than other NRTs. Used as multidose bottles with pumps which deliver 0.5 mg of nicotine per 50mcL squirt.Most patients are started with 1 or 2 doses per hour which may be increased to 40 doses per day. Orally administered products i)Nicotine gum Nicotine gum is a chewing gum formulation containing nicotine. Users are instructed to use a piece of gum every 1-2 hours for the first 6 weeks,then to reduce use gradually.
  • DIRECTIONS 1)Acidic beverages interfere with buccal absoption of nicotine hence patients Should avoid acidic beverages eg soda,coffee,beer) for 15 mts before and during chewing gum. 2)Nicotine gum chewing may cause jaw soreness.therefore the smoker should chew the gum to release nicotine,and then move the gum b/w the cheek and gum for a minute or so. II LOZENGE Nicotine containing lozenges are available as 2mg and 4 mg formulations . III INHALER Nicotine inhalers are currently marketed as prescription medication in the US. Each inhaler catridge contains 10 mg nicotine, of which 4mg can be delivered and 2mg is absorbed.
  • IV)VAPORIZER A vaporizer is a device used to release the active ingredients of plant material,commonly cannabis or tobacco.Rather than burning the herb, which produces numerous harmful by-products, a vaporizer heats the material,ideally to 180C (356F),so that the active compounds contained in the plant melt and convert into an aromatic vapour. V)SUBLINGUAL TABLET The product is designed to be held under the tongue, where the nicotine in the tablet is absorbed sublingually.
  • NON-NICOTINE THERAPIES BUPROPION The drug bupropion was introduced by Glaxo-Smithkline under the brandname,Zyban. Dose-300mg/d,given as 150 mg bid. Adverse effects-Drymouth and insomnia,a very small risk of seizure exists Brand names-Zyban,Wellbutrin VARENICLINE It was developed as a nicotine receptor partial agonist. Common side effects-difficulty in sleeping and abnormal dreams,nausea,headache Brand name-Chantix,Champix
  • NORTRIPTYLINE Nortriptyline is used as a second generation tricyclic antidepressant marketed as the hydrochloride salt under the trade name Sensoval,Pamelor,Norpress,Allegron. ADR-Fast heart rate,blurred vision,urinary retention,dry mouth. CYTISINE Cytisine possesses a structure and mechanism of action that are similar to those of nicotine,but it has much lower toxicity.
  • NOVEL THERAPIES ANTI SMOKING VACCINE ( Nic VAX) Nic VAX developed by Nabi Biopharmaceuticals is a nicotine conjugate vaccine intended to reduce or eliminate physical addiction to nicotine and is presently in clinical trials. GREEN SMOKE ELECTRONIC CIGARETTE Green smoke e cigarette do not burn any tobacco,but rather,when you inhale from an e cigarette,containing nicotine,propylene glycol and a scent that stimulates the flavour of tobacco.
  • MOTIVATIONAL THERAPIES Self help books and websites can provide a no of ways to motivate smokers to quit smoking.One well known example is calculating the monetary savings. Some people have been able to find the motivation to quit just by calculating how much money they will save after they quit. SOME OTHER HERBAL TREATMENTS • MUCUS CLEAR • CRAVE-RX DROPS • NICOTONIC
  • CONCLUSION Cigarette manufacturers are the only manufacturers of any product anywhere in the world are allowed to sell something with known high levels of carcinogens.Overcoming nicotine dependence is difficult and takes commitment,support and time.Even longtime smokers can reverse much of the damage smoking has done to the body by quitting nicotine dependence plus taking healthy lifestyle steps. Quitting the smoke can keep the glow of life alive.
  • REFERENCES • Centres for disease control and prevention,Annual Smoking- Attributable mortality,years of potential life lost,and economic costs- us,1995-1999 • http//pmep.cce.cornell.edu/profiles/prf-nicotine.html • http//www.quit-smoking-stop.com/nicotine addiction.html • Nabibiopharmaceuticals,key facts about smoking nicotine addiction and cigarette smoking-a growing global health challenge • Emedicine.medscape.com • www.drugs.com • www.medicinenet.com
  • THANK YOU