DSA17 - Nicotine and Opiate Use Disorder

alkaline

Absorption of inhaled nicotine increased with () pH

avoids

Inhalation of Nicotine (requires/avoids) 1st pass metabolism

-t1/2 = 2.5 hr

-Metabolized by CYP2A6 to Continine (Biochemical marker w/ t1/2 of 16 hr), CO and Carboxyhemoglobin

-CYP1A2 accelerator

-Readily crosses placenta

-Found in breast milk

Describe Nicotine's metabolism

Nicotine Use!

What is the #1 cause of preventable death?

Tobacco/Nicotine Use Disorder

Define Condition:

A problematic pattern of Tobacco use leading to clinically significant impairment or distress, as manifested by at least two of the following SX, occurring within a 12-month period:

-Substance is often taken in larger amounts

-Persistent desire or unsuccessful effort to cut down

-Great amount of time obtaining or recovering from the effects of the substance

-Craving or strong desire to use

-Recurrent use resulting in failure to fulfill obligations

-Continued use despite negative consequences

-Important activities are sacrificed because of use

-Recurrent use in hazardous situations

-Use is continued despite knowledge of the problems it has caused

-Tolerance

-Withdrawal

-Hx: (increased use)

> Schizophrenia (80%)

> ADHA (40%)

> Certain Genetics

-Path: Increased DA Concentration (x5-10) on VTA and Nucleus Accumbens

-Sx/PE: (Mild = 2-3 Sx, Mod = 4-5 Sx, Severe = > 6 Sx); Also...

> Sx of TOLERANCE

> Sx of WITHDRAWAL

-Tx:

> 5 As (Ask, Advise --> Assess, Assist, Arrange)

> Counseling

> Group Support

> Meds = NRTs, Bupropion, Varenicline

-Prog:

> TOBACCO WITHDRAWAL

> Illicit drug use (>40% smokers, 4-5% non-smokers)

> Lung CA

> COPD

> CVD

> Oropharnyx cancer

> Bladder cancer

> Stomach cancer

> Pancreatic Cancer

> Macular Degeneration

> DVT (on estrogen)

> Low Birth Wt Infant

Tobacco Withdrawal

Define Condition:

After cessation of prolonged Tobacco use

-Sx:

> Dysphoric mood

> Insomnia

> Irritability

> Anxiety

> Restlessness

-Tx:

> Help w/ 5 As

> Help pt pick appropriate "quit-date"

> Med assistance if necessary (potential psych S/Es)

>> NRT = Patches, gum, lozenge, spray, inhaler (reduces craving and withdrawal severity) --> S/E = Skin irritation, insomnia/bad dreams, Preg D

>> Bupropion = Antidepressant that reduces craving & withdrawal severity --> S/E = C/I w/ Seizures or eating disorders, Insomnia if taken too late in day

>> Varenicline = Partial agonist at NACh receptor, less DA release than tobacco; better abstinence @ 6 mos, Preg C --> S/E = Nausea, insomnia, CVD events, Agitation, Depression, Suicidal thinking

•Do NOT have any accessible cigarettes at home, work, or in car (as a "just in case")

•Significantly reduce or stop alcohol consumption, especially early in recovery

•Reduce exposure to others smoking (bars, friends who go outside of workplace to smoke, spouse/partner should go outside to smoke, and NOT in car).

•Recognize and take extra caution during high risk times- first cup of coffee, after a meal

•Continue quit medications for reasonable period of time

What are some tips for preventing Tobacco Use Relapse?

•Decreases risk of low birth weight infant, and SIDS when pregnant women stop smoking

•Immediate reduction in CVD risk

•After 10-15 years abstinence, risk of all-cause mortality approaches that of persons who never smoked

What are benefits of Tobacco Cessation?

Analgesia, Euphoria

What are the effects of Mu1 (µ1) activation?

Constipation, Respiratory Depression

What are the effects of Mu2 (µ2) activation?

Spinal Analgesia, Dysphoria

What are the effects of Kappa activation?

Analgesia via endorphins/enkephalin/dynorphin system

What are the effects of Delta activation?

Acts by facilitating GABA-A function, by interacting with the GABA-A receptor, but at a site different from the GABA binding site or the benzodiazepine binding site. --> Activation of the VTA DA neuron

How does Alcohol dependence occur on a neurochemical level?

-Methadone (full agonist)

-Buprenorphine (partial agonist)

-Naltrexone (Antagonist)

List medications for treating Opioid Use Disorder (MOUD)