Neurobiology of Nicotine
How long does it take for the nicotinic receptors to become desensitized?
Receptors become re-sensitized and ______ resume
1 cigarette
craving resume
High rates of relapse are d/t
Molecular memory
Waht are the 3 tx for smoking cessation?
Nicotine replacement
Varenicline/Chantix
Buproprion/Zypan
Buproprion/Zyban MOA:
NDRI
gives back some of the DA downstream to craving postsynaptic D2 receptors in the Nucleus Accumbens which are adjusting to not getting the "DA fix" from Nicotine
ETOH use is treated with?
Naltrexone
Acamprosate/Campra
Disulfiram/Antabuse
BZDs (short acting)
What receptors adapt to the chronic intermittent pulsatile use of nicotine which leads to addiction?
Alpha 4, Beta 2, & Nicotinic receptors
The PMHNP knows the most promising treatment for Nicotine addiction is _________ delivered in a method other than __________
Nicotine
Smoking
Varenicline/Chantix MOA:
Alpha4,Beta2, nicotinic acetylcholine receptor partial agonist (NPA)
stabilizes the nicotinic receptors in an intermediate state (channels open less frequently than will a FULL agonist but ,more frequently than with an antagonist-Happy medium
(They ARE NOT DESENSITIZED)
Quit rates with Buproprion are _____ % of Varenicline/Chantix
50
EYOH use enhances ________ synapses and reduces excitation at _________ synapses
GABA, Glutamate
The Alpha 4, Beta 2, and Nicotinic receptors are in a _______ state and are ________ by the delivery of nicotine.
This results in the _______of DA and reinforcement of ________ & _______
resting, opened
release, pleasure & reward
What formulations are there for nicotine cessations?
Gums
Lozenges
Nasal sprays-not to much
inhalers-not to much
transdermal
How many weeks are recommended for Varenicline/Chantix therapy, still inefficient for optimal efficacy
12 weeks
The PMHNP knows that Buproprion/Zyban lowers the ________ _______ and should ALWAYS ask about a ________ of _______
seizure threshold
hx of seizures
Therefore ETOH action at the GABA synapses increases _________ release
ETOH binds to which receptors?
GABA
GABA A and GABA B
NIcotine as directly on the _______ _______ receptors in the _______ _____ circuits to release _______
nicotinic cholinergic
mesolimbic reward
DA
The PMHNP knows in these delivery methods of nicotine cessations, nicotine does not reach ________ ______ or _______ ______ delivered to the brain via smoking
high levels
pulsatile blasts
Compared to a placebo it _______ or _______ quit rates for 1 month, 6 months, and 1 yr
_____% of smokers are nicotine free
triple , quadrupled
10
EOH does not treat _______ ________ and is often combined with ___________
Psychiatric disorders
psychopathology
Reinforcing the effects of ETOH may be mediated by actions at the _________ synapes with in the ______ ______ _____
opioid
Ventral tegmental area (VTA)
Nicotine MOA:
Nicotine indirectly acts on ______ release from the
_______ ______ ____
By activating nicotinic presynaptic receptors on _________ neurons cause a _________ which activates DA release in the _______ _______
DA
Ventral tegmental area (VTA)
glutamate, glutamate
Nucleus Accumbens
How does this reduce methods of cravings?
by delivering a steady amount of nicotine and desensitizing some of the nicotine receptors
Past concerns for Varenicline/Chantix ?
BBW for Psychosis and suicidal.-It has been removed/taken away
Contaminates leading to a recall
Be careful with pt with comorbidities such as psychiatric disorders
Approx ______% of being that consume ETOH also _________
The PMHNP knows that with ingestion of ETOH there is a ________ risk for abusing (4) things
85, smoke
sedating medication
MJ
BZD
Opiates
Naltrexone is use to treat ETOH and Opiate use.
Rationale:
ETOH has an action on the _______ synapses which equals the release of _____ in the Nucleus Accumbens .
opioid
Da