NICOTINE NICOTINE

DeWitt S. Williams, EdD MPH CHES Director, Health Ministries North American Division Dewitt.williams@nad.adventist.org

Actual Causes of Death

Tobacco Inactivity/Poor diet Alcohol Microbial agents Toxic substances
43 55 85

435
400

Motor vehicle crashes

Incidents involving firearms Sexual behaviors Illicite use of drugs
JAMA March 10, 2004

43
29 20 17 0 100

Leading Causes of Death, US 1. Tobacco, 18.1% 2. Poor diet and Physical inactivity, 16.6% 3. Alcohol, 3.5%

200

300

400

500

Deaths per Year in U.S. (1,000s)

Contents of Cigarette
More than 4,000 chemicals 43 Carcinogenic 300 Poisons Arsenic, rat poison, Naphthalene moth ball chemical Mercury- found in thermometers Nitrobenzene gasoline additive Cadmium- component in batteries Stearic acid- candle wax

Contents of Cigarette
Vinyl chloride-component of PVC pipe Ammonia- household cleaner Nitrous oxide- disinfectant Butane-cigarette lighter fluid Cyanide DDT insecticide

CONTENTS OF CIGARETTES

Acetic acid - vinegar Acetone - nail polish remover Formaldehyde - embalming fluid Hexamine - barbecue lighter Hydrogen cyanide - gas chamber poison Methanol - rocket fuel Toluene - industrial solvent Radon Asbestos phenol,

Disastrous Chemicals in Cigarettes

Tar Carbon

Monoxide Nicotine Irritants

Amount of tar taken into lungs

Tar blackened lungs with cancer (white pink area)

Tar is carcinogenic !

Healthy Lung

Smokers Lung

Lung Cancer in Women

40

Cancer Death Rates / 100 000

35 30 25 20 15
Lung Breast

10
5 0 1954 1960 1966 1972 1978 1984

1990

1996

Year
JAMA April 14, 2004

Therefore
Curtailing the increase in tobacco use among women represents one of the greatest opportunities for disease prevention in the world today.
JAMA Apr 14, 2004

Carbon Monoxide:
Decreases ability to carry oxygen Helps develop arteriosclerosis

Blood Vessels magnified 1500 times

Blue cells with carbon dioxide

Red cells with oxygen

Nicotine
one drop will kill a rat four drops will kill a monkey 7 drops will kill an elephant

Action of Nicotine
Smoking is a complex behavior
physiological psychological cognitive social cultural

Nicotine is the major culprit

influences and reinforces smoking behavior

 Nicotine is a colorless, oily liquid that, on exposure to air, gives tobacco its pungent smell and brownish color. Takes its name from Jean Nicot, the 16th century French ambassador to Portugal who introduced tobacco to the French court. He cured the headaches of Catherine de Medicis of France. French chemists isolated the active ingredient in 1828 Thought to have medicinal properties

 The slow advance of medical science through the eighteenth and nineteenth centuries gradually removed tobacco from the doctors black bag, and nicotine was dropped from The United States Pharmacopeia in the 1890s.

 In the devastated cities of Europe after World War II, people cheated, stole, and prostituted themselves for a smoke, and German prisoners of war on diets of 900 calories a day would sometimes swap food for cigarettes.

Nicotine causes damage to the artery walls

Nicotine makes heart muscle work harder

Nicotine increases deposits of cholesterol

Nicotine causes blood vessels to constrict

For young people, it is good to let them know that this same constricting factor will produce impotence and erectile dysfunction

When youre addicted . . . Your baby is addicted too

 A powerful acting drug

Effects the mind and body

Stimulates the nervous system

Also acts as a depressant

Produces withdrawal effects

 How nicotine hooks you

Understand withdrawal symptoms Break your craving patterns Change your thinking Reward yourself for

not smoking

 Titration hypothesis- how smokers manipulate their smoking pattern, inhaling more or less deeply or more or less often, to get the desired blood levels of nicotine- on average 35 nanograms per milliliter

Action of Nicotine
In 7 seconds nicotine reaches the brain Nicotine has a direct action on specific nicotine receptors in the brain It has a two phase (bi-phasic) effect Stimulant Depressant

Bi-phasic Action of Nicotine

Nicotine is a drug for all occasions It affects the chemistry of the brain Influences the response of neurotransmitters such as Dopamine

Shallow, quick puffs tend to increase alertness Longer drags relax the smoker

The Pleasure Circuits:

Turned on! Tuned in! Torqued out!

Addictive drugs{substances} though different, MJ, Cocaine, Nicotine all seem to affect the Pleasure & Reward circuits Deep within the brain!

Cocaine, Amphetamines, Tobacco, Alcoholect.

Nicotine in the Body

Nicotine has a half life of about 2 hours. After every 2 hours there is half as much nicotine left in the body

10

12

14

16

Hours

Nicotine Levels

Blood level of nicotine

x
6 am

Nicostat - comfort level 12 pm

Smoking and NRT Comparisons

Cigarette
18 16

Gum

Patch

Spray

Plasma Nicotine Conc(ng/ml)

14
12 10 8 6 4 2

0
0 5 10 20 30

Minutes

40

50

60

70

90

120

Strategy: Nicotine Fading

Cut number of cigarettes you smoke by onequarter, then one-half, then three quarters Switch to lower-nicotine brands, but do not increase number of cigarettes Reduce the length you smoke each cigarette Decrease the number of times you inhale the smoke Nicotine Replacement Therapy-an aid to quitting, not a cure. Will not make you stop wanting a cigarette, but will make it a whole lot more bearable not having one.

46

Nicotine Dependence
Psychological

Behavioral Habit

Physical

Nicotine Dependence
Psychological Habit

X X

Neuro-chemical Physical

NICOTINE REPLACEMENT THERAPY (NRT)

Fight nicotine with nicotine Although these therapies do contain nicotine, they do not contain any of the harmful substances such as tar and carbon monoxide normally found in tobacco smoke Designed to wean you off nicotine Gives the body about 30% of the nicotine to which smoker has become accustomed Pregnant and lactating women, and those with cardio-vascular disease or asthma should not use them Should be taken with doctors advice

NICOTINE GUM
Nicorette, technically speaking, is an oral resin containing a transmucosal sustained release medication 1984- 2 mg gum available by prescription 1996- available over the counter Gum that releases nicotine into the mouth; user decides WHEN they want to satisfy a nicotine craving PRO: satisfies cravings and oral fixation; fast action CON: unpalatable for some; often used incorrectly

NICOTINE GUM
Chew a new piece a few times when you first put it into your mouth, you need only give it an occasional gentle bite-to expose a fresh surface-thereafter. Chew too vigorously and you get too much, which can cause burning in the mouth and throat, nausea, or vomiting. Many foods and drinks, especially high acidic ones like coffee and soda, can interfere with absorption of nicotine. Must wait 15 minutes after eating to chew.

NICOTINE GUM
Must learn how to park gum in your cheek after you get a spicy taste or tingling in your mouth Should be continued for at least four months and you must be weaned off of it before one year. A Physician in Kuwait became addicted to the gum and had been chewing it for more than three years

NICOTINE PATCH
1991: hit the market accompanied by an unprecedented flood of advertising 1993: 4 mg patch available by prescription only 1996- available over the counter (OTC) Releases nicotine through the skin. Available in two strengths, one for heavy smokers and one for light smokers PRO: easy to use; discreet CON: takes effect slowly; can cause skin rash and itching; can cause heart problems if smoker continues to smoke
53

Nicotine Patch Replacement Therapy

Suggested a 6-10 week program Treatment should be individualized as appropriate Precautions to pregnant, lactating women, patients within 4 week of myocardial infarction, with serious arrhythmias, and with severe or unstable angina Rotate patch sites and treat with steroid creams to minimize skin reactions

NicoDerm CQ Has What Nicotrol Does NOT

Nicotrol stop smoking patch has only one strength of nicotine After 6 weeks youre looking at one single step down NicoDerm CQ has 3 strengths You gradually step down your dose over 10 weeks

NICOTINE INHALER
Cigarette-like inhaler that releases nicotine into the mouth PRO: satisfies cravings and oral fixations; simulates cigarette smoking CON: use requires more puffs than a cigarette, causing some to overdose Available by prescription only

NICOTINE NASAL SPRAY

Spray that releases nicotine into the nasal passages PRO: fastest acting of the nicotine products CON:Needs to be used once or twice an hour; can irritate nasal membranes; very addictive Available by prescription only

LOZENGE

NICOTINE REPLACEMENT THERAPY

For these medications to be effective and harmless, they should be used AFTER YOU QUIT smoking

Zyban
First non-nicotine smoking cessation aid cleared by FDA Drug is available by prescription only 49% of patients quit smoking after 4 weeks of using Zyban The active ingredient is bupropion Also found in antidepressant drug marketed as Wellbutrin SR

Zyban
Must begin taking Zyban before your quit date, while you are still smoking and let the dose build up in your body Whereas NRT helped with the physical symptoms of withdrawal, Zyban helps with the emotional and mental See your doctor right away to get a prescription

Dr. Linda Hyder Ferry

Fifth-generation Adventist and LLU graduate I believe this happened by Gods guidance. He gave me a persistent burden to do something about smoking Noticed that nicotine was a wonderful anti depressant

The Great American Smoke-Out

Third Thursday in November

Thinking About Quitting

Breaking the addiction is possible.

Physical addiction to nicotine is relatively easy to break. (1 week of total abstinence)

Breaking the psychological addiction is more challenging.

(Session V -develop our own master plan)

Pharmacologic Therapy
Non-Nicotine

Therapy

Bupropion-Zyban

Nicotine

Replacement Therapy

Nicotine

patch Nicotine gum Nicotine nasal spray Nicotine inhaler Nicotine lozenge
Combination

Therapy

Free and bound nicotine Ammonia Caffeine