Nicotine

1
Nicotine

• Chapter 7

2
History of Tobacco

• History of Tobacco Nicotine
• Smoking practiced among the early Mayas, probably
  in the district of Tabasco, Mexico, as part of
  their religious ceremonies 86-161 AD
• Europeans first exposure from Columbus 1492.
  Exposure was not widespread. Tobacco was not
  well thought of at first

3
History of Tobacco

• 1560 - Marked as 1st yr tobacco officially
  introduced to Europe
• Proponents of tobacco
• Sir Francis Drake
• Sir Walter Raleigh
• Led to the fashionability of pipe smoking of
  tobacco

4
History of Tobacco

• King James I of England
• 1604 - Pamphlet condemning tobacco
• bewitching of tobacco
• Early 1700s Russia
• Westernization of people
• penalties for smoking (torture, Siberian exile,
  death)

5
History of Tobacco

• By 17th century
• Tobacco here to stay
• In Western Europe, used as treatment for
  migraines
• Japan China stop enforcing prohibition of use
• Russia opens door to West
• Sultan of Turkey begins to smoke

6
History of Tobacco

• 1828 - Nicotine was isolated
• Cigarettes first appeared in 1850s, but chewing
  still more popular

7
Tobacco Nicotine In US

• In U.S., tobacco became major commodity in early
  1600s, used as currency
• Financed Revolutionary War
• Ben Franklin promised Virginia's tobacco to
  France
• Had it not been for tobacco, no French assistance
  no USA

8
Tobacco Use in 20th Century

• Future favored cigarettes over other usage
• New emphasis on social manners
• Public health issues of infectious disease
• decrease in chewing except in small rural towns
  of U.S.
• Women began smoking
• But, 1904 NYC woman arrested for smoking in
  public
• 1920s - reach for a Lucky instead of a sweet
• Promoted weight loss effects
• Also cigarettes in WWI

9
Tobacco Nicotine In US

• 1890s - no medicinal value for nicotine
• dropped from U.S. pharmacopia
• 1925 - 14 states banned smoking
• 1938 - study linking cigarettes lung cancer
• 1954 - more stats relating smoking to lung cancer
  cardiovascular disease
• 1964 - first Surgeon General's report
• advised smoking shortens life expectancy
• 1986 - Surgeon General's report on passive
  smoking
• Use continued to decline over past twenty years
• 2000 Worldwide consumption still on increase

10
Nicotine Forms

• Tobacco
• Smokeable
• Cigarette
• Pipe
• Cigar
• Leaf (Chewing)
• Leaf (Dip)
• Snuff (powdered)
• Transdermal Patch

11
Snuff

• Grind tobacco into fine powder
• Pinch into nose exhale with sneeze (cleared
  head of superfluous humours)
• 1700s snuff overtook smoking as method of
  choice
• Started in France spread through rest of Europe

12
Chewing

• In U.S., snuffing replaced by chewing
• Freed hands for working
• Low cost - democratic custom all could have
• spitting seen as nasty habit, also health issue
• Major cause of spread of infectious disease (TB)

13
Cigar Smoking

• Tight rolls of tobacco leaves
• Flue-curing - process of heating tobacco leaves
• to cure them, makes milder smoke
• Also new type of leaf
• North Carolina 1 tobacco-growing center
• Mixed effects of chewing with ingestion of smoke

14
Cigarettes

• Rolls of shredded tobacco wrapped in paper
• 1614 Invented by beggars in Seville, Spain from
  scrap of cigars
• 1856 - Became popular with English soldiers in
  Crimean War - Spread throughout Europe
• U.S, not inclined to use it
• Public image
• Rumors of opium, arsenic laced paper, camel
  dung,
• Also image
• cigarette - dainty sissy
• vs. cigars - fat, long dark

15
Cigarettes

• 1881 - James Bonsack patented cigarette-making
  machine
• Made cigarettes even more low-cost
• Revolutionized tobacco industry
• From 300 cigarettes per hour by hand to 3
  machines producing 200 cigarettes per minute

16
Cigarette Smoking

• Nicotine in a cigarette 8 to 10 mg
• Smoking delivers about 1-3 mg to the smoker
• Technique of smoker can increase nicotine (time
  smoke is in lungs, rapid puffing)

17
Nicotine Pharmacology

• Biphasic action- nicotinic acetylcholine
  receptors
• Agonist low doses
• Antagonist high doses
• Although a stimulant, it is often used to relax
• Works in CNS and PNS
• One of the most toxic dependence-producing
  psychoactive compounds overall
• Nicotine acts to stimulate dopamine release in
  mesolimbic dopamine pathway (reward center).

18
Nicotine Pharmacology

• One of most powerful poisons ingested by
  Americans
• LD50 60 mg
• Can't happen via inhalation
• Orally, two protections against death
• quick first pass metabolism through liver
• activation of vomiting center

19
Peripheral Effects

• A sympathomimetic
• Increases heart rate, blood pressure, respiration
• A parasympathomimetic
• Increases smooth muscle (GI tract) activity
• Increases HCL production in stomach

20
Central Effects

• Arousal
• Improves vigilance rapid information processing
• Improves mental performance memory
• Stimulates adrenalin and ADH release
• Nicotine may reverse some deficits caused by
  alcohol

21
Biotransformation/Excretion

• Broken down by lung and liver
• gt90 in liver
• Metabolization of nicotine and other toxins in
  cigarette smoking lowers blood levels of many
  important drugs.
• Excreted through kidneys (urine)
• Lungs do some excretion

22
Tolerance

• Develops rapidly
• Within the first exposure for some effects
• Area Postrema
• Can build up and dissipate over the course of a
  day
• Chronic tolerance happens as well
• Dispositional Tolerance
• Some smokers clear nicotine faster

23
Dependence

• One of the most dependence-producing drugs
• Pharmacology Stimulates reward center
  influences ANS
• Function Weight control, coping with negative
  affect/stress, cognitive enhancement
• Social Factors Friends, habit, context

24
Withdrawal Symptomsof Nicotine

• Lethargy, decreased arousal
• Constipation
• Headaches
• Disrupted sleep cycles
• Irritability/anxiety
• Excessive hunger (blood sugar drop)

25
Compounds in Tobacco

• Tar - sticky substance
• Amount varies from 12 - 16mg to 6mg
• Last 3rd of cigarette contains 50 of tar (final
  puffs more hazardous)
• Prevents cilia from working, decreases cilia
  escalator
• Increases carcinogens compounds to settle on
  tissue rather than being expelled

26
Compounds in Tobacco

• Carbon Monoxide
• Odorless tasteless, but extremely toxic
• Attaches to hemoglobin
• Hemoglobin has greater affinity for CO than
  oxygen
• Accumulation of CO occurs
• Leads to asphyxiation of body

27
Health Effects of Nicotine Addiction

• Cardiovascular Disease
• Most likely killer
• Cancer
• Approx 90 of all lung cancer
• Chronic Obstructive Pulmonary Disease
• All long-term smokers get some level of COPD
• Emphysema most serious

28
Approaches to Treatment

• Self-help
• Behavioral intervention
• Pharmacotherapy
• Combined strategies

29
Nicotine Replacement

• Nicotine gum
• Transdermal nicotine
• Nicotine aerosols

30
Pharmacotherapy

• Clonidine
• SSRIs
• Zyban

31
Quitting Overall

• Combination of strategies works best
• Behavioral replacement pharmacotherapy
• Quitting reduces risk of all-cause mortality
  among other diseases
• Risk of lung cancer remains elevated but drops
  significantly