Exam (elaborations)
NURS 517-Substance Abuse Questions answers latest update
- Course
- NURS 517
- Institution
- University Of Hawaii - Manoa
NURS 517-Substance Abuse Questions answers latest update
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NURS 517-Substance AbuseHow do Nicotine works? - Nicotine is a direct agonist on the nicotinic-type of
cholinergic receptors located in the brain, autonomic ganglia of both the
sympathetic and parasympathetic nervous systems, and the adrenal medulla.
Nicotine, in its most commonly abused formulation (cigarettes), is a stimulant on
these receptors, increasing the activity of certain parts of the brain and the
sympathetic nervous system functions especially.
Kinetics:
Commercial forms of nicotine can be absorbed by inhalation (cigarettes, cigars,
pipe tobacco) and by the transmucosal route (dip, chewing tobacco, and other
forms of smokeless tobacco). Medicinally, it is administered orally as a gum or
lozenge, transdermally (as nicotine patches), and as a nasal spray. Absorption by
the inhalational route bypasses the liver and allows for very rapid increase in
brain levels of the drug. Nicotine by any route is rapidly distributed to the brain
and achieves very high serum levels quickly. It is extensively metabolized in the
liver and has a relatively short half-life (about 1-3 hrs.). It is excreted in the urine.
What are the pharmacologic effects of Nicotine? - - Stimulates nicotinic receptors
in sympathetic ganglia and the adrenal medulla causing the release of
norepinephrine and epinephrine; this results in tachycardia, elevated blood
pressure (even hypertension), and peripheral vasoconstriction from alpha 1
receptor activation.
- Stimulates nicotinic receptors in the brain resulting in arousal, increased
alertness, increased memory functions, increased cognitive functions, mood
, enhancement, improved attention and reaction time, and reduced
aggressiveness.
- It can produce, by unknown mechanisms, nausea, vomiting, decreased appetite
- Nicotine stimulates the secretion of hydrochloric acid by the stomach and
increased G.I. motility.
- Tolerance develops to many, but not all, of the pharmacologic effects of
nicotine (the nausea, vomiting, and tachycardia seem to abate with time)
- Nicotine is a hepatic enzyme inducer; this results in the increased metabolism
(clearance from the serum) of many other drugs.
- Nicotine potentiates the action of sympathomimetic agonists.
- Nicotine antagonizes the action of the alpha-1 and selective beta-1 sympathetic
blocker drugs; when using these types of sympathetic blockers in nicotine
abusers, it may be necessary to use larger than expected doses.
- Nicotine potentiates the peripheral vasoconstrictive effects of the non-selective
beta blockers; it is better to use the selective Beta-1 blockers rather than the non-
selective (Beta-1 and 2 receptor blockers) to avoid the additional peripheral
vasoconstriction that would occur from the combination of nicotine and Beta-2
blockade on peripheral arteries.
- Nicotine enhances the procoagulant effects of the exogenous estrogen drugs
(covered later under Disadvantages of the Estrogens); increases the inappropriate
blood clotting noted with these drugs. Women who smoke and take estrog
What are the withdrawal symptoms of nicotine abuse? - - Withdrawal symptoms
associated with nicotine abuse usually begin within about 24 hrs. and include:
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