From the Guidelines
The physiologic effects of nicotine that a nurse practitioner should correctly teach in a smoking cessation class include increased blood pressure, increased alertness, and suppression of appetite. Nicotine stimulates the sympathetic nervous system, causing the release of catecholamines like epinephrine and norepinephrine, which leads to increased blood pressure and heart rate, as supported by the study published in the Journal of the American College of Cardiology 1. Nicotine also acts on the central nervous system to increase alertness and cognitive function by stimulating the release of neurotransmitters such as dopamine and acetylcholine. Additionally, nicotine suppresses appetite by affecting the hypothalamus, which regulates hunger signals, contributing to weight control in smokers and potential weight gain during cessation. Some key points to consider when teaching about nicotine's effects include:
- Increased blood pressure: Nicotine poses risks to the cardiovascular system, including causing an increase in blood pressure, heart rate, flow of blood to the heart, and a narrowing of the arteries, as stated in the study published in the Journal of the American College of Cardiology 1.
- Increased alertness: Nicotine acts on the central nervous system to increase alertness and cognitive function.
- Suppression of appetite: Nicotine suppresses appetite by affecting the hypothalamus, which regulates hunger signals. It's also important to note that nicotine actually increases gastric acid production rather than decreasing it, which can contribute to gastrointestinal issues in smokers, and while nicotine can cause nausea in new users or at high doses, it does not suppress nausea, and vomiting is typically associated with nicotine toxicity rather than regular use, as discussed in the study published in Pediatrics 1.
From the FDA Drug Label
The cardiovascular effects of nicotine include peripheral vasoconstriction, tachycardia, and elevated blood pressure Nicotine toxicity is characterized by nausea, abdominal pain, vomiting, diarrhea, diaphoresis, flushing, dizziness, disturbed hearing and vision, confusion, weakness, palpitations, altered respiration and hypotension. Withdrawal from nicotine in addicted individuals can be characterized by craving, nervousness, restlessness, irritability, mood lability, anxiety, drowsiness, sleep disturbances, impaired concentration, increased appetite, minor somatic complaints (headache, myalgia, constipation, fatigue), and weight gain The most common nicotine-related adverse event was dyspepsia. Other nicotine related events present in greater than 3% of patients on active drug include nausea, diarrhea, and hiccup.
The correct answers are:
- Increased blood pressure: The FDA drug label states that the cardiovascular effects of nicotine include elevated blood pressure 2.
- Vomiting: The FDA drug label states that nicotine toxicity is characterized by vomiting 2.
- Increased alertness: Although not directly stated, the FDA drug label mentions that nicotine has a stimulating effect, mainly in the cortex via the locus ceruleus, which could be related to increased alertness 2.
- Suppression of appetite: The FDA drug label states that withdrawal from nicotine is characterized by increased appetite, which implies that nicotine itself may suppress appetite 2.
- Suppression of nausea: The FDA drug label does not provide direct information to support this claim. However, it does mention that nicotine-related adverse events include nausea, which could imply that nicotine may not suppress nausea, but rather induce it 2.
From the Research
Physiologic Effects of Nicotine
The physiologic effects of nicotine include:
- Increased blood pressure 3
- Increased alertness 4
- Suppression of appetite 3
- Suppression of nausea is not directly mentioned in the provided studies, however, vomiting is mentioned as a symptom of nicotine withdrawal 5, 4
- Decreased gastric acid is not mentioned in the provided studies
Nicotine Withdrawal Symptoms
Nicotine withdrawal symptoms include: