What are the physiologic effects of nicotine, a highly addictive substance found in tobacco (Nicotiana tabacum), on the human body, particularly in relation to blood pressure, gastric acid secretion, nausea, alertness, and appetite regulation?

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 concerns during smoking 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 high doses or in new users, it does not typically suppress nausea or cause vomiting at the doses obtained through regular smoking, as seen in cases of green tobacco sickness reported 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 3
• Suppression of appetite 3
• Suppression of nausea 4
• Vomiting is a symptom of nicotine withdrawal, not a direct effect of nicotine 4
• Decreased gastric acid is not a well-documented effect of nicotine, however, nicotine can stimulate gastric acid secretion in some cases 3

Nicotine Withdrawal Symptoms

Nicotine withdrawal symptoms include:

• Negative affect 5
• Somatic symptoms 5
• Sleep problems 5
• Craving 5, 6
• Increased heart rate variability and weight gain have been observed after smoking cessation 3