THE PATHOPHYSIOLOGY OF NICOTINE DEPENDENCE - TREATMENT OPTIONS AND THE CARDIOVASCULAR SAFETY OF NICOTINE

Not long ago tobacco smoking was regarded as a bad habit. Today some o f the neuropharmacological effects of nicotine intake are well underst ood. The nicotine acts on the nicotinic cholinergic receptors, causing an upregulation in receptor density leading to tolerance and physical withdrawal. The neuroadaptation varies in degree, and some smokers ra pidly become dependent on nicotine for their well being. Physicians ha ve an important task in helping motivated smokers to quit or in buildi ng up that motivation in smokers. Medical treatment, almost exclusivel y nicotine-containing medications, can effectively help smokers deal w ith the nicotine dependence aspect of tobacco smoking. Although a few may need to use these medications to prevent relapse for many months o r even years, their safety is generally not a problem. Fairly complete tolerance develops to most of the cardiovascular effects of nicotine, Nicotine, as delivered by the present nicotine medications (slow onse t, lower concentrations, and no arterial boli), does not influence the established cardiovascular risk factors in the same way as smoking ci garettes. The development in the field of smoking cessation is rapid, and the future will bring new tools for diagnosing and treating the sm oker.