PS452 Unit 5 Nicotine and Sedatives Paper Example

A Prescription and a Pack a Day: A PS452 Unit 5 Nicotine and Sedatives Paper

[Student Name]

Purdue University Global

PS452: Psychopharmacology of Alcohol and Drugs

Unit 5 Nicotine and Sedatives Paper

[Instructor Name]

[Date]

The writer, the unit, the patient and every detail are composite and illustrative; the sources cited are real.

Rhonda

Rhonda, sixty-three, was prescribed alprazolam for anxiety twelve years ago after her husband's death. Over time her dose rose, she began getting extra pills from a second doctor, and two falls in one winter led her family and physician to arrange a supervised taper on our Albuquerque withdrawal unit. She has also gone through twenty cigarettes a day since she was eighteen. Our unit is smoke-free, and within an hour of arriving, she asked the nurse for a nicotine patch.

Both of Rhonda's drugs are legal. Both act on the brain's reward system, both produce tolerance and dependence, and stopping either brings withdrawal. Their mechanisms and their dangers differ.

The Cigarette

Benowitz (2010) reviewed the pharmacology of nicotine addiction. Nicotine attaches to nicotinic acetylcholine receptors, especially a subtype found on dopamine neurons in the brain's reward pathway, and stimulates dopamine release. Each puff carries nicotine from the lungs to the brain in a matter of seconds, and a pack-a-day smoker repeats that rapid delivery hundreds of times a day, tightly linking the drug's effects to routines such as coffee, meals and stress. With repeated exposure, nicotinic receptors adapt and increase in number, and when nicotine levels fall, as overnight, the smoker experiences irritability, anxiety, difficulty concentrating and craving. Many smokers describe the first cigarette of the day as relief more than pleasure.

Benowitz also noted that most of the harm of smoking comes not from nicotine but from the other compounds in tobacco smoke, which cause cancer, heart disease and lung disease. Treatments that supply nicotine without smoke, such as patches and gum, or that act on nicotinic receptors, such as varenicline, help many people quit.

Benzodiazepines

Alprazolam and the other benzodiazepines strengthen GABA's action at GABA-A receptors, so inhibition increases. That action reduces anxiety, promotes sleep and relaxes muscles. For years, benzodiazepines were thought to carry little risk of addiction because they do not act directly on dopamine.

Tan et al. (2011) described how benzodiazepines do reach the reward system, indirectly. In the brain region that contains dopamine neurons, GABA-releasing interneurons normally hold dopamine neurons in check. Benzodiazepines act strongly on a type of GABA-A receptor found on those interneurons, quieting them, which releases the brake on dopamine neurons and increases dopamine signaling. This disinhibition, they argued, helps explain the addictive potential of benzodiazepines in some users.

Benzodiazepines do not push dopamine up directly; they quiet the cells that were holding it down.

Why Rhonda's Dose Kept Rising

Rhonda described a pattern common with short-acting benzodiazepines. Alprazolam takes effect quickly and wears off within hours, so as each dose faded she felt a surge of anxiety, sometimes worse than the anxiety she had been treated for. She took the next pill sooner, and over the years her doctor raised the dose. Part of what she experienced was likely withdrawal between doses, a rebound that a short-acting drug produces several times a day once dependence has developed. Tolerance also develops unevenly: people become tolerant to the sedating effects of benzodiazepines faster than to some of their other effects, so a dose that once made her drowsy no longer did, while the cycle of relief and rebound continued. This is one reason her physician switched her to a longer-acting benzodiazepine for the taper. A drug that leaves the body slowly produces steadier levels and smaller swings between doses.

Smoking and Other Medicines

Smoking also changes how the body handles some medicines. Chemicals in tobacco smoke, not nicotine itself, speed up a liver enzyme that breaks down certain drugs, including some antipsychotics and caffeine. When a heavy smoker stops, levels of those drugs can rise. Rhonda took none of them, but the nurse checked her medication list for interactions when the patch replaced her cigarettes, as our protocol requires for every smoker.

Withdrawal Compared

Nicotine withdrawal is unpleasant but not medically dangerous. Benzodiazepine withdrawal can be. Like alcohol, long-term benzodiazepine use leads the brain to adapt to constant GABA enhancement, and abrupt stopping can produce severe anxiety, insomnia, tremor, perceptual changes and seizures (Meyer & Quenzer, 2019). For that reason, Rhonda's physician planned a gradual taper, switching her to a longer-acting benzodiazepine and reducing the dose slowly, with the outpatient phase to continue for weeks after discharge.

The Danger of Combining Sedatives

Benzodiazepines are especially dangerous combined with other depressants. Alcohol and opioids also suppress breathing, and the combination can stop it altogether. Rhonda did not drink or use opioids, but her falls showed another risk: sedation and unsteadiness make falls and broken bones more likely, particularly at her age.

Treating Both on the Unit

The nurse gave Rhonda a nicotine patch on the physician's order, which eased her craving and irritability within the first afternoon and kept her from adding nicotine withdrawal to the anxiety of the benzodiazepine taper. We also offered information about quitting smoking for good. She said she would think about it after the taper, which her physician considered reasonable: stopping two dependence-producing drugs at once is hard, and the benzodiazepine taper was the medical priority.

Rhonda's Course

Over six days, Rhonda's dose fell by a quarter without seizures, though her sleep was poor and her anxiety rose each evening. Her outpatient plan continues the taper over two months with cognitive behavioral therapy for anxiety, so that she has another way to manage it as the medication comes down. Her daughter will drive her to the first appointments, and her physician agreed to see her every two weeks while the dose falls, adjusting the pace if her sleep or anxiety becomes unmanageable.

What the Comparison Shows

Legal status says little about pharmacology. Nicotine is highly addictive and its delivery by smoking is deadly, though nicotine itself is relatively safe. Benzodiazepines are useful medicines with a real risk of dependence and a withdrawal that can be dangerous. Understanding the mechanisms helps explain why one patient needed a patch within an hour and a taper over months.

Conclusion

Rhonda's two legal drugs act through different receptors, nicotinic acetylcholine receptors for nicotine and GABA-A receptors for alprazolam, and both reach the reward system, nicotine directly, as Benowitz describes, and benzodiazepines through disinhibition, as Tan and colleagues explain. Their withdrawals differ in danger, which is why her treatment combined a patch with a slow taper.

References

Benowitz, N. L. (2010). Nicotine addiction. New England Journal of Medicine, 362(24), 2295-2303. https://doi.org/10.1056/NEJMra0809890

Meyer, J. S., & Quenzer, L. F. (2019). Psychopharmacology: Drugs, the brain, and behavior (3rd ed.). Oxford University Press.

Tan, K. R., Rudolph, U., & Lüscher, C. (2011). Hooked on benzodiazepines: GABAA receptor subtypes and addiction. Trends in Neurosciences, 34(4), 188-197. https://doi.org/10.1016/j.tins.2011.01.004