Effects of Nicotine

• Contents of tobacco smoke?

  There are gaseous and particulate phases

  • nicotine
  • CO
  • cyanide
  • ammonia
  • benzene
  • heavy metals
  • Free radicals
  • PAHs
  • Nitrosamines
• What do free radicals do?

  Damage DNA and cause inflammation
• what are nitrosamines 


  carcinogens
• what does CO do?

  deplete oxygen supply
• Nicotine effects?

  • stimulates neuronal receptors
  • affects +++ areas of brain
  • stimulants and relaxant
  • other neurotransmitters and hormones effected
  • cellular receptors
  • immune function depressed = cancer stimulation
• Nicotine receptor -> N1 or Nm

  neuromuscular junction
• Nicotine receptors -> N2 or Nn

  Autonomic ganglia, CNS and adrenal medulla
• effect on the brain ?

  • reduced electrical flow through grey and white white as it affects myelin sheath
  • reduced blood flow via vasoconstriction - linked to dementia depression
  • Reduced electrical flow through grey and white matter
  • Reduces blood flow – promotes dementia
  • Increases anxiety and depression
  • Greater risk of schizophrenia and bipolar
  • More strokes + aneurysms
  • Sleep disturbance due to altered neurotransmitters
  • Enhances dopamine production - protects against Parkinson’s
• particulate phase 


  mostly tar which contains the carcinogens
• Gaseous phase?

  • contains nicotine
  • carbon minoxide
  • nitric oxide
• What are the mental benefits of nicotine?

  • reduced anxiety
  • better concentration
• what are the heavy metals?

  cadmium and lead
• what are free radicals

  highly reactive short term chemicals that can attack macromolecules like DNA, lipids and proteins. They can also combine w macromolecules to change structures
• What are the two types of nicotonic receptors in the brain

  N1 and N2
• nicotine receptors are found on

  immune cells
• Head and neck ?

  • Topical and systemic effects – perio, cancer,
  • Affects saliva (reduces enzymes and ionic components), oral flora (more pathogens), reduces bone formation
  • Enhances HPV infection
  • Tongue; nasopharangeal and laryngeal cancer
  • Thyroid effects - changes hormone levels
  • Taste, smell and hearing diminished
  • Major cause of blindness
  • Facial skin – wrinkles, yellowing (free rads changes elasticity of collagen)
  • Hair loss
• CVD?

  • cause of CHD
  • Enhances atherosclerosis
  • +++ risk of stroke
  • Worsens peripheral arterial disease
  • Weakens heart muscles, makes myocardia less active, leads to heart failure
  • risk factor for cardiac surgery
  • Greater risk of leukaemia and lymphoma (affects blood cell formation in bone marrow)
• How does smoking cause heart disease ?

  • interacts with lipids in blood
  • increases activity of platelets
  • causes greater deposition of fat into wall = atherosclerosis and reduces diamater of vessels to heart
  • lack of o2 = cardiac muscle dies
• GI?

  • Increases reflux and Barrett’s - nicotine in saliva and swallowed so affects valve
  • Stomach cancer
  • Peptic ulcers - bc reduced HCO3
  • Increased risk of pancreatitis and reduced insulin prod
  • Hepatitis and non-alcoholic liver disease
  • Small intestine - increases risk of Crohn’s disease
  • Colon - decreases risk of ulcerative colitis – inflammatory response
  • Colon and rectal ca increased – HPV infection
• lungs ?


  • Increases inflammation and COPD ( +++ mucous and cilia are inhibited by nicotine)
  • Nicotine absorbed through mucosal lining
  • Free radical attack
  • DNA changes by adduction, mutation and breakage
  • Increased risk of squamous cell cancer, asthma
  • More respiratory infections including TB
  • epithelial becomes columnar epithelium and so have more goblet cells = more mucous
• what is barretts oesophagus

  cells of oesophagus lining become more columnar rather than square. Leads to tightening of oesophagus and eventually cancer
• what are peptic ulcers

  a break in lining of the stomach, neutral barrier destroyed as smoking reduces protoglandins which means they dont make bicarbonate ions
• side effects of vaping?

  • Dry mouth
  • Dry skin
  • Rash/burning sensation on face
  • Itchiness
  • Puffy/dry eyes
  • Caffeine sensitivity as affects tastebuds
  • Minor blood nose issues
• UT?

  • Increased risk of chronic kidney disease
  • Renal and bladder cancer more prevalent in smokers- accumulation of toxins in urine and contact with tissues while stored
  • Reduced effect of renal replacement therapy (dialysis)
  • Poorer outcome after transplant
  • More UTIs and STDs
• Male reproductive tract ?

  • Vasoconstriction induced impotence
  • Low sperm count and viability
  • Increased risk of prostate cancer
• Women reproductive tract ?

  • Increased Cervical intraepithelial neoplasia (precancerous condition caused by HPV)
  • Reduced pregnancy and viability, ovaries have reduced capacity to release eggs
  • Poorer outcome from IVF
  • Small for gestation babies as uterus have reduced blood flow
  • early delivery
  • Reduced risk of endothelial cancer
• skin and bones ?

  • Reduced blood flow to skin
  • Distorted and inadequate collagen = wrinkles, premature aging
  • Poor wound healing = complications after plastic and ortho surgery, more scarring
  • Reduced bone growth = +++ dental implant failure
  • Poorer recovery after fracture
  • Increased osteoporosis
• issues with asking about smoking ?

  • might lie
  • +++ antisocial attitudes
  • need biochemical testing for accuracy - either co monitor or lab continine testing
• issue with CO monitoring

  CO is short lived in the body and so can only measure smoking over 8 hour period, is also expensive
• nicotine cant be measured, conitinine is measured instead why?

  nicotine has short HL but is broken down into continine which has a longer half life (3days)
• issues with continine ?

  • time consuming (3/4 days for results)
  • what do you do with result as pt already left
  • expensive
• Rapid continine testing ?

  • Developed urine smokescreen to engage pregnant smokers
  • Feedback improved intervention as near patient test (pt still present)
  • Developed saliva test - done in 5 mins
  • urine/saliva turns pink if smoking
  • Result correlate with oral variables
• E cigarettes?

  • Nicotine not carcinogenic but tumour promoting
  • Many of the effects due to immune suppression
  • Nicotinic receptors on oral epithelium