24 Tobacco Dependence

Question 1

How would you treat a PE if the patient was becoming hypotensive?

(body cannot dissolve the clot quick enough)

Answer 1

Give:

streptokinase or tissue plasminogen activator

Question 2

When does wheezing occur and why?

Answer 2

• Expiration as there is more resistance on expiration
• Due to narrowing of airways so high pitched whistling sound

Question 3

What is consolidation and why are bronchial breath sounds heard when you auscultate over an area of consolidation?

Answer 3

• When air from the airways is replaced by something else
• As the consolidation conducts sounds from larger airways so heard louder

Question 4

Why is there creptius over the wound, why does he have a low blood pressure and how would you manage this patient?

Answer 4

• Fracture of the rib
• Increased pressure in the right side so reduced venous return as SVC compression and mechanical shock
• Insert cannula into 2nd ICS mid clavicular line - reliev tension pneuomthorax

Question 5

What are some lung conditions that cause mediastinal shift to the same side?

Answer 5

• Lobar collapse
• Pulmonary fibrosis

Question 6

If your’re a smoker, what are your chances of dying from tobacco related disease?

Answer 6

If you are a smoker, chances of dying from a tobacco related disease are 1 in 2

Question 7

Why is knowing about the prevalence of smoking important?

Answer 7

• 14 in 100 smoke
• Tobacco related disease is the single biggest cause of preventable morbidity and mortality

Question 8

What are some tobacco related diseases?

Answer 8

• Risk of CVS disease
• More likely to get influenza
• Risk of sudden infant death
• Lung cancer
• Stroke
• AAA

Question 9

What are the markers of addiction?

Answer 9

Question 10

How does nicotine cause an addiction on a chemical level?

Answer 10

• Acts on nAchR to stimulate dopamine release so satisfaction
• Chronic nicotine exposure causes AChR to be upregulated, increasing affinity and sensitivity to an agonist
• Drop in nicotine leads to withdrawals
• Takes 6-12 weeks fo receptors to desensitise after last cigarette

Question 11

What is the speed of nicotine delivery?

Answer 11

Seconds

Question 12

What approach should a doctor initially take to try and stop somebody from smoking? (AAA)

Answer 12

Health professional have big impact on a person’s decision and low NNT (number needed to treat to prevent one death) so good

Question 13

What are some pharmacological treatments for a tobacco addiction?

Answer 13

• Long acting patches
• Short acting gum, lozenges, spray
• Champix for 4-12 weeks
• Course of tablets which can help to relieve the craving and withdrawal symptoms associated with stopping smoking*

Question 14

What is a harm reduction approach to curing a tobacco addiction?

Answer 14

• E-Cigarettes

–> Contain nicotine but not tobacco so still addiction but less harm from tobacco

Question 15

What are the arguments for and against the use of e-cigarettes as a harm reduction strategy for tobacco addiction?

Answer 15