35: Vaping

Question 1

how does vaping work?

Answer 1

e liquids that contain nicotine are heated to produce an aerosol, which can then be inhaled

Question 2

T or F: ecigs do not have vapors

Answer 2

T

Question 3

what are first gen Ecigs

Answer 3

disposable ecig

Question 4

what are 2nd gen ecigs

Answer 4

battery pen with cartridge (prefilled or refillable)

Question 5

what are 3rd gen ecigs

Answer 5

modifiable- allows variable voltage/ watts, tank/ subohm (refillable)

Question 6

what are 4th gen ecigs

Answer 6

pod mod (prefilled or refillable)

Question 7

why do people modify their vaping devices

Answer 7

to drip liquids directly onto atomizer to get more aerosol conversion

Question 8

e liquids are typically a mix of

Answer 8

water,, food grade flavoring, nicotine/ cannabis, propylene glycol, vegetable glycerin

Question 9

___ and ___ are used as humectants in vapes

Answer 9

PG and VG

Question 10

T or F: the toxic effects of aerosol flavoring chemicals are well known

Answer 10

F- unknown, effects of nicotine well known

Question 11

newer modes of ecigs use nicotine ___

Answer 11

salts

Question 12

what is different about nicotine salts from normal free base nicotine

Answer 12

lower pH than free base nicotine = ↑ exposure = ↑ lvls inhaled more easily with less throat irritation

Question 13

T or F: ecigs are approved as a quit smoking aid

Answer 13

F- but may assist

Question 14

which of the following is true
1. ecigs generally contain fewer toxic chemicals than regular smoking
2. e cig aerosols are only inhaled by the smoker, there is less chance of second hand smoke
3. e cigs are approved by HC as a harm reduction alternative to smoking
4. 2nd gen devices are modifiable

Answer 14

1

Question 15

vapine requires users to do _______ (shorter/ longer and harder/ softer) puffs than cigs

Answer 15

longer, harder

Question 16

thermal degradation of 1,2, propylene glycol and glycerin produces

Answer 16

acetaldehyde, acrolein, formaldehyde

Question 17

____ and ____ are found in majority of ecigs as the flavoring agent

Answer 17

diacetyl and 2,3 pentanedione

Question 18

diacetyl and 2,3 pentanedione are linked to ___________. there is evidence they _________

Answer 18

bronchiolitis obliterans
impair production and function of cilia in human airways

Question 19

which of the following is not an ingredient found in vape aerosols
1. carbonyl compounds
2. diaetyl and 2,3 pentanedione
3. organic compounds
4. metals
5. all of the above are found in vape aerosols

Answer 19

5

Question 20

VAPI is

Answer 20

vaping associated pulmonary injury

Question 21

VAPI sx

Answer 21

acute or subacute chemical pneumonitis, cough, dyspnea, chest pain, N/V/D, and pain
Rapid onset
Pulmonary infiltrates on chest radiography (atypical pneumonia)
some pts require ICU and vent support, some develop ARDs

Question 22

VAPI predominantly affects

Answer 22

young males and healthy individuals who used an ecig within 90d of onset

Question 23

describe the pathogenesis of VAPI

Answer 23

largely unknown- associated with products that contain THC and/or vit E acetate used to thicken or dilate the THC in vaping products

may be due to interference with membrane function, heating producing ketenes (Reactive compound)

Question 24

T or F: what is vit E acetate used for in cannabis vapes

Answer 24

to thicken or dilute THC

Question 25

what is bronchiolitis obliterans

Answer 25

popcorn lung inflam of bronchioles = damage = scarring = airway occlusion

Question 26

what is the major toxic substance associated with developing popcorn lung

Answer 26

acetaldehyde (found in most flavoring agents) also diacetyl,. ammonia, chlorine, formaldehyde, fumes from metal oxides, HCL, mustard gas or sulfur mustard, nitrogen oxides, sulfur dioxides

Question 27

what does dumbbbelss stand for in the cholinergic toxidrome

Answer 27

diarrhea, urination, miosis/ muscle weakness, bronchorhea, bronchospasm, bradycardia, emesis, lacrimation, salivation, sweating

Question 28

nicotine poisoning is ____ absorbed by ______, enters ____ and _______ metabolized

Answer 28

rapidly absorbed by all routes enters brain quickly rapidly metabolized

Question 29

nicotine undergoes _____ excretion

Answer 29

urinary

Question 30

there is an ____ incidence of nicotine poisoning in children

Answer 30

increased

Question 31

sx of nicotine poisoning includes

Answer 31

dependence, feeling awake or relaxed, diarrhea ↑ HR/ stroke volume, weight loss, ↑ BP, inhibition of urine production, vomiting, ↑ pain sensitivity, risk of thrombosis, ↑ RR

Question 32

nicotine dose and time dependent effects are ______

Answer 32

biphasic

Question 33

GI sx in early nicotine poisoning

Answer 33

N/V, salivation, abd pain

Question 34

resp sx in early nicotine poisoning

Answer 34

bronchorrhea, hyperpnea

Question 35

CV sx in early nicotine poisoning

Answer 35

HPTN, tachycardia, pallor

Question 36

neuro sx in early nicotine poisoning

Answer 36

Agitation, anxiety, dizziness, blurred vision, HA, hyperactivity, confusion, tremors, fasiculations, seizures

Question 37

GI and resp sx in late nicotine poisoning

Answer 37

diarrhea hypoventilation, apnea

Question 38

CV sx in late nicotine poisoning

Answer 38

bradycardia, hypotension, dysrhythmias, shock

Question 39

neuro sx in late nicotine poisoning

Answer 39

lethargy, weakness, paralysis

Question 40

key cannabis receptors are

Answer 40

CB1 and CB2

Question 41

cannabis triggers both _______ and _______

Answer 41

catecholamine release + inhibition of sympathetic reflexes

Question 42

acute effects of cannabis include

Answer 42

↓ coordination, muscle strength, lethargy, concentration, psychomotor activity

Question 43

nonclassical effects of cannabis include ________ and are more common with __________

Answer 43

agitation and seizures more common with synthetic or spice blends, incense packaging

Question 44

AEs from synthetic cannabinoids

Answer 44

sx: blank stare, slow response, normal vitals, lethargy, arousable, normal reflexes, normal pupils, groaning sounds, slow mech movements = zombie like description

Question 45

why do people do bagging/ huffing/ sniffing/ spraying

Answer 45

Intoxicating effects immediately Plethora of chemicals readily absorb through lungs + distribute rapidly Initially stimulating, then less inhibited + less in control Chemicals prevent/ limit breathing in oxygen

Question 46

ST effects of huffing/ etc

Answer 46

HA, N/V, loss of balance, dizziness, slurred and slowed speech, mood changes, hallucinations

Question 47

LT effects of huffing/ etc

Answer 47

cardiotoxicity (from inflam, CHF, sudden cardiac death), respiratory damage, anoxic brain damage, liver and kidney damage, progressive neuro injury (ex- hearing loss, muscle spasms, loss of coordination), loss of concentration, ST memory loss

Question 48

what is sudden sniffing death syndrome

Answer 48

abrupt CV collapse due to irreg HR (~505 of inhalant related deaths)

Question 49

1,1 difluoroethane (DFE) is an ____________ used as refrigerant chemical component of canned air

Answer 49

organic HC, colorless, odorless gas

Question 50

sx of inhaling DFE

Answer 50

inebriation, frostbite, blisters, CNS depression (drowsiness, N, HA, fatigue, weakness) Asphyxiant (displaces oxygen) + heavier than air + flammable

Question 51

pathophys of sudden sniffing death syndrome

Answer 51

Cardiac dysrhythmias Sensitization of myocardium to catecholamines Blocks K and Ca channels and sodium current = prolongs repolarization or ↑ QT dispersion Effects often unpredictable and occur in first time users Startled by being caught = sudden release of catecholamines

Question 52

how to tx sudden sniffing death sx

Answer 52

CPR, defibrillation, BB (avoid epi)