Exam 4 Smoking Cessation Drugs Flashcards
Describe Nicotine replacement therapy
○ nicotine = potent vasoconstrictor
○ know contraindications before prescribing
○ patients must completely stop smoking prior to therapy
–important to set a “quit” date before initiating therapy
– nicotine raises cardiovascular risk, so can’t smoke at same time
○ formulations: gum, lozenge, inhaler, nasal spray
–most available OTC
○ used in step-down approach for 7-12 weeks (3 months period of time)
–dose used is less than what is obtained through smoking
– decreasing dosage w/ time
○ dosing gradually tapers down to wean off nicotine
○ all products designed to decrease cravings for nicotine
Describe bupropion (Zyban
○ dopamine reuptake inhibitor
–antidepressant = Wellbutrin
○ treatment = 7-12 weeks
○ risk for seizures: avoid alcohol (lowers risk)
○ risk of emergent hypertension w/ concurrent patch use
–Always take BP before giving epinephrine
○ adverse psychological events
Describe varenicline (Chantix)
○ Newest smoking cessation drug on market
○ partial neuronal alpha-4 B2 nicotinic receptor agonist
–occupies nicotine receptor sites in brain
○ prevents nicotine stimulation of mesolimbic dopamine system associated w/ nicotine addiction
○ stimulates dopamine activity, but to a lesser extent than nicotine
–results in decreased craving + withdrawal symptoms
○ increased side effects when used w/ nicotine replacement therapy
○ oral side effects = xerostomia, taste alteration
○ general side effects = insomnia, headache, abnormal dreams, nausea
–new reports of suicidal thoughts, erratic/aggressive behavior, adverse cardiac events
○ safety + efficacy NOT established in children
Describe the length of time typically needed for successful smoking cessation therapy.
● 70% of women who smoke want to quit
● Average number of quit attempts: 8-11
● Women/girls prefer cessation programs that offer social support
● Smokers are 50% more likely to quit with social support
● Ask, Advise, Refer= program to assist dental professionals with helping patients to quit smoking
● Length of treatment ~ 7-12 weeks
What are the dental considerations related to the use of Nicotine?
○ potent vasoconstrictor
○ Highly addictive (physical and psychological)
○ patients must completely stop smoking prior to therapy
–important to set a “quit” date before initiating therapy
–nicotine raises cardiovascular risk, so cannot smoke at the same time
○ raises cardiovascular risk, so can’t smoke during cessation therapy
○ stimulates IL-6 that increases osteoclastic resorption
○ decreases estrogen-protective effects on bone
○ 30% of inhaled smoke is absorbed in oral cavity → risk of cancer
–risk is higher in women
What are the desired effects of Nicotine?
■ increased alertness
■ muscle relaxation
■ facilitation of concentration and memory
■ decreased appetite (weight loss = primary reason why girls smoke)
What are the harmful effects of Nicotine?
■ irritability ■ hypertension ■ increased pulse rate ■ induces nausea/vomiting ■ dizziness ■ coronary artery disease ■ lung cancer ■ oral cancer
What are the dental considerations related to the use of bupropion (Zyban)?
○ dopamine reuptake inhibitor
○ Risk for seizures: avoid alcohol (lowers seizure risk)
–Many drug interactions that lead to increased seizure risk
○ Risk of treatment emergent hypertension with concurrent patch use
–Always take BP before giving epinephrine
○ Adverse psychological events
What are the dental considerations related to the use of varenicline (Chantix) ?
○ partial neuronal alpha4 B2 nicotinic receptor agonist
–occupies nicotine receptor sites in the brain
○ Stimulates dopamine activity, but to a much lesser extent than nicotine does
–results in decreased craving and withdrawal symptoms
○ Increased side effects when used with nicotine replacement therapy
○ Oral side effects: xerostomia, taste alteration
○ General side effects: insomnia, headache, abnormal dreams, nausea
–New post-marketing reports of suicidal thoughts and erratic/aggressive behavior
–Post-marketing data of adverse cardiac events
- Who is at a higher rate for smoking?
- average age?
- grade level?
- race?
○ teenage girls smoke at higher rate than male counterparts
○ average age of initiation= 14.5 years
○ 28% of girls in grades 9-12 smoke
○ white adolescent girls use at higher rate
○ women smoke during reproductive years
What are the Consequences for smoking?
1) lung cancer
■ women more susceptible, due to increased permeability of mucous membranes to carcinogens
2) oral cancer
■ 30% of inhaled smoke absorbed in oral cavity
■ risk for oral cancer is higher in women
3) lowered estrogen levels
■ low birth weight babies, pregnancy complications, early menopause, osteoporosis
4) heart disease
■ lowers age of first heart attack, raises risk for heart attack
5) periodontal disease
■ nicotine stimulates IL-6 that increases osteoclastic resorption; nicotine decreases estrogen-protective effects on bone (normally, estrogen decreases IL-6)
Other cancers smoking can cause?
■ oral cavity ■ pharynx ■ larynx ■ esophagus ■ bladder ■ stomach ■ cerix ■ kidney ■ pancreas ■ acute myeloid leukemia
smokings contribution to cancer?
○ 599 additives are approved by the US government in the manufacturing of cigarettes
○ ingredients were not tested by burning them
–changes their properties often for the worse
**when burned, cigarette smoke contains over 4000 chemicals
–many toxic and/or carcinogenic
–40 known carcinogens
–carbon monoxide, nitrogen oxides, hydrogen cyanide and ammonia are all present in cigarette smoke
○ carcinogens in tobacco smoke damage genes that control cell growth
–grow abnormally or to reproduce too rapidly
- cigarette smoking= major cause of esophageal cancer
- *Mouth cancers
- -increases among people who smoke pipes and cigars
What are the Notable chemicals in cigarettes?
1) Tar
■ used to pave streets and driveways
■ causes yellow/brown staining of teeth in smokers
■ cigarettes that have a lower yield of tar DOES NOT substantially reduce the risk for lung cancer
2) hydrogen cyanide
■ used to kill rats
3) benzene
■ used in manufacturing gasoline, known cause of acute myeloid leukemia
4) acetone
■ nail polish remover
5) formaldehyde
■ preservative; industrial fungicide
6) ammonia
■ household cleaners
7) carbon monoxide
■ found in automotive exhaust fumes
8) nicotine
■ typical cigarette = 8 or 9 mg of nicotine
■ cigar= 100 to 200 mg some as high as 400 mg
What are “Light” cigarettes?
○ still inhale same amounts of harmful toxins
○ no safe cigarettes
○ only proven way to reduce risk of smoking related disease is to quit smoking completely
*Smokers who quit before age 50 cut their risk of dying in half over the next 15 years compared with people who keep smoking
○ quitting also decreases risk of lung cancer, heart attacks, stroke and chronic lung disease
