Final Exam Flashcards
(188 cards)
what percent of the US population currently smokes cigarettes?
14% (34 million)
how many people die per year as a result of DIRECT tobacco use? what about INDIRECT tobacco use?
direct - 8 million
indirect - 1.2 million
what is the most common form of tobacco use worldwide? what are other forms of tobacco use?
most common - cigarette smoking
other - smokeless tobacco, cigars, pipe, bidis, and roll-your-own tobacco
disparity in tobacco use remains across groups defined by:
race, ethnicity, educational level/socioeconomic status, and regions of the country
8.2% of Hispanic adults in the US smoke cigarettes. Who are more likely to smoke cigarettes?
those born in the US
in the hospitality industry, who is the most exposed to secondhand smoke?
hispanics
who has the highest prevalence of cigarette smoking compared to other racial/ethnic groups in the US
american indians/alaskans
deaths attributed to smoking
pulmonary disease, cancer, or cardiovascular disease
what are the primary effects of smoking due to?
toxins and chemicals produced by burning of tobacco
what is the most effective mechanism to deliver nicotine to the brain?
inhalation thru the lungs
what are the nicotine addiction mechanisms?
- rewarding experience of smoking (dopamine release)
- increased tolerance and dependence of nicotine (leading to withdrawal symptoms)
- learnt experience of responding to situational and emotional triggers with smoking
what is the tobacco mechanism of action?
nicotine acts on dopaminergic receptors in ventral tegmental area, causing burst firing of dopamine neurons leading to drug reinforcement
increasing dopamine release from ventral tegmental area neurons contribute to addiction
what receptor does nicotine work thru? what part of brain works for drug reinforcement?
- works thru dopamine receptor
- midbrain plays pivotal role in drug reinforcement
dopamine reward pathway
nicotine enters brain > stim nicotine receptors > ventral ttegmental area > nucleus accumbens > prefrontal cortex
how can you approach tobacco cessation?
behavioral intervention or pharmacologic strategies
what is behavioral intervention?
- only 3-5% of smokers who quit on their own succeed
- intervention by HC professional combined with appropriate medication increases success of maintaining abstinent by 30%
- dentists can have significant impact on tobacco quit rates
how do pharmacological agents aid with tobacco cessation?
provides nicotine in various forms to lessen or relieve cravings
examples of pharmacological agents for tobacco cessation
- nicotine replacement therapy (NRT) - gum, lozenge, nicotine patch, inhaler, spray
- varenicline - decreases craving and withdrawal syndrome
- bupropion - antidepressant
how does NRT work
pure nicotine is administered, removes exposure to nitrosamines and toxins while behavior changes are made
by self-dosing, the user has control over amount of nicotine needed for cessation
OTC nicotine gum
doubles odds of successful cessation attempt
can lead to toxicity as many users use it like reg gum
OTC transdermal nicotine patch
- diffuse steady dose nicotine thru skin
- peaks about 4-8 hours, maintains for 15-24 hours
- milk skin irritation experienced
- insomnia may be side effect, so lower dose
prescription nicotine inhaler
- nicotine puffed into mouth where held and diffuse thru oral mucosa
- mimics smoking and meets smokers emotional need
- benefits highly addicted users, results in immediate dose of nicotine
- can cause local irritation and congestion
prescription varenicline - chantix
pill form stimulates nicotine receptors
12 weeks of therapy
prescription bupropion - wellbuttrin
antidepressant pill form
safe, doubles chances of quitting
contraindicated in seizure disorders, alcoholics, and eating disorders