Lecture 13 - Smoking And Lung Health Flashcards
1
Q
Nicotine chemistry
A
- poorly absorbed in an acid environment but well absorbed as a base
- nicotine base absorbed across the mouth
- Modern tobacco is fermeted - burns with an aromatic smoke that doesn not cause cough. HAs acid smoke and so needs to be inhaled deeply into the lungs for nicotine to be well absorbed. Ammonia is added to alkalinise smoke
2
Q
4 standard elements of dependence
A
- context: some places are closely associated with smoking while others are negattively associated with craving
- ritual behavior
- sensory stimulation
- reinforcing stimulus: nicotine goes from
3
Q
Nicotine and the receptor
A
- there is no nicotine receptor
- its a nicotinic ACh receptor
- nicorine has a longer receptor occupancy time than ACh
- this leads to altered receptor activation and downregulaion
4
Q
BRain reward system
A
- site of action of nicotine
- common pathway for innate pleasure responses: Food, alcohol, sex
endogenous and exogenous influences:
- cocaine inhibits reuptake
- opitates enhance neurotransmission
- amphetamiens increase release and reduce reuptake
- endocannbinoids increase neuronl firing rate
5
Q
How smokers smoke
A
- from inhalation to peak arterial concentration is less than 10 sec
- nicotine easily crosses the blood brain barrier
- smokers control inhalation to manage nicotine delivery
- initial puffs are rapid and deep - smokers take smaller puffs towards the end of a cigarette
- smokers take more and deeper breaths from low nicotine cigarettes
6
Q
Chippers
A
- smoke a small number of cigarettes
- quit without withdrawal symptoms
- often periods on and off smoking
- not harm free
- often do not identify with the public health message
7
Q
Strategies to limit smoking
A
- information campaign
- denormalisation
- plain-packaging
8
Q
Ineffective health strategies: mild or light cigarettes
A
- same or more lung cancer
- causes over smoking: more and deeper breaths
9
Q
- ineffective strategies: smoking fewer cigarettes
A
- reduction in smoke exposure does not match reduction in cigarettes smoked
- causes compensatory oversmoking
- not a harmful strategy, unless taken as a meaningful alternative to quitting
10
Q
Copenhagen study: reducers vs continuing smokers vs quitters
A
- Reducing was associated with the same effects as quitting for CV disease and resp disease
- reducing was not associated with improvements in tobacco related cancers and all cause mortality, unlike quitting
11
Q
The 4 country cessation study
A
- Professed desire to quit in the near future is associated with higher rate of attempts
- quit attempts are more successful in those not planning to quit
- be opportunistic
- support unplanned quit attempts
12
Q
Treatments that ease craving
A
- NRT
- Buproprion
- VArenicline
13
Q
Nicotine and NRT
A
- Spray is best
- gum/inhaler/ tablet slower action but achieve same level over time
- patch is slowest
14
Q
Nicotine toxicity from NRT
A
- only ever likely from patches: need a lot
- symptoms: Nausea, sweatiness, hypotension
15
Q
Cut down then stop - which smokers
A
- increase in actual quit attempts seen
- smokers unkeen to quit now but happy to try to reduce harm
- eventual aim should be cessation
16
Q
NRT and heart disease
A
- NRT is safe in stable cardiac disease
- always better than smoking itself
- in unstable disease: consider NRT to palliate withdrawal
- dont use NRT in critically ill patients unable to experience withdrawal symptoms
17
Q
NRT and pregnancy
A
- NRT much safer than smoking
- no excess of birth defects
- benefits of NRT without cessation
- higher birth weight
- no usable pregnancy data for varenicline or bupropion
18
Q
Buproprion
A
- inhibitor of neuronal reuptake of noradrenaline and dopamine: limits cravings only, no effect on reinforcement
- overall outcomes are similar to NRT
- specific groups unsuitable for buproprion
- risk of seizures
- PBS subsidy
19
Q
Varenicline: a partial agonist
A
- able to bind to a specific receptor
- able to activate that receptor
- unablet o activate that receptor to its full potential
- quit rate is superior to buproprion and NRT
- small real life studies show results near those of NRT
- safety profile good
- no increase in major adverse psychological effects
- no increase in CV events
20
Q
E- cigarettes
A
- proven intrinsically safe or excellent arguments exists for safety from first principles
- proven to increase the chance of smoking cessation in people using for that purpose
- stable use of e-cigarettes only is the most common outcome of use
- proven to reduce exposure to toxic components in concurrent users of combustible tobacco
- use in youth reduces /does not increase subsequent combustible tobacco use
21
Q
E-cigarette efficacy data
A
COCHRANE REVIEW
- possible benefit for cessation
- possible increase in >50% smoking reduction
- low quality evidence
4 NATION ITC STUDY
- 85% of users reported intent to quit
- not more likely to be smokefree at 1 year
- E-cigarette users had greater reduction
22
Q
E-cigaretted in cancer patients
A
- E cigarette use rising
- E-cigarette users have higher dependency
- smoke slightly more cigarettes/day
- 7-day smoking abstinence rate at follow up lower for e-cigarettes users
23
Q
E-cigarettes and attitude to smoking
A
- E-cigarettes users showed more willingness to smoke cigarettes
- mediated through more positive epxectancies about smoking and a direct path from use to willingess
- number of never-smoking youth who used e-cigarettes increased
- 43.9% of never-smokers who had ever used e-cigarettes, intended to smoke cigarettes
- 21.5% of never smokers who had never used e-cigarettes intended to smoke cigarettes
24
Q
Long term E-cigs users vs NRT users
A
- stronger smoker identity
- like their product more
- more likely to continue use
25
Q
Non-toxicity harms of e-cig
A
- diversion from more effective smoking cessation strategies
- illusory benefits of smoking reduction
- decrease selected incentives for smoking cessation
- compromise other measures for community tobacco control
