Lectures 7 & 8 Flashcards
1
Q
Fraction of tobacco users in the U.S.:
A
1/3
2
Q
Around what time in a persons life do most people start smoking?
A
childhood or adolescence
3
Q
Fraction of teenagers who try smoking that will die of tobacco-teated diseases:
A
1/3
4
Q
More than ___ teenagers smoke their first cigarette each day.
A
3,000
5
Q
% of men/ women smokers in 2006:
A
men: 23.4%, women: 18.4%
6
Q
When was the 1st Surgeon General’s Report on the dangers of smoking?
A
1964
7
Q
What change has caused a sharp decline in the prevalence of smoking?
A
the doubling of federal cigarette tax
8
Q
Most prevalent source of tobacco for users, highest to lowest:
A
cigarette, cigar, snuff and chew (tie), then pipe
9
Q
Current male/female % users of any tobacco:
A
men: 31.3, women: 21.3
10
Q
Current male/female % users of cigarettes:
A
men: 25.7%, women: 21.0%
11
Q
Does a higher % of people start using tobacco in middle school or high school?
A
high, 27.4% any use, 21.7% cigarette
12
Q
of different gases, particles and compounds in tobacco:
A
4,000
13
Q
of carcinogens in tobacco:
A
60+
14
Q
Tobacco use causes __ time more deaths than firearms:
A
18
15
Q
% of deaths caused by tobacco, diet/exercise, and alcohol, respectively:
A
18%, 15%, and about 4% respectively
16
Q
of smoking related deaths per year:
A
400,000
17
Q
What is the single largest preventable cause of premature death and disability in U.S.?
A
smoking
18
Q
1 in __ death/ year are due to smoke-related illness:
A
5
19
Q
__% of all cancer deaths, and more than __ % of all lung cancers are related to smoking:
A
30%, 80%
20
Q
Smoking is linked to these health concerns:
A
colds, gastric and peptic ulcers, chronic bronchitis, emphysema (COPD), heart disease, atherosclerosis, cerebrovascular disease, low birth weight babies, perinatal mortality, cataract, macular degeneration, hip fracture, and cancers.
21
Q
Cancers related to smoking:
A
lung, larynx, mouth, esophagus, bladder, pancreas, kidney and cervix
22
Q
Effects of nicotine:
A
increases heart rate, vasoconstriction, blood pressure, and cholesterol deposition, decreases O2 carrying capacity and appetite
23
Q
True or False? Nicotine is carcinogenic.
A
F, but may function as a “tumor promoter”
24
Q
Fetal and adolescent nicotine exposure can lead to:
A
brain damage
25
On what 7 neurotransmitters does nicotine have effects?
dopamine, serotonin, epi, ne, AcH, vasopressin, and B-endorphins
26
How does nicotine effect dopamine?
pleasure and appetite suppression
27
How does nicotine effect serotonin:
mood modulation and apetite suppression
28
How does nicotine effect epinephrine and norepinephrine?
arousal and apetite suppression
29
How does nicotine effect acetylcholine?
arousal and cognitive enhancement
30
How does nicotine effect vasopressin?
memory improvement
31
How does nicotine effect B-endorphins?
mood modulation and analgesia
32
"Positive" effects of nicotine:
increases memory, alertness, reaction time, vigilance and work performance. Decreases stress, aggressiveness, and boredom
33
This is the vehicle for nicotine:
smoke
34
This is the dispenser of smoke:
cigarette
35
True or False? Tobacco addiction is different than heroin and cocaine addiction.
F, similar to
36
Oral effects of cigarette smoking:
oral and pharyngeal cancer, periodontitis, slowed wound healing, issues with implants and periodontal theapy, staining, bad breath, cleft lip and palate (maternal smoking), black hairy tongue
37
Oral manifestation of heavy smoking, know if someone is lying about how much they smoke:
smoker's melanosis, gingiva or mucosa, reversible
38
What is smoker's palate?
white opaque palate
39
True or False? Cigars have fewer of the harmful compounds than cigarettes.
F, about 25 times more CO, different mode of entry, lungs vs. oral mucosa
40
wet mixture of tobacco with sweeteners, and flavorings:
shisha
41
This is tobacco derived nicotine with non-tobacco cellulose fibers:
verve discs
42
Types of smokeless tobacco:
chewing tobacco or snuff
43
Types of chewing tobacco:
loose leaf, twist, or plug
44
Types of snuff:
moist, dry or sachet
45
How many users of smokeless tobacco are there?
10 million
46
% of smokeless tobacco users, men and women:
men: 5%, women: 1%
47
Median age for initial use of smokeless tobacco:
12 years old
48
% of kids in grade 9-12 that use smokeless tobacco at least once a month and % that use daily;
10-20%, 2-3%
49
Which has more nicotine, smokeless tobacco or cigarettes?
smokeless tobacco
50
How is the nicotine in smokeless tobacco absorbed?
oral mucosa
51
physiologic effects of absorption of nicotine across oral mucosa:
increases heart rate, tingling
52
The average dip is equivalent to smoking __ cigarettes.
4
53
Dipping 2 cans a week is equivalent to:
1-1.5 pack-a-day smoking habit
54
True or False? Sales of smokeless tobacco have been decreasing in the last 20 years.
F. increasing, moist snuff. Loose leaf, the same
55
True or False? Sales of loose leaf chewing tobacco have increased dramatically in the last 20 years.
F. moist snuff has
56
How have the age groups of snuff users shifted in the last 30 years among men?
use increased with age in 70's, now decreasing. Younger men are the target for the advertising campaigns of the last couple decades
57
Men in rural areas are about __ times more likely to use smokeless tobacco.
3
58
Effects of smokeless tobacco:
addiction, abrasion, recession, caries, staining, bad breath, black hairy tongue, smokers palate/ melanoma, oral cancer, leukoplakia, hyperkeratosis
59
True or False? Smokers can get smoker's melanosis while users of smokeless tobacco can not.
F. Both can get it
60
If a patient comes to regular check up visits and has leukoplakia at each visit due to the use of smokeless tobacco, should you refer them for a biopsy at every appointment?
ask
61
Most common form of oral cancer:
oral squamous cell carcinoma
62
Tobacco is responsible for ___% of all oral cavity cancers.
80%
63
Smokers have __ times greater risk for oral cancer:
6
64
Tobacco users have __-__ times as much laryngeal cancer risk than a nonsmoker.
3-17 times the risk
65
__-__% of daily smokeless tobacco users have non-cancerous and precancerous leukoplakia.
50-75%
66
Is there a clinical distinction between keratosis and hyperkeratosis?
ask
67
True or False? If a person quits tobacco use, the tobacco pouch may disappear.
T. it MAY, depending on severity
68
Can oral leukoplakia be rubbed off?
no
69
True or False? Oral leukoplakia is almost always malignant.
F
70
% of oral leukoplakia that is malignant at 1st biopsy:
5%
71
% of oral leukoplakia that becomes malignant even if first biopsy is not malignant.
5%
72
oral squamous cell carcinoma:
non-healing, red or white, lateral border or floor of mouth
73
Former smokers have __ times the prevalence of periodontitis than people who never smoked.
2 times
| (5% vs 10%)
74
Current smokers have __ times the prevalence of periodontitis than people who never smoked.
3 times (5% vs 16%)
75
mean alveolar bone loss for a 5 pack-year smoker, 13y, 23y, 27y:
under 2mm, 2-2.9, 3-3.9, over 4mm
76
Current smoker-attributable periodontitis in U.S.:
42% (6.4 million)
77
Former smoker-attributable periodontitis in U.S.:
11% (1.7 million) (53% total, 8.1 million)
78
What is the major risk factor for periodontal disease
smoking
79
Smoking is responsible for this fraction of periodontitis in the last century:
1/2
80
Smoker are __ times more likely to perio disease:
4 times
81
Why do smokers show less inflammation at the gingival margin?
nicotine constricts vessels
82
What is found in the "water vapor?"
propylene glycol, an aerosol
83
What vaporizes nicotine in an E-cigarette?
microprocessor powered by a battery, heat
84
True or False? E-cigarettes have none of the toxic by-products of burning tobacco.
F? (check)
85
Sales of E-cigarettes are predicted to increase ___ times by 2030.
17 times
86
Use of E-cigarettes doubled between these years:
2008-2012
87
% of smokers and ex-smokers in U.S. that have tried E-cigarettes;
47%
88
Main reason of E-cigarettes use:
reduce or quit, used in smoke-free places
89
E-cigarette sales more than ___ between 2012 and 2013.
tripled
90
Tobacco products that have seen an increase in use in teenagers:
E-cigarettes (dry?) and hookahs (wet?)
91
Tobacco products that have decreases in use in teenagers:
cigarettes, cigars, smokeless, pipes
92
What does ENDS stand for?
Electronic Nicotine Delivery Systems
93
True or False? Electronic Nicotine Delivery Systems pose no risk to developing fetuses.
F.
94
Electronic Nicotine Delivery Systems can potentially irritate:
respiratory tract, eyes, nose and throat
95
True or False? Electronic Nicotine Delivery Systems are likely to be less toxic than conventional cigarettes or other combusted tobacco products.
T
96
Fraction of smokers that say they want to quit:
2/3
97
__ in 10 smokers make at least one quit attempt each year:
4
98
Most to least common methods used to TRY and quit in the past year:
cut back (52%), cold turkey (42%), medication (22%), with others (15%), switch to lights (12%), switch to chew (5%)
99
most effective method to quit:
Meds and counseling
100
Is advise to quit delivered by a health professional effective?
yes
101
% of smokers that regret smoking:
90%
102
% of smokers that have ever tried to quit:
70%
103
% of smokers that tried to quit in last year:
50%
104
% of smokers that would like to quit now:
40%
105
Questions to ask regarding tobacco use:
do you?, how much?, want to quit?, ready now?, how much per day?, how long after you wake up do you have first?
106
Heaviness of smoking index is on a scale from:
0-3
107
Heaviness of smoking index for how soon in am do you have first?
3: within 5 minutes, 2: 6-30 minutes, 1: 31-60, 0: after 1 hr
108
Heaviness of smoking index for # of cigarettes smoked per day:
3: over a pack and a half, 2: over a pack to a pack and a half, 1: over half a pack to a pack, 0: half pack or less
109
4 steps to take to ACT:
set quit date, quite advice/ referral, pharmacotherapy as needed, arrange follow-up
110
3 first-line pharmacotherapies:
NRT, Zyban (Bupropion), and Chantix (Varenicline)
111
Long term abstinence rates, highest to lowest:
chantix (44%), Zyban (30%), NRT (24%), placebo (17%), counsel (16%), nothing (11%)
112
Examples of NRT:
gum, patch, inhaler, nasal spray, lozenge
113
Efficacy of NRT is strongest in these patients:
higher dependence levels
114
What is the single best measure of nicotine dependence?
whether the person reports smoking within the first 30 minutes of waking
115
Those who PROBABLY can benefit most form combination therapy:
minimal withdrawal relief, unable to quit completely, heavy smokers and those with failed quit attempts
116
True or False? Bupropion is a NRT.
F. Non-nicotine medicaiton
117
Year FDA approved Bupropion for smoking cessation treatment:
1997
118
mechanism of action of Bupropion:
blocks reuptake of dopamine and/or norepinephrine. ( my way to remember: NSRI / DSRI
119
Year FDA approved Varenicline as a non-nicotine tobacco cessation medication:
2006
120
Brand name of Chantix outside of U.S.:
Champix
121
True or False? Chantix is a NRT.
F
122
Mechanism of action of Chantix:
alpha-4-Beta-2 receptor partial agonist, highly selective. Less dopamine release from the VTA at the nAcc and prevention of binding at the alpha-4-Beta-2 receptor
123
Where does nicotine bind the alpha-4-Beta-2 receptor?
Ventral Tegmental Area , believed to cause relate of dopamine at the nucleus accumbens
124
True or False? Chants has both agonist and antagonist activity.
T
125
When should treatment with Varenicline begin?
1 week before quit date, continue for 12 weeks
126
True or False? Titration of Zyban over the first week is important.
F. Chantix; day 1-3, single dose (0.5mg), day 4-7: both am and pm (0.5mg), after 1 week: am and pm (1 mg)
127
True or False? Varenicline should be taken on an empty stomach.
F. after eating
128
Side effects of varenicline:
nausea, sleep disturbances and headache, erratic changes in behavior, agitation, depressed mood, suicidal ideation, and actual suicidal behavior, possible connection to cardiac problems
129
True or False? Light cigarettes have less tar.
F
130
True or False? Lights have less nicotine.
F
131
True or False? Switching to lights can help a person quit smoking.
F
132
True or False? No SSRI or tricyclic antidepressants have been shown to help with smoking cessation.
F. nortriptyline (a tricyclic antidepressant)
133
NRT and Zyban increase quit rates __ - __ fold.
1.5 to 2 fold
134
Varenicline has quit rates that are __ fold over placebo.
3
135
Brand of low nicotine cigarettes:
Quest 3
