Lectures 7 & 8 Flashcards
Fraction of tobacco users in the U.S.:
1/3
Around what time in a persons life do most people start smoking?
childhood or adolescence
Fraction of teenagers who try smoking that will die of tobacco-teated diseases:
1/3
More than ___ teenagers smoke their first cigarette each day.
3,000
% of men/ women smokers in 2006:
men: 23.4%, women: 18.4%
When was the 1st Surgeon General’s Report on the dangers of smoking?
1964
What change has caused a sharp decline in the prevalence of smoking?
the doubling of federal cigarette tax
Most prevalent source of tobacco for users, highest to lowest:
cigarette, cigar, snuff and chew (tie), then pipe
Current male/female % users of any tobacco:
men: 31.3, women: 21.3
Current male/female % users of cigarettes:
men: 25.7%, women: 21.0%
Does a higher % of people start using tobacco in middle school or high school?
high, 27.4% any use, 21.7% cigarette
of different gases, particles and compounds in tobacco:
4,000
of carcinogens in tobacco:
60+
Tobacco use causes __ time more deaths than firearms:
18
% of deaths caused by tobacco, diet/exercise, and alcohol, respectively:
18%, 15%, and about 4% respectively
of smoking related deaths per year:
400,000
What is the single largest preventable cause of premature death and disability in U.S.?
smoking
1 in __ death/ year are due to smoke-related illness:
5
__% of all cancer deaths, and more than __ % of all lung cancers are related to smoking:
30%, 80%
Smoking is linked to these health concerns:
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.
Cancers related to smoking:
lung, larynx, mouth, esophagus, bladder, pancreas, kidney and cervix
Effects of nicotine:
increases heart rate, vasoconstriction, blood pressure, and cholesterol deposition, decreases O2 carrying capacity and appetite
True or False? Nicotine is carcinogenic.
F, but may function as a “tumor promoter”
Fetal and adolescent nicotine exposure can lead to:
brain damage
On what 7 neurotransmitters does nicotine have effects?
dopamine, serotonin, epi, ne, AcH, vasopressin, and B-endorphins
How does nicotine effect dopamine?
pleasure and appetite suppression
How does nicotine effect serotonin:
mood modulation and apetite suppression
How does nicotine effect epinephrine and norepinephrine?
arousal and apetite suppression
How does nicotine effect acetylcholine?
arousal and cognitive enhancement
How does nicotine effect vasopressin?
memory improvement
How does nicotine effect B-endorphins?
mood modulation and analgesia
“Positive” effects of nicotine:
increases memory, alertness, reaction time, vigilance and work performance. Decreases stress, aggressiveness, and boredom
This is the vehicle for nicotine:
smoke
This is the dispenser of smoke:
cigarette
True or False? Tobacco addiction is different than heroin and cocaine addiction.
F, similar to
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
Oral manifestation of heavy smoking, know if someone is lying about how much they smoke:
smoker’s melanosis, gingiva or mucosa, reversible
What is smoker’s palate?
white opaque palate
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
wet mixture of tobacco with sweeteners, and flavorings:
shisha
This is tobacco derived nicotine with non-tobacco cellulose fibers:
verve discs
Types of smokeless tobacco:
chewing tobacco or snuff
Types of chewing tobacco:
loose leaf, twist, or plug
Types of snuff:
moist, dry or sachet
How many users of smokeless tobacco are there?
10 million
% of smokeless tobacco users, men and women:
men: 5%, women: 1%
Median age for initial use of smokeless tobacco:
12 years old
% of kids in grade 9-12 that use smokeless tobacco at least once a month and % that use daily;
10-20%, 2-3%
Which has more nicotine, smokeless tobacco or cigarettes?
smokeless tobacco
How is the nicotine in smokeless tobacco absorbed?
oral mucosa
physiologic effects of absorption of nicotine across oral mucosa:
increases heart rate, tingling
The average dip is equivalent to smoking __ cigarettes.
4
Dipping 2 cans a week is equivalent to:
1-1.5 pack-a-day smoking habit
True or False? Sales of smokeless tobacco have been decreasing in the last 20 years.
F. increasing, moist snuff. Loose leaf, the same
True or False? Sales of loose leaf chewing tobacco have increased dramatically in the last 20 years.
F. moist snuff has
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
Men in rural areas are about __ times more likely to use smokeless tobacco.
3
Effects of smokeless tobacco:
addiction, abrasion, recession, caries, staining, bad breath, black hairy tongue, smokers palate/ melanoma, oral cancer, leukoplakia, hyperkeratosis
True or False? Smokers can get smoker’s melanosis while users of smokeless tobacco can not.
F. Both can get it
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
Most common form of oral cancer:
oral squamous cell carcinoma
Tobacco is responsible for ___% of all oral cavity cancers.
80%
Smokers have __ times greater risk for oral cancer:
6
Tobacco users have __-__ times as much laryngeal cancer risk than a nonsmoker.
3-17 times the risk
__-__% of daily smokeless tobacco users have non-cancerous and precancerous leukoplakia.
50-75%
Is there a clinical distinction between keratosis and hyperkeratosis?
ask
True or False? If a person quits tobacco use, the tobacco pouch may disappear.
T. it MAY, depending on severity
Can oral leukoplakia be rubbed off?
no
True or False? Oral leukoplakia is almost always malignant.
F
% of oral leukoplakia that is malignant at 1st biopsy:
5%
% of oral leukoplakia that becomes malignant even if first biopsy is not malignant.
5%
oral squamous cell carcinoma:
non-healing, red or white, lateral border or floor of mouth
Former smokers have __ times the prevalence of periodontitis than people who never smoked.
2 times
(5% vs 10%)
Current smokers have __ times the prevalence of periodontitis than people who never smoked.
3 times (5% vs 16%)
mean alveolar bone loss for a 5 pack-year smoker, 13y, 23y, 27y:
under 2mm, 2-2.9, 3-3.9, over 4mm
Current smoker-attributable periodontitis in U.S.:
42% (6.4 million)
Former smoker-attributable periodontitis in U.S.:
11% (1.7 million) (53% total, 8.1 million)
What is the major risk factor for periodontal disease
smoking
Smoking is responsible for this fraction of periodontitis in the last century:
1/2
Smoker are __ times more likely to perio disease:
4 times
Why do smokers show less inflammation at the gingival margin?
nicotine constricts vessels
What is found in the “water vapor?”
propylene glycol, an aerosol
What vaporizes nicotine in an E-cigarette?
microprocessor powered by a battery, heat
True or False? E-cigarettes have none of the toxic by-products of burning tobacco.
F? (check)
Sales of E-cigarettes are predicted to increase ___ times by 2030.
17 times
Use of E-cigarettes doubled between these years:
2008-2012
% of smokers and ex-smokers in U.S. that have tried E-cigarettes;
47%
Main reason of E-cigarettes use:
reduce or quit, used in smoke-free places
E-cigarette sales more than ___ between 2012 and 2013.
tripled
Tobacco products that have seen an increase in use in teenagers:
E-cigarettes (dry?) and hookahs (wet?)
Tobacco products that have decreases in use in teenagers:
cigarettes, cigars, smokeless, pipes
What does ENDS stand for?
Electronic Nicotine Delivery Systems
True or False? Electronic Nicotine Delivery Systems pose no risk to developing fetuses.
F.
Electronic Nicotine Delivery Systems can potentially irritate:
respiratory tract, eyes, nose and throat
True or False? Electronic Nicotine Delivery Systems are likely to be less toxic than conventional cigarettes or other combusted tobacco products.
T
Fraction of smokers that say they want to quit:
2/3
__ in 10 smokers make at least one quit attempt each year:
4
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%)
most effective method to quit:
Meds and counseling
Is advise to quit delivered by a health professional effective?
yes
% of smokers that regret smoking:
90%
% of smokers that have ever tried to quit:
70%
% of smokers that tried to quit in last year:
50%
% of smokers that would like to quit now:
40%
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?
Heaviness of smoking index is on a scale from:
0-3
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
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
4 steps to take to ACT:
set quit date, quite advice/ referral, pharmacotherapy as needed, arrange follow-up
3 first-line pharmacotherapies:
NRT, Zyban (Bupropion), and Chantix (Varenicline)
Long term abstinence rates, highest to lowest:
chantix (44%), Zyban (30%), NRT (24%), placebo (17%), counsel (16%), nothing (11%)
Examples of NRT:
gum, patch, inhaler, nasal spray, lozenge
Efficacy of NRT is strongest in these patients:
higher dependence levels
What is the single best measure of nicotine dependence?
whether the person reports smoking within the first 30 minutes of waking
Those who PROBABLY can benefit most form combination therapy:
minimal withdrawal relief, unable to quit completely, heavy smokers and those with failed quit attempts
True or False? Bupropion is a NRT.
F. Non-nicotine medicaiton
Year FDA approved Bupropion for smoking cessation treatment:
1997
mechanism of action of Bupropion:
blocks reuptake of dopamine and/or norepinephrine. ( my way to remember: NSRI / DSRI
Year FDA approved Varenicline as a non-nicotine tobacco cessation medication:
2006
Brand name of Chantix outside of U.S.:
Champix
True or False? Chantix is a NRT.
F
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
Where does nicotine bind the alpha-4-Beta-2 receptor?
Ventral Tegmental Area , believed to cause relate of dopamine at the nucleus accumbens
True or False? Chants has both agonist and antagonist activity.
T
When should treatment with Varenicline begin?
1 week before quit date, continue for 12 weeks
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)
True or False? Varenicline should be taken on an empty stomach.
F. after eating
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
True or False? Light cigarettes have less tar.
F
True or False? Lights have less nicotine.
F
True or False? Switching to lights can help a person quit smoking.
F
True or False? No SSRI or tricyclic antidepressants have been shown to help with smoking cessation.
F. nortriptyline (a tricyclic antidepressant)
NRT and Zyban increase quit rates __ - __ fold.
1.5 to 2 fold
Varenicline has quit rates that are __ fold over placebo.
3
Brand of low nicotine cigarettes:
Quest 3
