Smoking Flashcards
What are the main mediators of nicotine addiction in the brain?
Ventral tegmental area
Nucleus accumbens
Which receptor does nicotine have the highest binding affinity to?
Alpha-4-beta-2 nicotinic receptors
How quickly does inhaled nicotine reach the receptors?
7-10 seconds
What impact does smoking have of nicotinic receptors?
Smoking increases receptors x3-4 times, making it more addictive and harder to quit
What is chronic smoking?
Smoking is a chronic relapsing organic brain disease, and not a lifestyle choice
With combination therapy,. how more likely is a patient to quit?
4 times greater
What are the four main goals of behavioural support?
- Reduce motivation to smoke
- Bolster commitment to abstain
- Enhance ability to cope with cravings
- Ensure effective use of pharmacotherapy
Outline the standard NHS stop smoking services regime:
4-6 appointments over 6012 weeks
Outline the advantage of doctor delivered smoking cessation
- Doctors are independent prescribers, used to tailoring treatment
- Cessation advice can be more effective from doctors than counsellors and nurses
- Smokers know, trust and want help to stop from their doctor
What are the examples of NRT?
skin patches, gums and inhalators ,lozenges, mini lozenges, oral spray, nasal spray , oral film
Why are there multiple options for NRT?
- Allows choice in treatment
- What works for one doesn’t work for another
- Self determination-you guide, they decide
- If the quit attempt fails, theres other options
What is the reality of smoking cessation?
- 20-30% long term quit rate with support and treatment
- 3-5% long term quit rate with willpower alone
- 2 or 3 quit attempts with support and treatment for >50% smokers to stop long term
- This makes it very cost effective
What is the long-term quit rate with support and treatment?
20-30%
What is the long term quit rate with willpower alone?
3-5%
What are the 5 main causes of death in the UK?
Ischaemic heart disease, stroke, COPD, Cancer, Pneumonia
What suggests high addiction in terms of smoking?
When waking at night to smoke
Waiting for 2 hours after waking up, for a smoke, is considered to be what tier of addiction?
Mild addiction
How long does it take nicotine receptors to downregulate?
8-12 weeks
How would you test smoking cessation?
Carbon monoxide monitoring
What number of cigarettes smoked per day suggests high addiction?
> 20
What number of cigarettes smoked per day suggests moderate addiction?
10-20
What number of cigarettes smoked per day suggests lower addiction?
<10
When a patient wakes at night to smoke, what type of addiction is this?
Very high addiction
When a patient smokes <30 minutes from waking, what type of addiction is this?
High addiction
When a patient smokes for 30 minutes to 2 hours from waking, what type of addiction is this?
Moderate addiction
When a patient smokes more than 2 hours from waking, what type of addiction is this?
Lower addiction
What is the only safe level of smoking?
No smoking
Why do smoking cravings occur?
The dopamine triggered by inhaled nicotine rapidly gets reabsorbed which leads to craving and low moods which leads to addiction
What % increase in nicotine receptors does regular smoking cause?
300% increase
How long does stopping smoking take?
24-48 hours for nicotine to leave the body
8-12 weeks for nicotine to down-regulate
What is the average number of brief advice required to promote a quitter?
51
What is the average number of NRT expected to promote a quitter?
23
What is the average number of buproprion required to promote a quitter?
22
What is the average number of varenicline required to promote a quitter?
11
What is NRT based on?
Nicotine weaning
What is buproprion?
- Non-nicotine prescription tablet originally developed to treat depression
- Modifies dopamine levels and noradrenergic activity
What are the adverse effects on buproprion?
Insomnia
Headache
Dry Mouth
Nausea
What are the two effects exhibited by varenicline as a partial agonist and block?
Blocking- Reduces the pleasurable effects of smoking and potentially the risk of full relapse after a temporary lapse
Stimulating-Relieves craving and withdrawal symptoms
