Smoking

Question 0

Smoking Cessation

Answer 0

1. Varenicline: partial agonist at alpha4-beta2 subunit of nicotinic acetylcholine receptor; 1st line therapy
2. Nicotine patch: continuous nicotine delivery weans patient off nicotine; dose gradually decreased; no peaks or troughs as associated w smoking so eliminates nicotine withdrawal sx; wear for 16 hours/day but not while sleeping (can cause headaches); pt should not continue to smoke while wearing patch bc can get MI
3. Nicotine chewing gum: whenever urge to smoke, 2-4 months
4. Bupropion (Zyban)
   - quit rates similar to nicotine replacement therapy; up to 2 months; can take in combo w nicotine replacement;
   adverse effects: dry mouth, insomnia, headaches

Question 1

Health risks associated with smoking

Answer 1

1. Cardiovascular dz: CAD, acute MI, stroke; dose dependent relationship bw smoking and CVD
2. COPD risk: increases w smoking in dose dependent manner
3. Malignancy: smoking increases risk of cancer in lungs, oral cavity, esophagus, larynx/pharynx, bladder, cervix, pancreas
4. PUD
5. Osteoporosis: decreases peak bone mass and increases rate of bone loss
6. Premature skin aging
7. PVD, Buerger’s disease
8. Adverse effects during pregnancy: smoking increases risk of spontaneous abortion, fetal death, neonatal death, sudden infant death syndrome, low birth weight

Question 2

Most important causes of smoking-related mortality

Answer 2

1. lung cancer
2. COPD
3. atherosclerotic cardiovascular disease

Question 3

Behavioral modification and smoking

Answer 3

crucial for long term smoking cessation

patch or gum should be used in conjunction w smoking withdrawal clinic (behavioral program)

quit rates higher with combo