smoking Flashcards
mx of smoking
giving up smoking has benefit
simple advice - keep giving, ask about smoking in consultations
ensure advice is congruent with the pts beliefs
get pt to enumerate the advantages of giving up increases motivation
get them to choose a date, one where there will be few stresses, when they will be a ‘non-smoker’
throw away all accessories (cigarettes, pipes, ashtrays, lighters, matches) in advance
inform friends - practice saying no to their offers
assess their understanding of consequences
follow up
medical mx of smoking
nicotine gum - chewed intermittently to limit nicotine release >=10, 2mg sticks/day. transdermal nicotine patch (easier). dose increase at 1wk
follow up
varenicline - oral selective nicotine receptor partial agonist. start 1wk before stop date and gradually increase the dose
bupropion (amfebutamone)
SE of varenicline
- appetite change
- dry mouth
- taste disturbance
- headache
- drowsiness
- dizziness
- sleep disorders
- abnormal dreams
- depression
- suicidal thoughts
- panic
- dysarthria
SE of bupropion
seizures
insomina
headache
complications of smoking
CVS problems
Ix for smoking
pack years - 20/day for 1 year = 1 pack year
prognosis for smoking
stopping smoking massively benefits your health
what is in cigarettes
nicotine - inhaled from the tabacco - stimulant - addictive - get withdrawal - relieved by next cigarette. Peak at 24hr and ease over 2-4wks
tar
CO - affects ox carrying ability. Reduced ox to the growing baby
nicotine withdrawal sx
Craving.
Anxiety.
Restlessness.
Headaches.
Irritability.
Hunger.
Difficulty concentrating
Dizziness.
Constipation.
A craving for nicotine.
Just feeling awful.
complications of smoking
main cause of premature death and preventable illness
lung cancer
COPD
pneumonia
heart disease
stroke
cancer of mouth, nose, throat, larynx, gullet (oesophagus), pancreas, bladder, neck of the womb (cervix), blood (leukaemia) and kidney
atheroma
Peripheral arterial disease, PVD
aneurysms
buerger’s disease
impotence
RA
reduced fertility
early menopause
maternal DVT and pre-eclampsia, preterm birth, premature rupture of membranes, placental abruption, placenta praevia, ectopic pregnancy, miscarriage
fetal complications - behavioural problems, dm, infant mortality, SIDS, stillbirth, birth defects, IUGR, low birthweight
adverse outcomes post surgery
stomach and duodenal ulcers
erectile dysfunction
osteoporosis, RA
cognitive harm
cataracts
age related macular degeneration
increased risk of menigococcal disease
periodontal disease and tooth decay
increased risk of nephropathy, retinopathy and neuropathy with dm
conditions made worse by smoking
Asthma.
Colds.
Flu (influenza).
Chest infections.
Tuberculosis infection of the lungs.
chronic rhinitis
diabetic retinopathy
hyperthyroidism.
multiple sclerosis
optic neuritis
Crohn’s disease
what does smoking increase the risk of
Dementia.
Optic neuropathy - this is a condition affecting the nerve supplying the eye.
Cataracts.
A breakdown of the tissue at the back of the eye (macular degeneration).
Pulmonary fibrosis.
A skin condition called psoriasis.
Gum disease.
Tooth loss.
‘Thinning’ of the bones (osteoporosis).
Raynaud’s phenomenon - in this condition, fingers turn white or blue when exposed to cold.
nicotine replacement therapy
patches, gum, nasal spray, mouth spray, inhalation cartridge, lozenges, sublingual tablets
most effective with behavioural interventions
controls weight gain
CI - severe cardiovascular disease (severe arrhythmias, post-infarction period), recent cerebrovascular accident inc TIA
SE - nausea, dizziness, flu-like sx, palpitations, dyspepsia, hiccups, insomnia, vivid dreams, myalgia
withdrawal sx of stopping smoking
irritability/aggression
depression
restlessness
poor concentration
increased appetite
light headedness
disturved sleep
nicotine cravings
epidemiology of smoking
prevalence fallen
higher in Bangladeshi, Irish and Pakistani men and among Black Caribbean and Irish women, Lesbian, gay and bisexual people, people with mental health
linked to deprivation
