Smoking Addiction

Question 1

Smoking addiction

Answer 1

Pack a day smoker takes more than 70,000 cigarettes puff per year.
Nicotine addiction fulfills the criteria.

Question 2

Tobacco use

Answer 2

Leading cause of preventable disease in the US .
Responsible for 1/5 deaths in US
8.6 Millie illness from smoking

Question 3

Hazards of smoking

Answer 3

Nonsmokers who breath smoke and environmental factors

150,00-300,000 of respiratory illness occurring in infants and children 18 months of age

Question 4

Epidemiology

Answer 4

Low socioeconomic status 
Low educational attainment
90% start before age 18
1/5 still smoke
Oral cancer

Question 5

Pathphsiology

Answer 5

4000 chemical inhaled into lungs
Active ingredients- nicotine 
3,4 benzpyrene most dangerous cargenosus
Low dose acts as a stimulant CNS
Inhalation is the quickest method 
1-2mg nicotine is delivered into the lungs
60 mg are lethal
25% crosses BBB

Question 6

Effects. Of nicotine

Answer 6

Occupies receptor sites at the synapse and prevents the transmission of nerve impulses
Causes the release of epinephrine increases heart rate and blood pressure
Cytochrome oxidase (CO) increase myocardial consumption by 250
Increase mucus production -
* negative inotropic effect

Question 7

Chronic effects of smoking

Answer 7

Tolerance/dependents
Withdrawal: dysphoric, depression, insomnia, irritable , frustration, anger, poor concentration
Pet scan show decreased monoamine oxidase B in smoker
Simulates dopamine receptors increases smoking,
Vomiting center can be initiated

Question 8

Subjective

Answer 8

Drink more caffeine drinks
Weight a blood pressure is lower, increased heart rate.
Decreased fruitily
Women have increased risk of early menopause, decrease bone density and osteoporosis
SIDS is 2-4 times higher in moms who smoke
Depression is 2x more common in smokers
Increase risk for cad, pvd, bone fx, cataracts, glaucoma

Question 9

Objective

Answer 9

Periodontal diseases
Red spots of sores in mouth
Frequent pneumonia, flu, bronchitis,
cardiovascular signs: tachycardia, increased blood pressure
S/s few hours to 48-72h4 and baseline 3-4 weeks

Question 10

Nicotine dependence disorder

Answer 10

Euphoric, depression. Insomnia,irritability, anger, frustration, anxiety loss of concentration, decrease heart rate

Question 11

Diagnostic reasoning

Answer 11

All pt ask about smoking starting with adolescence
Fagerstrom test fer nicotine dependence ; high levels of nicotine dependence
Smoking cessation success

Question 12

Diagnostic testing

Answer 12

Urine- excretion produces effects of smoking
Blood- co is found in blood >2 % indicate smoking
breath,
saliva- 3 ml of unstimulates salvia,.
Cotatine deverative nicene

Question 13

Management

Answer 13

Ask pt at every visit if they are ready to quit
Five A
Ask- smoking hx
Advise- 4R ; risk, relevance, rewards, repeat
Assess- motivation to quit
Assist- ready to quit, uncertain, not ready
Arrange- f/u 1-2 weeks
Offer quit date in 30 days
Offer pregnant women

Question 14

Pre-contemplation stage

Answer 14

No desire to quit in next 6-12 months

Benefits from awareness

Question 15

Contemplation stage

Answer 15

Thinking about quitting and express interest, but are not ready
Benefits from counseling

Question 16

Preparation stage

Answer 16

Serious about quitting and having taken the initial steps to quiting
*Bought gum, patares

Question 17

Action stage

Answer 17

Smoker quits smoking the action last several weeks to 6 months after cessation, which is common time for relapse
Rewarding success

Question 18

Maintain stage

Answer 18

Smoker abstained from smoking for 6 months

Can recycle 3-4 times before abstaining long term abstinence

Question 19

Hypnosis

Answer 19

Enable the smoker to achieve altered state of mind to stop smoking.

Question 20

Aversion conditioning

Answer 20

Relating the ability to smoke to a negative effect

• Shock
• nausea induced drugs
• Hazard health

Question 21

Bupropion (zyban)

Answer 21

Anti-depression and smoke deterrent
Dopaminergic/ noradremergic
. » Start 1-2 weeks before the patient quit date
* history of head trauma, SEIZURES ,eating disorders, MI, heart disease, ETOH should not take!
Duration 7-12 weeks

Question 22

Varenicline (chantix)

Answer 22

' Begin I week before a target date
0.5 mg daily x3 days
0.5mg bid 4days
1 mg bid 12 weeks
* neuropsychiaric symptoms ( depressive)

Question 23

Nicotine

Answer 23

Patches- stronger than gum, applied in Am for 24 hours, change sites
* insomnia, vivid dreams, myalgia- take off at night if dreams occur
Gum - chewed, placed into buccal mucoua( Max 24 pieces in 24 hours)
Do not eat 15 minutes before or after, acidic food decrease absorption of nicotine
1 every 6 hours
nasal spray- more rapid, peak 4-15 minutes
* dysrtrythmias, high blood pressure, angina post mi
X do not give to asthma, pud, renal impairment, liver disease, dm, hypothyroidism
Inhalers-
* cough, throat, mouth, irritation mimics be havoc of smoking

Question 24

Follow-up

Answer 24

• Phone call a week after quit date
  Follow-up 1-3 months after quitting
  Can have constipation due to withdrawal stimulation of nicotine
  Smokers die 5-8 years earlier