Smoking cessation

Question 1

Smoking is:

Answer 1

the most preventable cause of death in our society

Question 2

Second hand smoke (SHS):

Answer 2

>contains more than 7,000 chemicals with >50 chemicals that cause cancer
>no such thing as no risk free exposure
>46,000 adults die from CVD each year
>3,400 die from lung cancer
>SHS from 1 cigar = 1 pack of cigarettes

Question 3

Environmental tobacco smoke (ETS) and children:

Answer 3

> 32 million ages 3-11 are exposed daily
25% of children live with 1 adult smoker*
30% high risk for respiratory diseases
150,000-300,000 new cases of bronchitis & pneumonia for 34% high risk of lung cancer by adulthood
increase in the # of asthma attacks & severity of symptoms in 200,000 to 1 million kids

Question 4

Third-hand smoke:

Answer 4

toxic residue from tobacco smoke that remains after a cigarette is extinguished (clothes, furniture, ect.)

Question 5

Chemicals in tobacco and smoke:

Answer 5

300 chemicals ignited leads to >7000 chemicals such as: formaldehyde, arsenic, cyanide, DDT, lead, radioactive materials, ammonia, acetone, hexamine, mercury, CO, nitrous oxide, nitrobenzene, cadmium, butane, vinyl chloride, hydrogen cyanide, and steric acid.

Question 6

Nicotine:

Answer 6

psychoactive drug in tobacco products, most common form of chemical dependence in U.S., as addictive as heroin, cocaine, or alcohol. usually takes 10 attempts to quit.

Question 7

Ammonia used to treat tobacco:

Answer 7

allows nicotine to be absorbed 100x more readily than tobacco in its’ natural state.

Question 8

What happens with nicotine when a person smoke?

Answer 8

onset: immediate>6-10 seconds to hit the brain
peak: 5 min.
duration: 5-15 min.
half-life: 2 hrs
withdrawl: 3-4 hrs

Question 9

Amount of nicotine absorbed:

Answer 9

> 1ppd = 20 cigarettes, x10 puffs.
200 puffs/day x 7 days = 1400 puffs/week
1-3.5 mg per cig. (20-70 mg/pk)*
1-20 mg per cigar (varies with the size)

Question 10

Averages for cigarettes depends on brand:

Answer 10

reg = 1.2-3.5 mg
light = 1 mg
>individuals adjust how they smoke depending on whether its a light or regular cigarette

Question 11

E-cigarettes (e-cigs):

Answer 11

> nicotine inhalation devices
FDA has classified them as drug-delivery device
more than 200 companies manufacture the devices
about 1 in 5 adult smokers of traditional cigarettes in US have tried e-cigarettes
current research: do they help smokers quit?

Question 12

Absorption of nicotine:

Answer 12

stimulates the release of multiple neurotransmitters:
>dopamine*- pleasure & reward
>acetylcholine- cognitive enhancement, arousal
>norepinephrine- appetite suppression, arousal
>glutamate- learning & memory enhancement
>b-endorphins & g-aminobutyric acid - decrease anxiety & tension
>serotonin- mood modulation, appetite suppression
*w/in seconds of first puff, “feel good” pathway occurs

Question 13

Physical effects of nicotine:

Answer 13

Increased: arousal, alertness, HR/BP, cutaneous vasoconstriction, gastric motility, cardiac outpt, peripheral vasoconstriction, and platelet adhesion.
decreased: appetite

Question 14

Direct effects of cigarette smoking:

Answer 14

> hyperplasia of cells
*goblet cells = increased mucous production
*reduces airway diameter
*reduces ciliary activity
*abnormal dialation of distal airways
*large atypical nuclei develop
changes in small airway function
decreased oxygen carrying capacity on Hgb
effects of tobacco smoke on the respiratory system

Question 15

Passive smoking (ETS):

Answer 15

secondhand smoke (SHS) -
>decreased pulmonary function
>increased respiratory symptoms
>severe lower respiratory infections (adults & kids)
>increased lung and nasal sinus cancer
>increased number of gene mutations (immune cells in newborns) similar to those associated with childhood cancers

Question 16

Myths:

Answer 16

>light & ultra light are safer
>filters make cigarettes safer
>nicotine causes cancer 
>nicotine patches cause heart attacks
>smoking makes you thin

Question 17

Why people smoke:

Answer 17

>something to do with hands
>relaxation
>friends
>like it
>decreases stress
>sophisticated & sexy
>eat less

Question 18

Why smoking is so difficult to quite:

Answer 18

> addiction
habit
emotional dependence

Question 19

What nurses can do to help a patient quit smoking:

Answer 19

(5 A's)
Ask- every patient
Advise- to quit and give facts
Assess- readiness to quit
Assist- with quit plan & discuss med options
Arrange- follow up

Question 20

Medications to help smokers quit:

Answer 20

>nicotine replacement products (NTR):
*Patch
*Gum
*Lozenge
*Spray
*Inhaler
>Non nicotine prescription:
*bupropion (zyban)
*varenicline (Chantix)

Question 21

Withdrawl and quit rates:

Answer 21

> w/d symptoms- start in a few hours, peak 2-3 days later (some 1-2 weeks later)
*anxiety, irritability, restlessness, cravings, cough
quit rates:
*25-35% quit >6 months with meds
*5-16% quit 6 months w/o meds
*2-3% successful per year
RELAPSE not a sign of failure**