Smoking & E-cigs

Question 1

How does tobacco smoke increase cardiac, pulmonary & oncologic morbidity risk?

Answer 1

Cardiac:
Toxins inflame & damage endothelial lining (risk MI, stroke, PVD)

Pulm:
Toxins deposit in lungs, infection

Onc:
Carcinogens (NH4, formaldehyde, CO) =. Mouth, throat, lung, bladder, pancreas, uterus

Question 2

What is the proportional impact of pack years on LE?

Answer 2

1 pack yr = 20 cig/day for 1 year

40 pack yrs = loss 14 yrs life

Question 3

What is self-titration in smoking?

Answer 3

Smokers able to self-titrate nicotine dose by inhaling frequently, deeper, longer (amount of smoke proportional to nicotine dose absorbed to blood stream)

Question 4

Which NTs are released due to activation of the nicotine receptor?

Answer 4

• dopamine
• ACh
• glutamate

Question 5

Smoking produces dopamine. What are the psychological effects of dopamine?

Answer 5

• pleasure
• attention
• faster mental processing
• better working memory

Question 6

Smoking produces dopamine. What is the system associated with dopamine?

Answer 6

Mesolimbic (reward) system
- nucleus accumbens (stim by dopamine)
- ventral tegmentum (stim: glutamate = dopamine; inhibits GABA)

Question 7

What is the effect of smoking on the peripheral nervous system?

Answer 7

• HTN
• tachy
• increased cardiac contractility (AF?)
• increased GIT activity

Question 8

What are the two hypotheses for the mechanism of nicotine tolerance?

Answer 8

1. Reduced nicotine sensitivity (receptors less responsive)
2. Down-regulation of receptors

Question 9

What are the key symptoms of nicotine withdrawal?

Answer 9

• severe craving
• irritability, anger
• anxiety, restlessness, impatience
• poor concentration
• increased appetite, WG
• insomnia

Question 10

Due to its short half-life, on average how often must cigarettes be smoked to maintain serum nicotine concentration & avoid withdrawal?

Answer 10

1 cigarette every 1-2hrs (6-20 a day)
= chain smoking

Question 11

What nicotine replacement therapies are available to individuals who want to quit smoking?

Answer 11

• gum, lozenges
• transdermal patches
• nasal/mouth sprays, inhalers
• dissolvable tobacco
• sublingual products

Question 12

What medications can be prescribed to reduce nicotine withdrawal symptoms & prevent relapse?

Answer 12

• buproprion
• varenicline
  (With NRT)

Question 13

What are the 5A’s of initiating lifestyle changes? (I.e. - smoking cessation)

Answer 13

• ask (about use)
• advise (quit)
• assess (willingness)
• assist (prescribe)
• arrange (refer to support)