tobacco Flashcards
what product has the highest nic content
cigars
When inhale cigarette (directly or secondhand) inhaling more than _____ chemicals, _____ of these are hazardous ______ are known carcinogens
When inhale cigarette (directly or secondhand) inhaling more than 7,000 chemicals
Hundreds of these are hazardous
70 are known carcinogens
______ cancer is the leading cause of cancer related death in US for both men and women
Lung cancer is the leading cause of cancer related death in US for both men and women
what causes a majority of lung cancer
smoking
SMOKING EFFECTS ON THE MOUTH
breath?
Perio?
throat?
Reduced senses?
Unhealthy tissue
Delayed?
cancers?
staining?
Poor response to?
lesions?
Sores?
Bad breath
Periodontal (gum) disease
Sore throat/hoarseness
Reduced smell/taste
Unhealthy tissue
Delayed healing
Oral cancer
Throat cancer
Teeth staining
Poor response to dental treatment
Oral lesions
Sores on mouth, lips, tongue
all smokeless product contain
carcinogens and nic
SMOKELESS TOBACCO EFFECTS
ON THE MOUTH
breath?
Irritates and inflames?
cancer?
Increased risk of?
Painful?
staining?
disease?
SMOKELESS TOBACCO EFFECTS
ON THE MOUTH
Bad breath
Irritates and inflames tissue= Tissue changes
Oral cancer
Increased risk of tooth decay
Painful ulcers
Teeth staining
Periodontal/Gum disease
Approximately _____ Americans are diagnosed with OPC (oral and/or pharyngeal cancer)
________die each year from disease
Approximately 42,000 Americans are diagnosed with OPC (oral and/or pharyngeal cancer)
8,000 die each year from disease
____% of OPC can be attributed to tobacco use, heavy
alcohol consumption and in many cases both
75%
prevalence of e cigs increasing where?
high schoolers and adolescents due to fruit flavors
“VAPING”…..
Act of inhaling and exhaling what? which is produced by?
E-cigarettes do not produce? , but rather an? often mistaken for? , that actually consists of?
Vapor is generated from?
“VAPING”…..
Act of inhaling and exhaling the aerosol, often referred to as vapor, which is produced by an e-cigarette or similar device.
E-cigarettes do not produce tobacco smoke, but rather an aerosol, often mistaken for water vapor, that actually consists of fine particles.
Vapor is generated from a solid, semi-solid, or liquid substance
components of vape pens
COMPONENTS
Battery
Heating element
Atomizer
Cartridge/pod
Indicator light
E-LIQUID INGREDIENTS
Vegetable glycerin
Propylene glycol
Flavorings
Nicotine**
Other compounds/chemicals: Diacetyl and Benzoic acid
e liquid ingredients deemed safe?
Ingredients may be deemed safe for use and/or ingestion
But not evaluated for inhalation and heat
e liquid 3rd hand exposure?
Can remain on surfaces for weeks to months
Potential for 3rd hand exposure or accidental ingestion by
children
e liquid effects in pregnancies
May cause adverse effects during or after pregnancy
Nicotine can cross the placenta
nic salts
hit?
More like a?
nicotine concentrations?
Potential to be more?
nicotine solutions available?
Each pod contains same amount of nicotine as?
“Smoother hit”
More like a cigarette rush
Higher nicotine concentrations
Potential to be more addictive
1.8 % - 5% nicotine solutions available
Each pod contains same amount of nicotine as an
entire pack of cigarettes**
AEROSOL composition
Volatile organic compounds
Nicotine
Ultrafine particles
Heavy metals – nickel, tin, lead
why ?
HEALTH CONCERNS ASSOCIATED
POPULARITY OF DEVICES
Easy to get? how?
Flavorings?
design?
11 to 17-year olds think?
Easy to get: Via online, convenience stores*, Smoke/vape shops
Flavorings make these devices appealing
Discreet use/sleek design
11 to 17-year olds think e-cigarettes are less
harmful than smoking
HEALTH CONCERNS ASSOCIATED with vaping
Increased heart rate due to? =Higher risk for?
blood pressure?
bronchitis?
lung disease?
“popcorn lung”?
glycemic control?
Increased heart rate due to spike in adrenaline=Higher risk for heart attack
Increased blood pressure
Increase in bronchitis
Increase in lung disease
“popcorn lung” – bronchiolitis obliterans
May cause blood sugar levels to rise
vaping EFFECTS ON ORAL HEALTH
Chemical vapors produced can alter or damage what cells?
ulcerations?
Oral cancer?
Indicates an inflammatory response where/cells?
May lead to greater risk for?
throat?
Dry?
Chemical vapors produced can alter or damage epithelial cells
Oral ulcerations
Oral cancer may result
Indicates an inflammatory response in the PDL fibroblasts
May lead to greater risk for periodontal disease
Sore throat
Dry mouth
vaping heat and chemicals effect in the mouth
Dry?
Bone?
Inflam?
Increased?
Tooth?
Dry mouth
Bone loss
Inflammation
Increased plaque, calculus
Tooth decay
nic as a stim can induce what habit?
bruxism
NICOTINE
Distributed quickly through the ___________ and
crosses the ____________barrier
Reaches the brain within __________seconds with inhalation
Elimination half-life?
Nicotine is metabolized in the?
An alkaloid that is contained in the leaves of plants
Distributed quickly through the bloodstream and
crosses the blood–brain barrier
Reaches the brain within 8–20 seconds with inhalation
Elimination half-life of nicotine is around two hours
Nicotine is metabolized in the liver
nic physio effects
adrenal glands
heart
panc
NTs released?
The amount of nicotine absorbed by the body
from smoking depends on:
type of tobacco
whether the smoke is inhaled
whether a filter is used
smoke vs. smokeless tobacco and nic into body
more in smokeless
nic and braind dev
Research indicates development of brain continues to occur until the age of 25
Nicotine changes the way synapses are formed
can harm the parts of the brain that control attention and learning
The nicotine in e-cigarettes and other tobacco products can also prime the adolescent brain for addiction to other drugs such as cocaine.
HOW (nic) IMPACTS YOUTH/YOUNG ADULTS
Depression
Anxiety
Mood disorders
Addiction
Difficulty paying attention
Reduced impulse control
nic addiction cycle (increased usage)
TOBACCO DEPENDENCE:
A 2-PART PROBLEM
WITHDRAWAL SYMPTOMS
timeframes
BENEFITS OF QUITTING SMOKING
20 min
8hrs
24hrs
48hr
3days
2-12 months
5yrs
10-15 yrs
f
quitting smokeless tobacco decreases risk for:
cancer?
teeth?
gums?
cholesterol?
bp?
infarctions?
oral, head and neck cancer
tooth decay
progression of gum recession
high cholesterol
high blood pressure
heart attack or stroke
what product has the highest 1 year cessation rates
nic gum and lozenges
the 5 A’s for user
how to ask about tobacco use
◼ “Do you ever smoke or use any type of tobacco?”
◼ “Do you use any form of e-cigarette or vaping device?”
◼ “Do you, or does someone in your household smoke?”
pack year figure
Number of cigs per day/20 x number of years of smoking = number of pack years
advising quitting
(clear, strong, personalized)
◼ Best results if you can personalize this and be open, non-judgmental
ways to assists with the quit at different stages
◼ Not ready to quit: provide motivation
◼ Ready to quit: design a treatment plan
◼ Recently quit: relapse prevention
Transtheoretical Change
Model
(Stages of Change)
arranging follow up care
greater success with more appts
Quit-line available 24
hours a day, 7 days a
week?
1-800-quitnow
CESSATION OPTIONS
Cold Turkey (no additional help)
Replacement?
Medications*
Therapy?
Apps?
Combination?
Hypnotherapy?
Acupuncture?
Yoga, meditation?
Herbs?
Cold Turkey (no additional help)
Nicotine Replacement Therapy (NRT’s)*
Medications*
Behavioral Therapy
Counselor/Coach, app/tech use, telephone counseling (1-800-QUITNOW)
Apps – QuitNow!, KWIT, Smoke Free, Quitters Circle, Quick Tracker
Combination Therapy: Multiple uses of NRTs, NRTs and medications
Hypnotherapy – Reveri app
Acupuncture
Yoga, meditation
Herbs
contraindications for pharm agents
Hypothyroidism
Insulin-dependent diabetes
Active peptic ulcer
Anti-depressant medications
BUPROPION SR (ZYBAN)
what is this?
when to begin?
when to double dose?
)
150 mg sustained release tablet
Begin taking 1 week prior to quitting
Double dose after 3 days
zyban advantages
Easy to use
Can be used with Nicotine Replacement Therapy
zyban adverse effects
sleep, mouth, nerves, concentration, GI, convolutions?
Insomnia, dry mouth, nervousness/difficulty
concentrating, rash, constipation, seizures
starter and maintenence?
How to write the prescription for zyban
Rx: Zyban Starter Pack
Disp: 1 (one) package
Sig: Take as directed
0 refills
Rx: Zyban Maintenance Pack
Disp: 1 (one) package
Sig: Take as directed
2 refills
dosage/ days and weeks frame
VARENICLINE
(CHANTIX®)
0.5 mg and 1.0 mg tablet
Days 1-3: take one 0.5 mg tablet in the AM
Days 4-7: take 0.5 mg tablet twice daily
Weeks 2-12: take 1.0 mg tablet twice daily
chantix advantages
Easy to use and offers a new mechanism of action for
patients who have failed with other agents (decreases dopamine for less withdrwl effects)
chantix adverse effects
sleep, GI, nn, nausea?
Nausea, insomnia, vivid dreams, constipation, vomiting, Neuropsychiatric Symptoms (behavior changes, agitation, depressed mood, suicidal ideation or behavior)
starter/maintence?
chantix prescription
Chantix® Starting Month/Pack
Disp: 1 (one) package
Sig: Take as Directed
0 Refills
Chantix® Continuing Month/Pack
Disp: 1 (one) package
Sig: Take as Directed
2 refills
chantix quitting methods
3 ways: fixed , flexible and gradual quit approaches
dosage (wks; 1-6, 7-9, 10-12)? max per day? food?
(GUM – NICORETTE, ZONNIC)
Week 1-6: 1 piece every 1-2 hours
Week 7-9: 1 piece every 2-4 hours
Week 10-12: 1 piece every 4-8 hours
Max of 24 pieces per day. No food or beverage 15 min before or during use
nic gum pros
May delay weight gain and satisfy oral cravings
nic gum cons
Mouth/jaw soreness, hiccups, dyspepsia
dosages possible for dif cases? (wks: 1-6,7-9, 10-12)? max per day? food?
(LOZENGE – COMMIT, ZONNIC)
2 mg (smoke > 30 min after waking) and 4 mg (smoke ≤ 30 min after waking)
Week 1-6: 1 lozenge every 1-2 hours
Week 7-9: 1 lozenge every 2-4 hours
Week 10-12: 1 lozenge every 4-8 hours
Max. of 20 lozenges/day. No food or beverage 15 min. before or during use.
Do not chew or swallow lozenge
advantages of the nic lozenge
May delay weight gain and satisfy oral cravings
cons of nic drop
Nausea, hiccups, cough, heartburn, headache, insomnia
dosages
(TRANSDERMAL PATCH - NICODERM CQ)
7 mg, 14 mg, 21 mg (24-hour release)
pros of slapping on a nic patch
Provides consistent Nicotine for 24 hrs, easy to use.
cons of wearing a fucking patch releaseing nic on your skin 24hrs a day
local, head, sleep?
Local skin reaction, headache, insomnia, vivid dreams (sex)
(NASAL SPRAY – NICOTROL NS)
dose per 50mcl
usual doses per hour?
doses/day?
Maximum doses/hr?
One dose = ?
0.5 mg metered spray per 50 mcL
1-2 doses per hour
8-40 doses/day
Maximum 5 doses/hr
One dose = 2 sprays (1 per nostril)
pros of the sweet ass nic spray
Patients can titrate therapy to help with withdrawal
cons of spraying fucking nic into your nose
Nasal/throat irritation, rhinitis, tearing, sneezing, headache, cough
(ORAL INHALER – NICOTROL)
___ mg cartridge – delivers ____ mg inhaled nicotine vapor
cartridges/day?
Begin with ___ cartridge every ____ hours
Best effects with?
10 mg cartridge – delivers 4 mg inhaled nicotine vapor
6-16 cartridges/day
Begin with 1 cartridge every 1-2 hours
Best effects with continuous puffing for 20 min
pros of having a nic enhanced inhaler with blue tiger camo and no stock
Patients can titrate amount to manage withdrawal and
mimics hand-to-mouth ritual
cons of the nic inhaler
Mouth/throat irritation, cough, headache, rhinitis, dyspepsia (indigestion)
umkc super cool smoking cessation program consists of
Prep-work by the student
Initial Visit Appointment
Follow-Up Visit Appointment(s)
maybe free hugs too idk
is smoking cool?
only if youre drunk or have a topcoat on then kinda
