Tobacco, Caffeine, Etc

Question 1

What is a good smoking Index for a measure of Nicotine dependence?

Answer 1

Number of cigs/day

OR

TTFC: Time to first cig

<30 min moderate

<5 min severe

Question 2

What is the role of the physician in tobacco addiction? What should we be doing?

Answer 2

the 5As! Ask, Advise, Assess, ASsist, Arrange

Brief physician advice has been shown to increase quitting

Question 3

What are the stages of Change in Quitting Smoking?

Answer 3

Pre-contemplation

Contemplation

Preparation

Action

Maintenance

Terminatoin

Question 4

How is Nicotine metabolized? What are the Pharmacokinetics?

Answer 4

Pharmacology depends on delivery route

Smoking fastest in 10 sec and half life 2 hours

Metabolized in Liver to Continine which can be measured to verify if pt quit smoking

Question 5

Who do you see nicotine intoxication in? what are the symptoms? What’s the problem later on?

Treatment?

Answer 5

Mostly seen in kids who eat cigarretes or people who use patches and cigarates

Can be fatal due to peripheral nicotinic receptor stimulation!!!

Symptoms: Tachy, HTN, Salivation, N/V, Sweating, palpitations, ubcreased alertbess, SEIZURES in some!!!!!

*May see hypotension, Bradycardia and shock several hours after

Tx: supportive, LAvage or charcoal if ingested

Treatment of Bradycardia in kids w/ Atropine

Question 6

What are symptoms of nicotine withdrawal?

Answer 6

feeling really awful

decresaed HR, increased appetite, restlessmness, poor concentration etc

Question 7

What are the FDA approved MEdications for Smoking Cessation? (note: not approved for maintenance like in alcohol)?

Answer 7

NRT - Nicotine Replacement Therapy

Bupriopion

Chantrix (Varenicline)

Question 8

What are the contraindications for NRT in smoking cessation therapy?

Answer 8

Do not use if:

Recent MI

Smoking

Pregnancy/breast feeding

Adolescents

Question 9

What are the different types of NRT? and a Pro/Con of each?

Answer 9

Transdermal - use in pregnancy and continuous long term use; can cause skin irritation

Gum - on demand sypply an good for oral fixation; must be chewed properly

Nasal Spray - easy to use but higher abuse/dependence and effects (rhinitis, watery eyes, coughing)

Inhaler/Puffer - harder to uses

Tablets/Lozenges - can cause mouth/gums soreness

Question 10

What is Buprioprion? How does it work? Who should NOT use it?

Answer 10

decreases withdrawal symptoms when used alone and can be used in conjunction w NRT which is better!!!

Affects NE and Da neurons w/ Nicotine receptors = NDRI

**CONTRAINDICATED if pt has a history of seizure disorder or eating disorder **

Question 11

What is Varenicline? How does it Wpork? What are risks?

Answer 11

Chantrix/Varenicline is a Partial Agonist for the nicotine receptor (alpha4beta2 subunit) and has modera ffinity for 5HT3 receptors

Caution in people w/ renal impairment

Side Effects - N/HA, Insomnia, WEIRD DREAMS and FDA warning for increased Suicide Risk

Question 12

What are symptoms of caffeine intoxication?

Answer 12

DEATH can result from people who have too much w/ pre-existing arrhythmias!!

Causes restlessness, insomnia, tachycardia

Frequent urination and diarhea, muscle twitching, agitation etc