TUPAC Flashcards
What was the cause of 2Pac’s death?
Drive-by Shooting
What are the benefits of vaping?
No tar or carbon monoxide smoke due to lack of combustion
What are possible dangers of vaping?
No regulation
No labelling / consistency of ingredients
Citric Acid: Tooth Erosion
Diacetyl: causes scarring of the lung (Popcorn Lung)
Microparticles
Propylene Glycol: eye/respiratory irritation
If a patient asked you if vaping was safe as a means to quit cigarettes, how would you respond in a patient centred manner?
Although there are benefits from vaping (less harmful additives + no combustion) they still contain nicotine - so may not help your goal to quit smoking. There is also a long way to go in terms of regulation, clear labelling of ingredients, and regulation of other ingredients that might be harmful. There is still a lot of research that needs to be done and to gauge long term health effects.
Why does modern smoking differ from traditional forms of smoking found in Indigenous cultures?
Processing of tobacco to create free nicotine - provides greater potency and adds to it’s addictive nature
What are THREE things that define a patient with substance abuse disorder?
- Withdrawal Syndrome on cessation
- Repeated, unsuccessful attempts at quitting. Relapses
- Continued use in spite of health risks
Chewing tobacco poses what oral health risk?
Local inflammation of mucosal tissue from being left in the mouth for long periods of time. Chronic use greatly increases the risk of oral cancers
What are the effects of cigarette tar?
70% stays in the lungs Staining of Teeth Narrowing of airways Damages cilia - leading to smokers cough Long term damage leading to cancer
How does nicotine work?
Attaches to nicotinic receptors in brain – release dopamine
Attaches to nicotinic receptors in adrenal glands – release adrenaline
Attaches to nicotinic receptors in muscle tissue – release acetylcholine causes muscle contraction
Increases blood sugar levels
What are the immediate systemic effects of nicotine
Dopamine: increased attention, improved mood and well-being
Adrenaline/Noradrenaline: alertness, vaso-constriction
What makes nicotine addictive?
Development of tolerance by the desensitisation of nicotinic receptors. Upregulation and modulation required to attain same “reward”, requiring increased frequency of cigarettes
What are 4 individual influences to why marginalised people smoke?
- Beliefs about smoking
- Self-Esteem
- Rebellion
- Curiosity
What are FIVE environmental influences to why marginalised people smoke?
- Parents + Siblings smoke
- Peers smoke
- Media
- Availability
- Smoking Areas
What is Sidestream Smoke?
Smoke drifting from the end of a lit cigarette
What is Mainstream Smoke?
Smoke breathed in by smoker
What is Environmental Tobacco Smoke?
Exhaled mainstream smoke and sidestream smoke
How is exhaled mainstream smoke different to mainstream smoke?
Different chemical composition that is modified by the smoker
What are some of the effects of Passive Smoke?
Asthma Bronchitis & pneumonia, respiratory tract infection Middle ear infection (“glue ear”) SIDS Low birth weight Meningococcal infections
What are 7 reasons why people choose to stop smoke?
Health reasons Financial reasons Family Social pressure Workplace policies Awareness campaigns Significant dates/events
What effect does Carbon Monoxide have on the body?
Binds to haemoglobin, reduces ability to carry oxygen by up to 15%
How does smoking affect a patient with cardiovascular disease?
Nicotine > Adrenaline > Vaso-constriction > Increased Blood Pressure > Increased stress on the cardiovascular system
What are the top 4 groups that are most likely to be smokers?
IV Drug Users
Homeless People
Prisoners
At Risk Young People
What are 3 very dangerous modes of nicotine consumption?
- Reverse Smoking
- Chop Chop (unregulated cheap tobacco)
- Chewing Tobacco
What are 6 preventable risk factors associated with high risk indigenous births?
- Smoking: 200% increase, and is dose dependent
- Alcohol: fetal alcohol syndrome
- Teenage Pregnancies: associated with more risk taking behaviours with negative health outcomes and low SES
- Nutritional Disorder: high levels of maternal malnutrition
- Stress: maternal stress, depression, victims of violent crime and domestic abuse
- Infection: STIs (genital herpes, syphilis, gonorrhoea, chlamydia) and UTIs
A lack of dietary folate during pregnancy results in what?
Neural tube defects (e.g. spina bifida)
A low birth weight associated with smoking can lead to what developmental issues with children?
Cerebral Palsy, Mental Retardation and Epilepsy
Behavioural problems (ADD, hyperactivity, high rates of school failure)
What are 5 possible complications that can happen during pregnancy due to smoking?
- Placental abruption (separation)
- Placenta praevia: damaged placenta compromises nourishment
- Premature labour
- Premature rupture of membranes (PROM)
- Ectopic pregnancy (egg implants outside the womb) => miscarriage
What are 7 possible perinatal (at/around time of birth) complications can happen due to pregnancy due to smoking?
- Still born or Perinatal death
- Premature Birth
- SIDS
- Low birth weight
- Poor lung function
- Neurodevelopment and behavioural disorders in children
- Neonatal nicotine withdrawal
Why is smoking underreported in teens? (THREE)
- Many don’t see themselves as smokers (only trying it out, only on weekends/social, they didn’t buy the cigarettes)
- Lack of trust to share that information when not anonymous
- Not willing to disclose that information whilst parents are in the room
Why is pregnancy an ideal time to try to get a woman to quit smoking? (THREE)
- Mothers feeling more responsible (eg. health of baby)
- Increased contact with health care providers: more motivation and support
- Dual Benefit: mother’s own health also improved
What are ways to maintain maternal health in the pregnancy to reduce the risk of low birth weight? (EIGHT)
- Planned Pregnancy
- Stress: address domestic violence, homelessness
- Quit Smoking
- Avoid alcohol / substance use
- Dental Care
- Normal pre-pregnancy BMI
- Adequate nutrition + pregnancy weight
- Folate and Iron supplements
What groups are at most risk of low-birth weight? (SIX)
- Past poor outcomes
- 10+ Cigarettes/day
- Substance Abuse
- Periodontal Disease
- Teenage mother
- Low SES
How would a dentist possibly intervene in helping a patient to quit during the pre-contemplation phase?
Provide information, feedback, raise awareness and develop rapport.
How would a dentist possibly intervene in helping a patient to quit during the contemplation phase?
Assist client to tip scales in favour of change (eg. strategies for success like removing ash trays at home)
How would a dentist possibly intervene in helping a patient to quit during the relapse phase?
Normalise the failure and frame as an opportunity to learn.
What are the TWO main aspects of motivation?
Importance: placing high value on something
Confidence: believing in one’s ability to achieve it
What are the 3 goals of Nicotine Replacement Therapy?
- Replace some of the nicotine obtained from cigarettes (whilst decreasing tobacco smoke)
- Reduce Withdrawal Symptoms
- Allow people to focus on other aspects of quitting (habits/behaviours/emotional dependency)
What are 3 commercially available NRT products?
Nicorette, Nicobate, QuitX
What are some known side effects of NRT products?
Vivid Dreams, Disturbed Sleep, Altered Mood, Nausea
T/F: Patients on NRT will not experience withdrawal symptoms to nicotine?
False, they may still experience withdrawal symptoms as NRTs are designed to have lower nicotine vs. cigarette (especially true for heavy smokers)
What is the rationale of Cut Down To Stop (CDTS)?
To reduce the number of cigarette intake prior to quitting.
What are the 5 methods of administering NRT?
- Patches
- Gum
- Inhalers
- Lozenges
- Sublingual Tablets
When is combination therapy for NRT recommended?
For heavy smokers - they require multiple administration pathways because they experience withdrawal symptoms with regular dosage of NRT
What are contraindications of Champix (varenicline)?
Pregnant or Lactating
Under 18 years old
Kidney issues
Medications: Insulin, Asthma, Blood Thinners, Mental Illness
What is the mode of action of Champix (varenicline)?
- Reduces craving and withdrawal symptoms by having a sufficient agonistic effect on the nicotinic receptors.
- By binding to the receptor, it prevents nicotine from binding to it, blocking the rewarding/reinforcing effects of nicotine
What are FIVE non-pharmacological aspects to the approach of smoking cessation?
- Counselling
- Cognitive and Behavioural coping strategies
- Written Information
- Quitline Referral
- Follow up
What are THREE indications of nicotine dependence?
- Smoking within 30 minutes of waking
- Smoking more than 10 cigarettes a day
- History of withdrawal symptoms in previous attempts to quit
What are 6 principles to motivational interviewing?
- Develop Discrepancy
- Roll with Resistance
- Avoid Solutions/Suggestions
- Build Self Efficacy
- Express Empathy
- Support Success
What are THREE reasons why there is a correlation between smoking and mental illness?
- Nicotine can provide short bursts of alleviation of some symptoms of mental illness
- Many aspects of psycho-social + environmental disadvantage between smoking and mental illness are the same (eg low SES, high stress, social isolation)
- Genetic basis (association between genetics of smoking [eg. susceptibility to withdrawal symptoms] and mental illness)
Why would smoking be a risk factor in the success of implants?
Vasoconstriction caused by the local absorption of nicotine into the bloodstream cuts off blood supply causing bone to resorb. Osseointegration success is therefore diminished.
Name 4 reactive lesions in the oral cavity that have a direct association to smoking
- Smokers melanosis (Mucosal pigmentation)
- Black Hairy Tongue
- Nicotinic Stomatitis
- Oral Cancers
Describe the pathway of direct harm from smoking that can lead to oral cancer
- Aromatic hydrocarbons present in cigarette smoke causes reactive change in mouth
- Dissolves in saliva
- Interference with DNA replication epithelial cells
- Possible tumour growth if in sufficient number and not suppressed by host factors
What are 2 compounding risk factors for oral cancer from smoking?
- Alcohol (dehydration and penetration of mucosa)
- Poor Nutrition (lack of antioxidants to counter free radical)
What are the SIX stages of change? (eg. pt trying to quit smoking)
- Pre-contemplation
- Contemplation
- Preparation
- Action
- Maintenance
- Relapse (hopefully it doesn’t come to this, but hey, we’re all human.)
What are THREE activities that can be used to facilitate change in someone smoking?
- Motivation (eg. confidence building)
- Decision balance (solidifies importance to quitting)
- Smoking diary
What are the 3 things that can be done in the brief approach to talk about smoking with a patient
- Ask about and record smoking status
- Assess their interest in quitting
- Advise of Quitline and refer as appropriate
What are 4 communication strategies that can be used when talking about smoking
- Open Questions
- Affirmation
- Reflective Listening
- Summarising
What does the Fagerstrom Test measure?
Gauges level of nicotine dependence
During Behavioural Motivational Interviewing, what are signs you’re doing it wrong?
- Take an authority position
- You do most of the talking
- Arguing with the patient
- Showing no understanding or empathy
- Get the patient offside
What are the stages of change in relation to quitting smoking?
- Thinking about it
- Preparing for Action
- Taking Action4.
Maintenance
When Should Champix (Varenicline) be used when attempting smoking cessation?
Start 1-2 weeks before quit attempt to allow optimal drug efficiency
How would smoking impact on xerostomia?
Cigarette smoke dehydrates the mouth
What are the stages of change in relation to quitting smoking?
- Thinking about it
- Preparing for Action
- Taking Action
- Maintenance
How should a dentist respond to a patient’s Change Talk?
- Reinforce, encourage and elaborate change talk
- Show empathy and understanding to their negative ambivalence
- Reflect & summarize
- Affirm
If a patient expresses resistance to talk about smoking cessation, what is this a sign of?
Resistance is usually an indicator that there is a mismatch between the counsellor’s assessment and patient’s readiness to change
What does Bupropion do in relation to smoking cessation?
It is a Norepinephrine-Dopamine Reuptake Inhibitor (NDRI) drug that reduces the severity of nicotine cravings/withdrawal
Which groups does Buproprion have proven effective effects for smoking cessation?
Patients with depression and schizophrenia
How does smoking affecting hard and soft tissue?
Stained Teeth, Dental Appliances, Prostheses
Halitosis + Impaired Taste
Coating on Tongue
Oral Mucosal Hyperpigmentation + Keratosis
Stomatitis Nicotina (Smoker’s Keratosis) on the palate
How might smoking affect a patient when administering LA?
Possible drop in blood pressure when giving LA with adrenaline
T/F: Nicotine is a nicotinic cholinergic receptor antagonist
False: it is a cholinergic receptor agonist - binding to the receptors to activate the brain’s reward system to release dopamine
What is the endogenous ligand that nicotine is aiming to mimic?
Acetylcholine
How quickly is nicotine activated in the brain?
Seconds
How long is the half-life of nicotine in the body?
2 hours
What neuronal changes occur with chronic nicotine usage
1) Increase in receptor populations
2) Desensitisation of receptors
3) Changes in neurotransmitter vesicle content
4) Changes in signalling pathways
What are 4 general effects of long term chronic nicotine use
1) Tolerance
2) Withdrawal Syndrome on cessation
3) Risk to Health (CVD, Lung/Oral Cancers)
4) Decreased oxygen in blood
How long is the peak acute withdrawal symptoms last for?
2-3 days with symptoms subsiding within several weeks
What are some symptoms of nicotine withdrawal?
1) Mood Changes - dysphoria, depressed mood
2) Irritability, Frustration, Anger,
3) Anxiety
4) Difficulty Concentration
5) Increased Appetite and weight gain
6) Decreased heart rate
7) Craving for smoking
Which NRT delivery mechanism is the most effective?
Nasal Spray: has a faster onset kinetics of NRT which would preempt the need to smoke. Other delivery mechanisms have slower onset.
