VAPING AND INHALANTS Flashcards
VAPING OR E-CIGARETTES
§ Known by different names e-cigs, ehookahs, mods, vape pens, vapes,
tank systems, electronic nicotine
delivery systems
§ Produce an aerosol by heating a liquid
– usually nicotine and flavorings
§ Inhale aerosol, bystanders can also
breathe aerosol
NOTE: No vapors actually involved in ecigarettes
Vapor – gas phase of a substance
Aerosol – suspension of particles of a
liquid, solid or both within a gas
HOW DO THEY WORK?
- Hacking or Modifying Devices
- Dripping
E-LIQUIDS
- Typically mixture of water, food grade flavoring,
nicotine, cannabis (THC, CBD), propylene
glycol (PG) or vegetable glycerin (VG) - PG and VG used as humectants
- Effects of nicotine well known
- Toxic effects of aerosol flavoring chemicals,
solvents and other products largely unknown
Nicotine: Newer Mods use nicotine salts - Lower pH than free base nicotine
- Allow for high levels to be inhaled more easily
with less irritation on throat
MARKETING AND ADVERTISING
- Pediatric exposure is a serious concern, notably, nicotine toxicity and addiction
issues - TV ads for cigarettes were banned 1971 but in a 2016 US study, it was found >75%
of grade school and high school students had seen TV ads for e-cigarettes
VAPING USAGE
Canadian Tobacco and Nicotine Survey (2019)
Ø 2019, ~16% (5 million) Canadians had vaped
Ø Most commonly used tobacco product in youth (~36%)
Ø Individuals >45 years tended to be previous smokers
Ø ~40% of 18-24 year old reported never being regular
cigarette smokers
E-CIGARETTES VS. REGULAR CIGARETTES?
Ø Not approved as a ‘quit’ smoking aid but may assist
Ø Generally have fewer toxic chemicals (regular smoking ~7000 chemicals)
Ø E-cigarette aerosols contain many harmful substances
- Nicotine
- Cannabinoids (THC, CBD)
- Volatile organics
- Ultrafine particles
- Heavy metals such as Cr, Ni, Pb, Sn
- Carcinogenic substances (formaldehyde, acetaldehyde)
- Flavoring – diacetyl (ie., ‘popcorn’ lung)
Ø Unintended injuries (exploding)
Ø Synthetic Cannabinoids –
Ø K2, Spice, Black Mamba, Kronic
AEROSOL COMPOSITION
Ø Over 250 e-cigarette brands and >8000 flavorings (Note: besides methanol all flavoring
banned in cigarettes)
Ø Full evidence of the impact on heating these substances is unknown
Ø Formation is linked to device characteristics (ie., coil temperature, metals used)
Ø Vaping requires user to more puffs both harder/longer than regular cigarettes
Carbonyl Compounds
§ Thermal degradation of 1,2-propylene glycol and glycerin produces
§ Acetaldehyde, acrolein and formaldehyde
Diacetyl and 2,3-pentanedione
§ Found in the majority of e-cigarettes
§ Flavoring agent (‘butter-flavored’ popcorn), but can create a variety of flavors
§ Previously linked to bronchiolitis obliterans (‘popcorn lung’)
§ Evidence they impair production and function of cilia in human airway
Volatile Organic Compounds
§ Benzene, toluene, ethylbenzene, xylene
Metals
§ Many types predominant include aluminum, iron, chromium, nickel, tin, copper, lead
VAPING ASSOCIATED PULMONARY INJURY (VAPI)
(EVALI – E-CIGARETTE OR VAPING ASSOCIATED LUNG INJURY)
§ ’New’ disease associated with vaping,
>2800 cases, 68 deaths (US)
§ USA reported an outbreak (Peak Aug 2019
- Feb 2020)
§ An acute or subacute chemical pneumonitis
§ Predominately young males (<35 in 80%
cases) and healthy individuals
§ Patients cough, dyspnea, chest pain
§ Common nausea, abdominal pain, diarrhea
§ Used e-cig within 90d of onset
§ Pulmonary infiltrates on chest radiography
(atypical pneumonia)
§ Many patients required ICU and ventilator
support
§ Some developed acute respiratory distress
syndrome (ARDS)
VAPING ASSOCIATED PULMONARY INJURY (VAPI)
(EVALI – E-CIGARETTE OR VAPING ASSOCIATED LUNG INJURY)
§ Pathogenesis largely unknown
§ Products that contained THC and/or
vitamin E acetate were associated with
disease
Study assessing bronchoalveolar lavage
fluid (BAL) in 51 patients with EVALI
§ 48 of 51 patients had vitamin E acetate
and 40 of 47 patients had THC
§ Used to thicken or dilute the THC in
vaping liquids
§ Not found with nicotine products (too
viscous)
§ MOA for pulmonary toxicity not known
§ Interfere with membrane function
§ Heating may produce ketenes (reactive
compound)
BRONCHIOLITIS OBLITERANS (POPCORN LUNG)
Toxic substances associated with developing popcorn lung
* Acetaldehyde
* Ammonia
* Chlorine
* Diacetyl
* Formaldehyde
* Fumes from metal oxides
* Hydrochloric acid
* Mustard gas or sulfur mustard
* Nitrogen oxides
* Sulfur dioxide
CHOLINERGIC TOXIDROME?
§ Cholinergic toxidrome represents acute phase of cholinesterase inhibitor poisoning
§ Accumulation of excessive levels of acetylcholine
§ Pathology depends upon receptors (nicotinic and muscarinic) differ in function, location, physiology
DUMBELS, Killer B’s Days of the week
SLUDGE
NICOTINE POISONING
- Nicotine binds to nicotinic cholinergic
receptors (mimics acetylcholine) - Absorbed rapidly by all routes, enters brain
quickly, volume of distribution ~2.6-3L/kg,
rapidly metabolized (CYP2A6 and
CYP2D6), - Urinary excretion, t½ 120min
- Increased incident in children (< 5years old)
~1000% (lethal dose <50mg), severe
toxicity ~6mg - 2.6X odds severe outcomes, highly
concentrated e-Liquid - Ex. 1x cigarette (10-30mg), 30mL eLiquid
(36mg/ml) (adult lethal doses 30-500mg)
NICOTINE POISONING
-Dose- and time-dependent effects (Biphasic response)
Early (0.25–1 h)
Late (0.5–4 h)
Gastrointestinal Respiratory Cardiovascular Neurologic
Cannabis - How safe is it?
Bill C-45 was approved by Parliament and given royal assent on June 1, 2018.
New status came into effect October 17, 2018.
1. USA legal cannabis market worth $7.97 billion
2. Dramatic increase in potency (from ~2-3% to 20%) over last 10years
3. Key constituents: Δ9-tetrahydrocannabinol (THC) vs cannabidiol (CBD)
4. Key receptors: CB1R versus CB2R
Cannabinoid Receptors - CB1R vs CB2R
Cannabinoid-related products can contain >60 chemicals, Δ9-
tetrahydrocannabinol
(THC) primary psychoactive compound
§ Cannabinoid receptors (CB1 and CB2) found throughout body but brain has stimulant,
sedative or hallucinogenic actions
§ Trigger both catecholamine release and inhibition of sympathetic reflexes
§ Acute effects – decreased coordination, muscle strength, lethargy, decrease
concentration, psychomotor activity
§ Non-classical effects (agitation and seizures) – synthetic or ‘spice’ blends ‘incense
packaging’ (Zombie)
