Week 7 smoking

Question 1

what are some common tobacco related diseases- cancers and chronic?

Answer 1

cancer- head and neck, lung, leukaemia, stomach, kidney, pancreas, colon, bladder, cervix
chronic disease- stoke, blindness, gum infections, aortic rupture, heart disease, pneumonia, hardening of arteries, chronic lung disease and asthma, reduced fertility, hip fracture

Question 2

what are some markers of addiction?

Answer 2

use despite knowledge of harmful consequences
cravings during abstinence
failure of attempts to stop
withdrawal symptoms during abstinence
- smoking is an addiction and a chronic relapsing disorder

Question 3

describe the epidemiology of smoking amongst different groups?

Answer 3

average 18%
professionals 12%
manual workers 25%
mental health 40%
unemployed 50%
prison 70-80%

Question 4

how does nicotine use lead to addiction- physiology?

Answer 4

nicotine acts on nicotinic acetylcholine receptor stimulating dopamine release= satisfaction associated with smoking
following chronic nicotine exposure ACh enter up-regulated state- increased affinity and functional sensitivity to an agonist= drop in nicotine levels= craving or withdrawal
- 1-2 puffs of cig binds to 50% ACh receptors
- ACh receptors take 6-12 weeks to desensitise from last cig

Question 5

how effective is cessation in relation to other cessations?

Answer 5

NNTS- number need to treat- to prevent a death- 16-40 for smoking
for statin as primary prevention- need to treat 107 to prevent 1 CVS death over 5 yrs
for cervical cancer need to screen 1400 to prevent 1 death over 10yrs

Question 6

what are some of the health benefits of giving up smoking?

Answer 6

20mins- BP falls to level before had last cig
8hrs- Carbon monoxide CO in blood drops to normal
24hrs- chance of heart attack decreases
2weeks-3months- circulation improves- lung function increases up to 30%
1yr- chance of MI halved
5yr- stroke risk reduced to that of non smoker
12yr- risk of dying from lung cancer down to 1/2 of current smoker

Question 7

what is the role of HCP in smoking cessation?

Answer 7

70% of smokers want to quit
AAA- ask- record smoking status
advise- pt of health benefits
act- on pts response- build confidence, refer to stop smoking services- if seen 4x more likely to quit

Question 8

how are nicotine and nicotine replacement therapy NRT used as part of smoking cessation?

Answer 8

nicotine deprivation in smokers causes withdrawal discomfort
- nicotine via therapeutic route provides relief and encourages complete abstinence
- NRT- temp nicotine substitution- weaning, contains nicotine only- short and long acting agents used in combination- patches (long acting) and gum (fast acting)
doubles success rate of quiting

Question 9

describe harm reduction as a new approach to smoking cessation

Answer 9

1. stop- still recommended approach
2. cut down to stop- using one or more NCP
3. smoke less- long term reduction
4. stop temporarily
5. e cig- toxins present but lower

Question 10

how do champix work?

Answer 10

bind to nicotinic ACh receptors in brain- high affinity and selectivity- acts as a partial agonist to reduce cravings

• reduces satisfaction smoker gets from a cig
• should be taken for 3months
• can be combined NRT prescribing