How does tobacco smoke increase cardiac, pulmonary & oncologic morbidity risk?
Cardiac:
Toxins inflame & damage endothelial lining (risk MI, stroke, PVD)
Pulm:
Toxins deposit in lungs, infection
Onc:
Carcinogens (NH4, formaldehyde, CO) =. Mouth, throat, lung, bladder, pancreas, uterus
What is the proportional impact of pack years on LE?
1 pack yr = 20 cig/day for 1 year
40 pack yrs = loss 14 yrs life
What is self-titration in smoking?
Smokers able to self-titrate nicotine dose by inhaling frequently, deeper, longer (amount of smoke proportional to nicotine dose absorbed to blood stream)
Which NTs are released due to activation of the nicotine receptor?
- dopamine
- ACh
- glutamate
Smoking produces dopamine. What are the psychological effects of dopamine?
- pleasure
- attention
- faster mental processing
- better working memory
Smoking produces dopamine. What is the system associated with dopamine?
Mesolimbic (reward) system
- nucleus accumbens (stim by dopamine)
- ventral tegmentum (stim: glutamate = dopamine; inhibits GABA)
What is the effect of smoking on the peripheral nervous system?
- HTN
- tachy
- increased cardiac contractility (AF?)
- increased GIT activity
What are the two hypotheses for the mechanism of nicotine tolerance?
- Reduced nicotine sensitivity (receptors less responsive)
- Down-regulation of receptors
What are the key symptoms of nicotine withdrawal?
- severe craving
- irritability, anger
- anxiety, restlessness, impatience
- poor concentration
- increased appetite, WG
- insomnia
Due to its short half-life, on average how often must cigarettes be smoked to maintain serum nicotine concentration & avoid withdrawal?
1 cigarette every 1-2hrs (6-20 a day)
= chain smoking
What nicotine replacement therapies are available to individuals who want to quit smoking?
- gum, lozenges
- transdermal patches
- nasal/mouth sprays, inhalers
- dissolvable tobacco
- sublingual products
What medications can be prescribed to reduce nicotine withdrawal symptoms & prevent relapse?
- buproprion
- varenicline
(With NRT)
What are the 5A’s of initiating lifestyle changes? (I.e. - smoking cessation)
- ask (about use)
- advise (quit)
- assess (willingness)
- assist (prescribe)
- arrange (refer to support)
