Exam 4 Smoking Cessation Drugs Flashcards Preview

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Flashcards in Exam 4 Smoking Cessation Drugs Deck (17):
1

Describe Nicotine replacement therapy

○ nicotine = potent vasoconstrictor
○ know contraindications before prescribing
○ patients must completely stop smoking prior to therapy
--important to set a “quit” date before initiating therapy
-- nicotine raises cardiovascular risk, so can’t smoke at same time
○ formulations: gum, lozenge, inhaler, nasal spray
--most available OTC
○ used in step-down approach for 7-12 weeks (3 months period of time)
--dose used is less than what is obtained through smoking
-- decreasing dosage w/ time
○ dosing gradually tapers down to wean off nicotine
○ all products designed to decrease cravings for nicotine

2

Describe bupropion (Zyban

○ dopamine reuptake inhibitor
--antidepressant = Wellbutrin
○ treatment = 7-12 weeks
○ risk for seizures: avoid alcohol (lowers risk)
○ risk of emergent hypertension w/ concurrent patch use
--Always take BP before giving epinephrine
○ adverse psychological events

3

Describe varenicline (Chantix)

○ Newest smoking cessation drug on market
○ partial neuronal alpha-4 B2 nicotinic receptor agonist
--occupies nicotine receptor sites in brain
○ prevents nicotine stimulation of mesolimbic dopamine system associated w/ nicotine addiction
○ stimulates dopamine activity, but to a lesser extent than nicotine
--results in decreased craving + withdrawal symptoms
○ increased side effects when used w/ nicotine replacement therapy
○ oral side effects = xerostomia, taste alteration
○ general side effects = insomnia, headache, abnormal dreams, nausea
--new reports of suicidal thoughts, erratic/aggressive behavior, adverse cardiac events
○ safety + efficacy NOT established in children

4

Describe the length of time typically needed for successful smoking cessation therapy.

● 70% of women who smoke want to quit
● Average number of quit attempts: 8-11
● Women/girls prefer cessation programs that offer social support
● Smokers are 50% more likely to quit with social support
● Ask, Advise, Refer= program to assist dental professionals with helping patients to quit smoking
● Length of treatment ~ 7-12 weeks

5

What are the dental considerations related to the use of Nicotine?

○ potent vasoconstrictor
○ Highly addictive (physical and psychological)
○ patients must completely stop smoking prior to therapy
--important to set a “quit” date before initiating therapy
--nicotine raises cardiovascular risk, so cannot smoke at the same time
○ raises cardiovascular risk, so can’t smoke during cessation therapy
○ stimulates IL-6 that increases osteoclastic resorption
○ decreases estrogen-protective effects on bone
○ 30% of inhaled smoke is absorbed in oral cavity → risk of cancer
--risk is higher in women

6

What are the desired effects of Nicotine?

■ increased alertness
■ muscle relaxation
■ facilitation of concentration and memory
■ decreased appetite (weight loss = primary reason why girls smoke)

7

What are the harmful effects of Nicotine?

■ irritability
■ hypertension
■ increased pulse rate
■ induces nausea/vomiting
■ dizziness
■ coronary artery disease
■ lung cancer
■ oral cancer

8

What are the dental considerations related to the use of bupropion (Zyban)?

○ dopamine reuptake inhibitor
○ Risk for seizures: avoid alcohol (lowers seizure risk)
--Many drug interactions that lead to increased seizure risk
○ Risk of treatment emergent hypertension with concurrent patch use
--Always take BP before giving epinephrine
○ Adverse psychological events

9

What are the dental considerations related to the use of varenicline (Chantix) ?

○ partial neuronal alpha4 B2 nicotinic receptor agonist
--occupies nicotine receptor sites in the brain
○ Stimulates dopamine activity, but to a much lesser extent than nicotine does
--results in decreased craving and withdrawal symptoms
○ Increased side effects when used with nicotine replacement therapy
○ Oral side effects: xerostomia, taste alteration
○ General side effects: insomnia, headache, abnormal dreams, nausea
--New post-marketing reports of suicidal thoughts and erratic/aggressive behavior
--Post-marketing data of adverse cardiac events

10

-Who is at a higher rate for smoking?
-average age?
-grade level?
-race?

○ teenage girls smoke at higher rate than male counterparts
○ average age of initiation= 14.5 years
○ 28% of girls in grades 9-12 smoke
○ white adolescent girls use at higher rate
○ women smoke during reproductive years

11

What are the Consequences for smoking?

1) lung cancer
■ women more susceptible, due to increased permeability of mucous membranes to carcinogens

2) oral cancer
■ 30% of inhaled smoke absorbed in oral cavity
■ risk for oral cancer is higher in women

3) lowered estrogen levels
■ low birth weight babies, pregnancy complications, early menopause, osteoporosis

4) heart disease
■ lowers age of first heart attack, raises risk for heart attack

5) periodontal disease
■ nicotine stimulates IL-6 that increases osteoclastic resorption; nicotine decreases estrogen-protective effects on bone (normally, estrogen decreases IL-6)

12

Other cancers smoking can cause?

■ oral cavity
■ pharynx
■ larynx
■ esophagus
■ bladder
■ stomach
■ cerix
■ kidney
■ pancreas
■ acute myeloid leukemia

13

smokings contribution to cancer?

○ 599 additives are approved by the US government in the manufacturing of cigarettes
○ ingredients were not tested by burning them
--changes their properties often for the worse
*******when burned, cigarette smoke contains over 4000 chemicals***
--many toxic and/or carcinogenic
--40 known carcinogens
--carbon monoxide, nitrogen oxides, hydrogen cyanide and ammonia are all present in cigarette smoke
○ carcinogens in tobacco smoke damage genes that control cell growth
--grow abnormally or to reproduce too rapidly

****cigarette smoking= major cause of esophageal cancer***
**Mouth cancers
--increases among people who smoke pipes and cigars

14

What are the Notable chemicals in cigarettes?

1) Tar
■ used to pave streets and driveways
■ causes yellow/brown staining of teeth in smokers
■ cigarettes that have a lower yield of tar DOES NOT substantially reduce the risk for lung cancer
2) hydrogen cyanide
■ used to kill rats
3) benzene
■ used in manufacturing gasoline, known cause of acute myeloid leukemia
4) acetone
■ nail polish remover
5) formaldehyde
■ preservative; industrial fungicide
6) ammonia
■ household cleaners
7) carbon monoxide
■ found in automotive exhaust fumes
8) nicotine
■ typical cigarette = 8 or 9 mg of nicotine
■ cigar= 100 to 200 mg some as high as 400 mg

15

What are “Light” cigarettes?

○ still inhale same amounts of harmful toxins
○ no safe cigarettes
○ only proven way to reduce risk of smoking related disease is to quit smoking completely
****Smokers who quit before age 50 cut their risk of dying in half over the next 15 years compared with people who keep smoking***

○ quitting also decreases risk of lung cancer, heart attacks, stroke and chronic lung disease

16

E-cigarette

1) tracked people who had no intention of quitting for 1 year
2) low rates of quitting
3) patients did smoke less
4) It pulls liquid from the cartridge to produce vapor.
5) It is virally odorless and stimulates smoke quickly dissipates int the air when exhaled.

17

Drugs used for cessation?

-Nicotine
-Potent vasoconstrictor
-Patients must complete stop smoking prior to therapy
--set quite date before intimating therapy
--nicotine raises cardiovascular risk so can't smoke at same time