What is a good smoking Index for a measure of Nicotine dependence?
Number of cigs/day
TTFC: Time to first cig
<30 min moderate
<5 min severe
What is the role of the physician in tobacco addiction? What should we be doing?
the 5As! Ask, Advise, Assess, ASsist, Arrange
Brief physician advice has been shown to increase quitting
What are the stages of Change in Quitting Smoking?
How is Nicotine metabolized? What are the Pharmacokinetics?
Pharmacology depends on delivery route
Smoking fastest in 10 sec and half life 2 hours
Metabolized in Liver to Continine which can be measured to verify if pt quit smoking
Who do you see nicotine intoxication in? what are the symptoms? What's the problem later on?
Mostly seen in kids who eat cigarretes or people who use patches and cigarates
Can be fatal due to peripheral nicotinic receptor stimulation!!!
Symptoms: Tachy, HTN, Salivation, N/V, Sweating, palpitations, ubcreased alertbess, SEIZURES in some!!!!!
*May see hypotension, Bradycardia and shock several hours after
Tx: supportive, LAvage or charcoal if ingested
Treatment of Bradycardia in kids w/ Atropine
What are symptoms of nicotine withdrawal?
feeling really awful
decresaed HR, increased appetite, restlessmness, poor concentration etc
What are the FDA approved MEdications for Smoking Cessation? (note: not approved for maintenance like in alcohol)?
NRT - Nicotine Replacement Therapy
What are the contraindications for NRT in smoking cessation therapy?
Do not use if:
What are the different types of NRT? and a Pro/Con of each?
Transdermal - use in pregnancy and continuous long term use; can cause skin irritation
Gum - on demand sypply an good for oral fixation; must be chewed properly
Nasal Spray - easy to use but higher abuse/dependence and effects (rhinitis, watery eyes, coughing)
Inhaler/Puffer - harder to uses
Tablets/Lozenges - can cause mouth/gums soreness
What is Buprioprion? How does it work? Who should NOT use it?
decreases withdrawal symptoms when used alone and can be used in conjunction w NRT which is better!!!
Affects NE and Da neurons w/ Nicotine receptors = NDRI
CONTRAINDICATED if pt has a history of seizure disorder or eating disorder
What is Varenicline? How does it Wpork? What are risks?
Chantrix/Varenicline is a Partial Agonist for the nicotine receptor (alpha4beta2 subunit) and has modera ffinity for 5HT3 receptors
Caution in people w/ renal impairment
Side Effects - N/HA, Insomnia, WEIRD DREAMS and FDA warning for increased Suicide Risk
What are symptoms of caffeine intoxication?
DEATH can result from people who have too much w/ pre-existing arrhythmias!!
Causes restlessness, insomnia, tachycardia
Frequent urination and diarhea, muscle twitching, agitation etc