2. :Introduction
ï¶Smoking is responsible for the death of 1/10 adults worldwide, or 5
million deaths /year.
ï¶50% will eventually die, mostly avoided by quiting.
ï¶The prevalence;18% - 30%, 50% in China& rising in developing
countries.
ï¶ Tobacco is one of the few causes of preventable death increasing
globally.
ï¶In West, decreasing.
ï¶Although the gap is narrowing specially in adolescents, males
more than females overall,
3. :Determinants of tobacco use
ï¶Tobacco dependence results from several closely interrelated
factors:
ï¶ Neurochemical
ï¶ Environmental
ï¶ Individual
4. :Neurochemical determinants
ï¶Nicotine is the critical reinforcing component.
ï¶ Nicotinic Ach receptors have reinforcing effects.
ï¶ Nicotine produces a sustained effect on dopamine release in the
nucleus accumbens& induce motivational / reinforcing properties.
ï¶Medications that act on glutamate or GABA systems hold the
promise of reducing drug cravings or avoiding relapse.
7. :Individual determinants
ï¶Individuals are not at equal risk of tobacco dependence.
ï¶ Genetic component:
ï¶ Psychiatric disorders *2- 3, more in schizophrenia, depression,
drug addiction.
ï¶Tobacco may improve the psychiatric conditions or reduce the
side effects of some psychiatric medications &mimic the effects of
antidepressants,as tobacco smoke contains chemical substances that
inhibit monoamine oxidase A/B.
ï¶ This may explain the increased risk of depression for 6 months or
longer following smoking cessation.
8. :Management of tobacco dependence
ï¶Adequate evaluation of the patient & environment.
ï¶Since 70% of smokers see a physician/year, physicians &health
professionals have a substantial opportunity to influence smoking
behaviour.
ï¶The essential features of smoking cessation treatment 5 As:
ï¶ Ask about smoking at every opportunity
ï¶ Advise all smokers to stop
ï¶ Assess their willingness to stop
ï¶ Assist the smoker to stop
ï¶Arrange follow-up
ï¶ Success is often obtained only after several attempts& HCWs
should adopt the same attitude as with other chronic disorders &
should provide support over a long period.
9. Management: overall
ï¶2 approaches proven effective:
ï¶Pharmacotherapy
ï¶ Nonpharmacologic interventions
ï¶Best results obtained when the 2 combined& pharmacotherapy
increase chance of initiating / maintaining abstinence 23-fold&
should be used more extensively.
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13. :Single-choice Qs
âą 1. The 1st-line management
pharmacological of tobacco dependence
include all except:
âą A. Tricyclic antidepressants.
âą B. Benzodiazepines.
âą C. Nicotine replacement.
âą D.Buprpion.
âą E.Varnecilin.
14. :Single-choice Qs
âą 2. Nicotine replacement therapy is given in
all these forms except:
âą A. Gums.
âą B.Inhaler.
âą C.Lozenges.
âą D. Patch.
âą E.Suppositories.
15. :Single-choice Qs
âą 17 The following are among non-
pharmacological interventions to enhance
smoking quitting except:
âą A.Physian advice.
âą B.Self-helpmterials.
âą C. Social support.
âą D.Hypnotherapy.
âą E. Individual, group & telephone counseling.