:Prepared byDr. Mohammad Shaikhani University of Sulaimani .College of Medicine .Dept of Medicine
:IntroductionSmoking is responsible for the death of 1/10 adults worldwide, or 5million deaths /year.50% will eventually die, mostly avoided by quiting.The prevalence;18% - 30%, 50% in China& rising in developingcountries. Tobacco is one of the few causes of preventable death increasingglobally.In West, decreasing.Although the gap is narrowing specially in adolescents, malesmore than females overall,
:Determinants of tobacco useTobacco dependence results from several closely interrelatedfactors: Neurochemical Environmental Individual
:Neurochemical determinantsNicotine is the critical reinforcing component. Nicotinic Ach receptors have reinforcing effects. Nicotine produces a sustained effect on dopamine release in thenucleus accumbens& induce motivational / reinforcing properties.Medications that act on glutamate or GABA systems hold thepromise of reducing drug cravings or avoiding relapse.
:Enviromental determinantsAvailability.Low cost.Advertising specially to thee youth.Friend, Peer pressure.
:Individual determinantsIndividuals are not at equal risk of tobacco dependence. Genetic component: Psychiatric disorders *2- 3, more in schizophrenia, depression,drug addiction.Tobacco may improve the psychiatric conditions or reduce theside effects of some psychiatric medications &mimic the effects ofantidepressants,as tobacco smoke contains chemical substances thatinhibit monoamine oxidase A/B. This may explain the increased risk of depression for 6 months orlonger following smoking cessation.
:Management of tobacco dependenceAdequate evaluation of the patient & environment.Since 70% of smokers see a physician/year, physicians &healthprofessionals have a substantial opportunity to influence smokingbehaviour.The essential features of smoking cessation treatment 5 As: Ask about smoking at every opportunity Advise all smokers to stop Assess their willingness to stop Assist the smoker to stopArrange follow-up Success is often obtained only after several attempts& HCWsshould adopt the same attitude as with other chronic disorders &should provide support over a long period.
Management: overall2 approaches proven effective:Pharmacotherapy Nonpharmacologic interventionsBest results obtained when the 2 combined& pharmacotherapyincrease chance of initiating / maintaining abstinence 23-fold&should be used more extensively.
:Single-choice Qs• 1. The 1st-line management pharmacological of tobacco dependence include all except:• A. Tricyclic antidepressants.• B. Benzodiazepines.• C. Nicotine replacement.• D.Buprpion.• E.Varnecilin.
:Single-choice Qs• 2. Nicotine replacement therapy is given in all these forms except:• A. Gums.• B.Inhaler.• C.Lozenges.• D. Patch.• E.Suppositories.
:Single-choice Qs• 17 The following are among non- pharmacological interventions to enhance smoking quitting except:• A.Physian advice.• B.Self-helpmterials.• C. Social support.• D.Hypnotherapy.• E. Individual, group & telephone counseling.