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Prepared by:
Dr. Mohammad Shaikhani
University of Sulaimani
College of Medicine.
Dept of Medicine.
Introduction:
Smoking is responsible for the death of 1/10 adults worldwide, or 5
million deaths /year.
50% will eventually die, mostly avoided by quiting.
The prevalence;18% - 30%, 50% in China& rising in developing
countries.
 Tobacco is one of the few causes of preventable death increasing
globally.
In West, decreasing.
Although the gap is narrowing specially in adolescents, males
more than females overall,
Determinants of tobacco use:
Tobacco dependence results from several closely interrelated
factors:
 Neurochemical
 Environmental
 Individual
Neurochemical determinants:
Nicotine is the critical reinforcing component.
 Nicotinic Ach receptors have reinforcing effects.
 Nicotine produces a sustained effect on dopamine release in the
nucleus accumbens& induce motivational / reinforcing properties.
Medications that act on glutamate or GABA systems hold the
promise of reducing drug cravings or avoiding relapse.
Enviromental determinants:
Availability.
Low cost.
Advertising specially to thee youth.
Friend, Peer pressure.
Individual determinants:
Individuals 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 the
side effects of some psychiatric medications &mimic the effects of
antidepressants,as tobacco smoke contains chemical substances that
inhibit monoamine oxidase A/B.
 This may explain the increased risk of depression for 6 months or
longer following smoking cessation.
Management of tobacco dependence:
Adequate evaluation of the patient & environment.
Since 70% of smokers see a physician/year, physicians &health
professionals have a substantial opportunity to influence smoking
behaviour.
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 stop
Arrange follow-up
 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.
Management: overall
2 approaches proven effective:
Pharmacotherapy
 Nonpharmacologic interventions
Best results obtained when the 2 combined& pharmacotherapy
increase 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:
• 3. 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.

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Poisoning smoking 2012.

  • 1. Prepared by: Dr. Mohammad Shaikhani University of Sulaimani College of Medicine. Dept of Medicine.
  • 2. Introduction: Smoking is responsible for the death of 1/10 adults worldwide, or 5 million deaths /year. 50% will eventually die, mostly avoided by quiting. The prevalence;18% - 30%, 50% in China& rising in developing countries.  Tobacco is one of the few causes of preventable death increasing globally. In West, decreasing. Although the gap is narrowing specially in adolescents, males more than females overall,
  • 3. Determinants of tobacco use: Tobacco dependence results from several closely interrelated factors:  Neurochemical  Environmental  Individual
  • 4. Neurochemical determinants: Nicotine is the critical reinforcing component.  Nicotinic Ach receptors have reinforcing effects.  Nicotine produces a sustained effect on dopamine release in the nucleus accumbens& induce motivational / reinforcing properties. Medications that act on glutamate or GABA systems hold the promise of reducing drug cravings or avoiding relapse.
  • 5.
  • 6. Enviromental determinants: Availability. Low cost. Advertising specially to thee youth. Friend, Peer pressure.
  • 7. Individual determinants: Individuals 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 the side effects of some psychiatric medications &mimic the effects of antidepressants,as tobacco smoke contains chemical substances that inhibit monoamine oxidase A/B.  This may explain the increased risk of depression for 6 months or longer following smoking cessation.
  • 8. Management of tobacco dependence: Adequate evaluation of the patient & environment. Since 70% of smokers see a physician/year, physicians &health professionals have a substantial opportunity to influence smoking behaviour. 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 stop Arrange follow-up  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 2 approaches proven effective: Pharmacotherapy  Nonpharmacologic interventions Best results obtained when the 2 combined& pharmacotherapy increase chance of initiating / maintaining abstinence 23-fold& should be used more extensively.
  • 10.
  • 11.
  • 12.
  • 13. 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.
  • 14. Single-choice Qs: • 2. Nicotine replacement therapy is given in all these forms except: • A. Gums. • B.Inhaler. • C.Lozenges. • D. Patch. • E.Suppositories.
  • 15. Single-choice Qs: • 3. 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.