The document discusses smoking cessation and the challenges associated with helping smokers quit. It notes that despite smoking being a leading preventable cause of death, most clinicians do not adequately help smokers quit due to various reasons like time constraints. Nicotine is highly addictive, making it difficult for smokers to quit on their own, and one third to one half of smokers die prematurely from smoking-related illnesses. The document examines the health benefits of quitting smoking and options for smoking cessation treatment, including counseling, pharmacotherapy like nicotine replacements and other drugs, and their effectiveness.
This document provides information on carbon monoxide (CO) poisoning, including its sources, effects on the body, signs and symptoms, and treatment. CO is an odorless, colorless gas produced by incomplete combustion of carbon-containing fuels. It binds to hemoglobin in the blood, reducing oxygen delivery to tissues. Early symptoms of low-level exposure include headache, dizziness, and nausea. Higher levels can cause confusion, loss of consciousness, organ damage, and death. Treatment involves removing the person from the source of CO and administering high-concentration oxygen.
This document provides an overview of smoking cessation. It begins with an introduction discussing the negative health impacts of smoking and statistics on smoking rates. It then covers the chemical components in cigarettes and negative effects of smoking on various parts of the body. Benefits of smoking cessation are outlined. The document also summarizes several research studies on smoking cessation methods and their effectiveness, including enhanced motivational interviewing versus brief advice, nicotine replacement therapy, and a randomized trial of nicotine replacement therapy patches in pregnancy. Barriers to smoking cessation and electronic cigarettes are also discussed.
The document summarizes respiration and the process of gas exchange that occurs in the lungs. It describes how oxygen diffuses from alveoli into the bloodstream and is transported throughout the body, while carbon dioxide diffuses in the opposite direction. It also discusses the harmful effects of air pollutants like cigarette smoke, explaining how substances like tar and nicotine can damage the lungs and lead to diseases such as emphysema, lung cancer, and heart disease.
The circulatory system transports blood throughout the body using the heart as a pump through a network of arteries, veins, and capillaries. It is a double circulatory system, with pulmonary and systematic circulation. Blood carries oxygen, nutrients, hormones, and waste products. The three main blood vessel types are arteries, which carry blood away from the heart; veins, which carry blood toward the heart; and capillaries, which connect arteries and veins and allow for the exchange of substances between blood and body cells.
This document provides an overview of a complete blood count (CBC) or hemogram test. It discusses the components of a CBC including red blood cell count, hemoglobin levels, hematocrit, mean corpuscular volume (MCV), white blood cell count, and platelet count. It defines and provides the normal ranges for these components. It also summarizes various types of anemia such as iron deficiency anemia, thalassemia, anemia of chronic disease, and hemolytic anemia, how they present on a CBC, and approaches to differentiating between them. The document emphasizes the importance of the CBC in evaluating patients for many medical conditions.
This document provides information on tobacco dependence treatment. It begins with objectives and an introduction noting the global impact of tobacco use. It then describes various types of tobacco products and their significant health side effects. Signs and symptoms of nicotine dependence are outlined using the Fagerstrom Test. The benefits of quitting and roles of medical staff in treatment are discussed. Treatment methods covered include counseling, nicotine replacement therapy, medications, and support groups. Nicotine withdrawal symptoms and specifics of nicotine patches, gum, and other replacement products are also summarized.
This document discusses smoking cessation strategies for patients with chronic obstructive pulmonary disease (COPD). It notes that cigarette smoking is highly addictive and the main cause of COPD. Effective smoking cessation is critical for improving outcomes for COPD patients. The document recommends that clinicians use a 5 A's approach to routinely ask about smoking status, advise patients to quit, assess willingness to quit, assist with treatment options, and arrange follow-up support. Pharmacotherapy combined with behavioral counseling is most effective for smoking cessation. Individualized treatment should address nicotine dependence and withdrawal symptoms.
This document discusses guidelines for smoking cessation interventions and treatment. It outlines recommendations from the WHO and US Public Health Service on promoting non-smoking as the norm, prohibiting tobacco promotion, and reducing tobacco industries. The goals of smoking cessation treatment are achieving long-term abstinence, offering treatment to all tobacco users, and consistently identifying and treating tobacco use. Dental professionals can play a key role in educating patients and the community about the harms of tobacco and helping to enroll them in cessation programs. Assessment tools like the Fagerstrom Test and stages of change model are also discussed to guide treatment and counseling approaches. A variety of nicotine replacement therapies and non-nicotine medications are described for treating nic
This document provides information on carbon monoxide (CO) poisoning, including its sources, effects on the body, signs and symptoms, and treatment. CO is an odorless, colorless gas produced by incomplete combustion of carbon-containing fuels. It binds to hemoglobin in the blood, reducing oxygen delivery to tissues. Early symptoms of low-level exposure include headache, dizziness, and nausea. Higher levels can cause confusion, loss of consciousness, organ damage, and death. Treatment involves removing the person from the source of CO and administering high-concentration oxygen.
This document provides an overview of smoking cessation. It begins with an introduction discussing the negative health impacts of smoking and statistics on smoking rates. It then covers the chemical components in cigarettes and negative effects of smoking on various parts of the body. Benefits of smoking cessation are outlined. The document also summarizes several research studies on smoking cessation methods and their effectiveness, including enhanced motivational interviewing versus brief advice, nicotine replacement therapy, and a randomized trial of nicotine replacement therapy patches in pregnancy. Barriers to smoking cessation and electronic cigarettes are also discussed.
The document summarizes respiration and the process of gas exchange that occurs in the lungs. It describes how oxygen diffuses from alveoli into the bloodstream and is transported throughout the body, while carbon dioxide diffuses in the opposite direction. It also discusses the harmful effects of air pollutants like cigarette smoke, explaining how substances like tar and nicotine can damage the lungs and lead to diseases such as emphysema, lung cancer, and heart disease.
The circulatory system transports blood throughout the body using the heart as a pump through a network of arteries, veins, and capillaries. It is a double circulatory system, with pulmonary and systematic circulation. Blood carries oxygen, nutrients, hormones, and waste products. The three main blood vessel types are arteries, which carry blood away from the heart; veins, which carry blood toward the heart; and capillaries, which connect arteries and veins and allow for the exchange of substances between blood and body cells.
This document provides an overview of a complete blood count (CBC) or hemogram test. It discusses the components of a CBC including red blood cell count, hemoglobin levels, hematocrit, mean corpuscular volume (MCV), white blood cell count, and platelet count. It defines and provides the normal ranges for these components. It also summarizes various types of anemia such as iron deficiency anemia, thalassemia, anemia of chronic disease, and hemolytic anemia, how they present on a CBC, and approaches to differentiating between them. The document emphasizes the importance of the CBC in evaluating patients for many medical conditions.
This document provides information on tobacco dependence treatment. It begins with objectives and an introduction noting the global impact of tobacco use. It then describes various types of tobacco products and their significant health side effects. Signs and symptoms of nicotine dependence are outlined using the Fagerstrom Test. The benefits of quitting and roles of medical staff in treatment are discussed. Treatment methods covered include counseling, nicotine replacement therapy, medications, and support groups. Nicotine withdrawal symptoms and specifics of nicotine patches, gum, and other replacement products are also summarized.
This document discusses smoking cessation strategies for patients with chronic obstructive pulmonary disease (COPD). It notes that cigarette smoking is highly addictive and the main cause of COPD. Effective smoking cessation is critical for improving outcomes for COPD patients. The document recommends that clinicians use a 5 A's approach to routinely ask about smoking status, advise patients to quit, assess willingness to quit, assist with treatment options, and arrange follow-up support. Pharmacotherapy combined with behavioral counseling is most effective for smoking cessation. Individualized treatment should address nicotine dependence and withdrawal symptoms.
This document discusses guidelines for smoking cessation interventions and treatment. It outlines recommendations from the WHO and US Public Health Service on promoting non-smoking as the norm, prohibiting tobacco promotion, and reducing tobacco industries. The goals of smoking cessation treatment are achieving long-term abstinence, offering treatment to all tobacco users, and consistently identifying and treating tobacco use. Dental professionals can play a key role in educating patients and the community about the harms of tobacco and helping to enroll them in cessation programs. Assessment tools like the Fagerstrom Test and stages of change model are also discussed to guide treatment and counseling approaches. A variety of nicotine replacement therapies and non-nicotine medications are described for treating nic
The document discusses drug abuse and addiction. It provides information on different types of drugs like cannabis, narcotics, CNS depressants, stimulants, and hallucinogens. It describes drug use patterns in Pakistan and surveys on drug abuse from the 1980s to 1990s. It also discusses the neurological basis of addiction, sociological factors contributing to drug abuse, effects of addiction, and approaches to treatment and rehabilitation of addicts. Government legislation and efforts to control drug abuse through surveys and policy plans are also summarized.
There are almost 10-15 million established smokers in Pakistan, commonly found in lower socioeconomic groups. Predictive factors for youth smoking include exposure to advertising, peers who smoke, low academic achievement, and perception that smoking is normative. Brief tobacco counseling can be effective, with clinicians asking two questions - if the patient smokes and wants to quit - and providing advice, setting a quit date, and prescribing medications. Pharmacotherapies like nicotine gum, patches and lozenges can reliably increase long-term smoking abstinence rates when used by patients attempting to quit.
This document discusses smoking among adults in the Kurdistan Region and strategies to control it. It provides background on tobacco, facts about smoking like its health risks, and prevalence rates. In the Kurdistan Region, smoking rates have increased from 18% in 2013 to 23% in 2021, with 43% of 15-25 year olds smoking. Benefits of quitting include reduced health risks after 1-15 years. Strategies to control adult smoking include health education, increased tobacco taxation, smoke-free policies, and restrictions on advertising. Secondary prevention involves smoking cessation programs, nicotine replacement therapies, and setting a quit date.
The abuse of prescription painkillers and illicit opioids has become a public health concern in the United States of America. The Centers for Disease Control and Prevention (CDC) reports that more than 1,000 Americans are given treatment in emergency departments every day for misusing prescription opioids.
This document summarizes a study that investigated motivations for smoking cessation, reasons for relapse, and methods of quitting smoking. The study involved focus groups and interviews with current and former smokers in Poland. Key findings included: (1) the main motivations for quitting were smoking bans and high cigarette costs, (2) the most common reason for relapse was stress, and (3) the most frequent method of quitting was a spontaneous decision triggered by a specific event. The study provided insights into factors that influence smoking behaviors and cessation attempts.
Improving smoking cessation approaches at the individual levelGeorgi Daskalov
This document discusses approaches to improving smoking cessation at the individual level. It notes that most smokers are addicted to nicotine and experience withdrawal symptoms when trying to quit. The two main approaches to assisting cessation are pharmacotherapy and behavioral support. Pharmacotherapy such as nicotine replacement therapy, bupropion, and varenicline can help reduce withdrawal symptoms and urges to smoke. Behavioral support through programs and counseling can boost motivation and help people avoid smoking cues. The document argues that treating tobacco addiction and assisting with cessation should be part of medical treatment due to the health risks of smoking.
This document summarizes a seminar presentation on tobacco cessation. It discusses the large number of tobacco users in India and the health impacts of tobacco use. It outlines regulatory, service-based, and educational approaches to tobacco control and the role of dentists in counseling patients. The 5 A's model for tobacco cessation counseling is described. Nicotine replacement therapies and other pharmacological aids are discussed. The presentation emphasizes the importance of dentists' involvement in tobacco control through counseling, advocacy, and community education efforts.
This document discusses approaches to improving smoking cessation at the individual level. It first explains that smoking is an addiction and describes withdrawal symptoms experienced when trying to quit. The two main approaches to assisting cessation are pharmacotherapy and behavioral support. Pharmacotherapy such as nicotine replacement therapy, bupropion, and varenicline can help reduce urges to smoke and withdrawal symptoms. Behavioral support aims to boost motivation and develop skills to avoid smoking. The document argues that treating tobacco addiction and assisting with cessation should be part of medical treatment due to the health risks of smoking.
Improving smoking cessation approaches at the individual levelGeorgi Daskalov
This document discusses approaches to improving smoking cessation at the individual level. It first explains that smoking is an addiction and describes withdrawal symptoms experienced when trying to quit. The two main approaches to assisting cessation are pharmacotherapy and behavioral support. Pharmacotherapy such as nicotine replacement therapy, bupropion, and varenicline can help reduce urges to smoke and withdrawal symptoms. Behavioral support aims to boost motivation and develop skills to avoid smoking. The document argues that treating tobacco addiction and assisting with cessation should be part of medical treatment due to the health risks of smoking.
This SlideShare discusses the challenges of smoking cessation and the potential solutions brought by integrating timed dosage, smart data analytics and digital behavioural support. It also talks about the major impacts of tobacco use worldwide, and how smokers that are aware of the health effects actually want to quit, and needs help/assistance in doing so.
This document discusses the health effects of smoking and provides information on smoking cessation. Some key points:
1) Smoking significantly increases the risk of developing respiratory diseases and cancer, and over half of respiratory disease deaths are due to smoking. The risks diminish rapidly after quitting.
2) Nicotine replacement therapies like patches, gum, and lozenges can help reduce withdrawal symptoms and increase success rates for quitting. Bupropion is also used as a non-nicotine oral therapy.
3) Electronic nicotine delivery systems (ENDS) like e-cigarettes are increasingly popular but their long-term safety is still unknown. While they may contain fewer toxicants than cigarettes, health risks may
Smoking cessation should be a priority for all smokers and healthcare providers should routinely evaluate smoking status and offer treatments. The document outlines smoking as an addiction that requires both brief interventions and more intensive behavioral and pharmacological treatments to increase chances of long term abstinence. It emphasizes treating tobacco dependence as a primary disorder and implementing systems to ensure all smokers are identified and receive evidence-based cessation support.
This document discusses tobacco control strategies according to the WHO MPOWER framework. It summarizes the six policies of MPOWER: Monitor tobacco use and prevention policies; Protect people from tobacco smoke; Offer help to quit tobacco use; Warn about the dangers of tobacco; Enforce bans on tobacco advertising, promotion and sponsorship; and Raise taxes on tobacco. For each policy, it provides details on effective implementation strategies, such as establishing comprehensive smoke-free laws and public education campaigns about the health risks of tobacco use and secondhand smoke exposure.
The WHO FCTC provides solutions to the global tobacco epidemic through six key measures: monitor tobacco use, protect from smoke, offer help to quit, warn about dangers, ban advertising and promotions, and raise taxes. Implementation has led to rapid decreases in smoke exposure and heart attacks. Most countries have implemented some measures, though few have comprehensively adopted all six. Recent developments include new legislation in several countries. The success of the WHO FCTC depends on empowering comprehensive implementation of all effective measures.
Physician attitude and practice pattern related to smokingEssam Elmoghazy
This document discusses physician attitudes and practices related to smoking cessation. It finds that while guidelines recommend doctors help all patients quit smoking, many doctors find cessation activities too time-consuming or lack knowledge to assist. Several studies also show doctors miss opportunities to provide smoking cessation advice. The potential public health impact of physician intervention is enormous, but increased efforts are needed to improve physician assistance and increase their familiarity with cessation resources.
This document discusses methods of tobacco cessation. It begins with an introduction to tobacco use as the leading preventable cause of death globally. It then covers the history of tobacco, forms of tobacco used in India, and the health effects of tobacco use. Barriers to cessation like nicotine addiction and lack of support are examined. The document outlines goals of cessation programs like long term abstinence. It discusses behavioral management, pharmacotherapies, and counseling approaches. India's tobacco control laws aiming to restrict advertising and smoking in public are also summarized.
Prescription opioids and the opiate epidemicSavanna Altman
The document discusses the opioid epidemic, mechanisms of opioid action, and solutions. It notes that while opioids are commonly prescribed for pain, their use has quadrupled in the last decade and led to increased overdose deaths. Opioid prescriptions often transition patients to heroin use due to development of tolerance and addiction. Guidelines aim to curb over-prescription and promote multi-modal pain management approaches to limit opioid dependence and misuse.
Smoking cessation intervention for nurses to use in clinical practice final ...tamieka24
This document outlines a seminar on smoking cessation interventions for nurses. It discusses the 5 A's model for cessation which involves asking about tobacco use, advising to quit, assessing readiness, assisting with a quit plan, and arranging follow-up. It also reviews stages of change, tobacco use in populations like adolescents and the elderly, and the nurse's role in providing brief counseling and referring patients to tobacco quitlines and other resources.
1) Tobacco smoking remains the leading preventable cause of disease and death worldwide. While smoking rates have decreased in developed countries, certain high risk groups have greater difficulty quitting.
2) Brief advice from doctors and other healthcare professionals on smoking cessation can more than double quit rates compared to no advice. Comprehensive treatment involving both behavioral support and pharmacotherapy is most effective for treating nicotine dependence.
3) Effective cessation medications include nicotine replacement therapy, varenicline, bupropion, and others depending on location. Behavioral support through counseling, telephone quitlines, internet programs, and motivational interviewing can also significantly increase success rates.
The document discusses virus-induced asthma attacks. It notes that viruses are a common cause of asthma attacks, with rhinoviruses being the most frequent trigger. Viruses can induce airway inflammation through epithelial cell production of inflammatory mediators. They may also impair inactivation of tachykinins and histamine, potentiate allergic responses, and alter neural control of the airways. Treatment of virus-induced asthma attacks should include anticholinergic bronchodilators, steroids, and prevention of viral infections through vaccination and antiviral medications when available.
This document discusses abdominal tuberculosis in children, including presenting symptoms, signs, investigations, diagnosis, and management. The most common symptoms are abdominal pain and fever. Diagnosis can be difficult as symptoms mimic other conditions. Investigations include blood tests, imaging, and biopsy. Treatment primarily involves antituberculosis drugs, though surgery may be needed in some cases to treat complications like obstruction or perforation. The majority of patients respond well to conservative treatment with drugs alone.
The document discusses drug abuse and addiction. It provides information on different types of drugs like cannabis, narcotics, CNS depressants, stimulants, and hallucinogens. It describes drug use patterns in Pakistan and surveys on drug abuse from the 1980s to 1990s. It also discusses the neurological basis of addiction, sociological factors contributing to drug abuse, effects of addiction, and approaches to treatment and rehabilitation of addicts. Government legislation and efforts to control drug abuse through surveys and policy plans are also summarized.
There are almost 10-15 million established smokers in Pakistan, commonly found in lower socioeconomic groups. Predictive factors for youth smoking include exposure to advertising, peers who smoke, low academic achievement, and perception that smoking is normative. Brief tobacco counseling can be effective, with clinicians asking two questions - if the patient smokes and wants to quit - and providing advice, setting a quit date, and prescribing medications. Pharmacotherapies like nicotine gum, patches and lozenges can reliably increase long-term smoking abstinence rates when used by patients attempting to quit.
This document discusses smoking among adults in the Kurdistan Region and strategies to control it. It provides background on tobacco, facts about smoking like its health risks, and prevalence rates. In the Kurdistan Region, smoking rates have increased from 18% in 2013 to 23% in 2021, with 43% of 15-25 year olds smoking. Benefits of quitting include reduced health risks after 1-15 years. Strategies to control adult smoking include health education, increased tobacco taxation, smoke-free policies, and restrictions on advertising. Secondary prevention involves smoking cessation programs, nicotine replacement therapies, and setting a quit date.
The abuse of prescription painkillers and illicit opioids has become a public health concern in the United States of America. The Centers for Disease Control and Prevention (CDC) reports that more than 1,000 Americans are given treatment in emergency departments every day for misusing prescription opioids.
This document summarizes a study that investigated motivations for smoking cessation, reasons for relapse, and methods of quitting smoking. The study involved focus groups and interviews with current and former smokers in Poland. Key findings included: (1) the main motivations for quitting were smoking bans and high cigarette costs, (2) the most common reason for relapse was stress, and (3) the most frequent method of quitting was a spontaneous decision triggered by a specific event. The study provided insights into factors that influence smoking behaviors and cessation attempts.
Improving smoking cessation approaches at the individual levelGeorgi Daskalov
This document discusses approaches to improving smoking cessation at the individual level. It notes that most smokers are addicted to nicotine and experience withdrawal symptoms when trying to quit. The two main approaches to assisting cessation are pharmacotherapy and behavioral support. Pharmacotherapy such as nicotine replacement therapy, bupropion, and varenicline can help reduce withdrawal symptoms and urges to smoke. Behavioral support through programs and counseling can boost motivation and help people avoid smoking cues. The document argues that treating tobacco addiction and assisting with cessation should be part of medical treatment due to the health risks of smoking.
This document summarizes a seminar presentation on tobacco cessation. It discusses the large number of tobacco users in India and the health impacts of tobacco use. It outlines regulatory, service-based, and educational approaches to tobacco control and the role of dentists in counseling patients. The 5 A's model for tobacco cessation counseling is described. Nicotine replacement therapies and other pharmacological aids are discussed. The presentation emphasizes the importance of dentists' involvement in tobacco control through counseling, advocacy, and community education efforts.
This document discusses approaches to improving smoking cessation at the individual level. It first explains that smoking is an addiction and describes withdrawal symptoms experienced when trying to quit. The two main approaches to assisting cessation are pharmacotherapy and behavioral support. Pharmacotherapy such as nicotine replacement therapy, bupropion, and varenicline can help reduce urges to smoke and withdrawal symptoms. Behavioral support aims to boost motivation and develop skills to avoid smoking. The document argues that treating tobacco addiction and assisting with cessation should be part of medical treatment due to the health risks of smoking.
Improving smoking cessation approaches at the individual levelGeorgi Daskalov
This document discusses approaches to improving smoking cessation at the individual level. It first explains that smoking is an addiction and describes withdrawal symptoms experienced when trying to quit. The two main approaches to assisting cessation are pharmacotherapy and behavioral support. Pharmacotherapy such as nicotine replacement therapy, bupropion, and varenicline can help reduce urges to smoke and withdrawal symptoms. Behavioral support aims to boost motivation and develop skills to avoid smoking. The document argues that treating tobacco addiction and assisting with cessation should be part of medical treatment due to the health risks of smoking.
This SlideShare discusses the challenges of smoking cessation and the potential solutions brought by integrating timed dosage, smart data analytics and digital behavioural support. It also talks about the major impacts of tobacco use worldwide, and how smokers that are aware of the health effects actually want to quit, and needs help/assistance in doing so.
This document discusses the health effects of smoking and provides information on smoking cessation. Some key points:
1) Smoking significantly increases the risk of developing respiratory diseases and cancer, and over half of respiratory disease deaths are due to smoking. The risks diminish rapidly after quitting.
2) Nicotine replacement therapies like patches, gum, and lozenges can help reduce withdrawal symptoms and increase success rates for quitting. Bupropion is also used as a non-nicotine oral therapy.
3) Electronic nicotine delivery systems (ENDS) like e-cigarettes are increasingly popular but their long-term safety is still unknown. While they may contain fewer toxicants than cigarettes, health risks may
Smoking cessation should be a priority for all smokers and healthcare providers should routinely evaluate smoking status and offer treatments. The document outlines smoking as an addiction that requires both brief interventions and more intensive behavioral and pharmacological treatments to increase chances of long term abstinence. It emphasizes treating tobacco dependence as a primary disorder and implementing systems to ensure all smokers are identified and receive evidence-based cessation support.
This document discusses tobacco control strategies according to the WHO MPOWER framework. It summarizes the six policies of MPOWER: Monitor tobacco use and prevention policies; Protect people from tobacco smoke; Offer help to quit tobacco use; Warn about the dangers of tobacco; Enforce bans on tobacco advertising, promotion and sponsorship; and Raise taxes on tobacco. For each policy, it provides details on effective implementation strategies, such as establishing comprehensive smoke-free laws and public education campaigns about the health risks of tobacco use and secondhand smoke exposure.
The WHO FCTC provides solutions to the global tobacco epidemic through six key measures: monitor tobacco use, protect from smoke, offer help to quit, warn about dangers, ban advertising and promotions, and raise taxes. Implementation has led to rapid decreases in smoke exposure and heart attacks. Most countries have implemented some measures, though few have comprehensively adopted all six. Recent developments include new legislation in several countries. The success of the WHO FCTC depends on empowering comprehensive implementation of all effective measures.
Physician attitude and practice pattern related to smokingEssam Elmoghazy
This document discusses physician attitudes and practices related to smoking cessation. It finds that while guidelines recommend doctors help all patients quit smoking, many doctors find cessation activities too time-consuming or lack knowledge to assist. Several studies also show doctors miss opportunities to provide smoking cessation advice. The potential public health impact of physician intervention is enormous, but increased efforts are needed to improve physician assistance and increase their familiarity with cessation resources.
This document discusses methods of tobacco cessation. It begins with an introduction to tobacco use as the leading preventable cause of death globally. It then covers the history of tobacco, forms of tobacco used in India, and the health effects of tobacco use. Barriers to cessation like nicotine addiction and lack of support are examined. The document outlines goals of cessation programs like long term abstinence. It discusses behavioral management, pharmacotherapies, and counseling approaches. India's tobacco control laws aiming to restrict advertising and smoking in public are also summarized.
Prescription opioids and the opiate epidemicSavanna Altman
The document discusses the opioid epidemic, mechanisms of opioid action, and solutions. It notes that while opioids are commonly prescribed for pain, their use has quadrupled in the last decade and led to increased overdose deaths. Opioid prescriptions often transition patients to heroin use due to development of tolerance and addiction. Guidelines aim to curb over-prescription and promote multi-modal pain management approaches to limit opioid dependence and misuse.
Smoking cessation intervention for nurses to use in clinical practice final ...tamieka24
This document outlines a seminar on smoking cessation interventions for nurses. It discusses the 5 A's model for cessation which involves asking about tobacco use, advising to quit, assessing readiness, assisting with a quit plan, and arranging follow-up. It also reviews stages of change, tobacco use in populations like adolescents and the elderly, and the nurse's role in providing brief counseling and referring patients to tobacco quitlines and other resources.
1) Tobacco smoking remains the leading preventable cause of disease and death worldwide. While smoking rates have decreased in developed countries, certain high risk groups have greater difficulty quitting.
2) Brief advice from doctors and other healthcare professionals on smoking cessation can more than double quit rates compared to no advice. Comprehensive treatment involving both behavioral support and pharmacotherapy is most effective for treating nicotine dependence.
3) Effective cessation medications include nicotine replacement therapy, varenicline, bupropion, and others depending on location. Behavioral support through counseling, telephone quitlines, internet programs, and motivational interviewing can also significantly increase success rates.
The document discusses virus-induced asthma attacks. It notes that viruses are a common cause of asthma attacks, with rhinoviruses being the most frequent trigger. Viruses can induce airway inflammation through epithelial cell production of inflammatory mediators. They may also impair inactivation of tachykinins and histamine, potentiate allergic responses, and alter neural control of the airways. Treatment of virus-induced asthma attacks should include anticholinergic bronchodilators, steroids, and prevention of viral infections through vaccination and antiviral medications when available.
This document discusses abdominal tuberculosis in children, including presenting symptoms, signs, investigations, diagnosis, and management. The most common symptoms are abdominal pain and fever. Diagnosis can be difficult as symptoms mimic other conditions. Investigations include blood tests, imaging, and biopsy. Treatment primarily involves antituberculosis drugs, though surgery may be needed in some cases to treat complications like obstruction or perforation. The majority of patients respond well to conservative treatment with drugs alone.
Hypersensitivity pneumonitis is a lung disease caused by inhalation of an antigen that the individual is sensitized to. It can present acutely following high dose exposure or chronically after long term low dose exposure. Common causes include moldy hay, grain, or bird droppings. Symptoms include breathlessness, cough, and fever occurring 4-8 hours after exposure. Chest imaging shows small nodules or infiltrates. Treatment involves avoiding the antigen and using corticosteroids. Prognosis depends on exposure type and duration, with acute cases often resolving but chronic exposure risking persistent symptoms.
1) COPD has historically been perceived as predominantly affecting men, but rates of COPD mortality have increased much more sharply in women since the late 20th century.
2) Women's lungs are biologically smaller than men's, with narrower airways, making them more susceptible to cigarette smoke and other irritants. Hormones like estrogen may also worsen lung damage from smoking.
3) Women tend to experience more severe symptoms of COPD like shortness of breath and have a lower quality of life. They also have more frequent exacerbations and are at higher risk of malnutrition.
Updates in management_of_malignant_pleural_mesotheliomaMoustapha Mounib
This document provides an overview and updates on the management of malignant pleural mesothelioma. It summarizes that asbestos exposure is the main risk factor for MPM. The diagnosis is difficult due to nonspecific symptoms and similarities with other diseases. Currently, chemotherapy including cisplatin and pemetrexed offers the best chance of increased survival. A combined modality approach of surgery, radiation and chemotherapy in specialized centers may provide benefit when included in clinical trials. Symptom management focuses on pain control, dyspnea relief through pleurodesis or oxygen, and palliative care.
This document discusses gender differences in COPD (chronic obstructive pulmonary disease). It notes that COPD has historically been perceived as predominantly affecting men, but rates of COPD in women have been rising significantly. Biological factors like smaller lung size and the effects of estrogen increase women's susceptibility. While the main symptoms are similar, research finds women experience more severe shortness of breath and lower quality of life. The document also suggests women may face biases in COPD diagnosis. It examines non-smoking risk factors and notes treatment should focus on smoking cessation, with considerations for gender differences in responses and side effects.
2. Despite the reality that smoking remains the most important
preventable cause of death and disability, most clinicians
underperform in helping smokers quit. Of the 46 million current
smokers in the United States, 70% say they would like to quit,
but only a small fraction are able to do so on their own because
nicotine is so highly additive. One third to one half of all smokers
die prematurely.
February 14, 2014
Moustapha Mounib
2
3. Reasons clinicians avoid helping smokers quit include
time constraints, lack of expertise, lack of financial
incentives, respect for a smoker’s privacy, fear that a
negative message might lose customers, pessimism
because most smokers are unable to quit, stigma, and
clinicians being smokers.
February 14, 2014
Moustapha Mounib
3
4. THE BURDEN OF SMOKING
Tobacco use remains the
single most preventable cause
of death, causing about 440
000 deaths per year in the
United States and almost 5
million worldwide. More than
8.6 million people in the United
States are disabled from
smoking-related diseases, such
as chronic obstructive
pulmonary disease and lung
cancer.
February 14, 2014
Moustapha Mounib
4
5. Smoking causes more than twice as many deaths
as human immunodeficiency virus and AIDS, alcohol
abuse, motor vehicle collisions, illicit drug use, and
suicide combined. It causes at least 100 000 more
deaths annually than obesity. On average, smokers
die 10 years earlier than nonsmokers.
February 14, 2014
Moustapha Mounib
5
6. Among smoking-related deaths, about 33% are from
cardiovascular diseases, 28% from lung cancer, 22% from
respiratory causes, and at least 7% from cancers other than
lung cancer. A disproportionate number of deaths from
smoking, probably more than 40%, occur among patients
mental illness and substance abuse disorders.
February 14, 2014
Moustapha Mounib
6
7. Nine per-cent of deaths
attributable to smoking occur
in nonsmokers, caused by
exposure to secondhand
smoke, most from
cardiovascular causes. In
addition, smoking is a risk
factor for an expanding list of
other illnesses; reduced
fertility in women, poor
pregnancy outcomes, breast
cancer, cataracts, macular
degeneration, and others. Mounib
February 14, 2014
Moustapha
7
10. Patients of any age can benefit quitting. Early
improvements that occur a few weeks include better
pulmonary function and exercise tolerance.
Respiratory symptoms also decrease, though
excretion of excess mucus and tobacco residue may
cause a transient increase in coughing.
February 14, 2014
Moustapha Mounib
10
11. One year after cessation, the risk of coronary
disease drops to half that of smokers, and by about
15 years later, it has fallen to the rate of never
smokers. The all-cause death rate declines within
the first 2 years of cessation. The risk of stroke
declines at a comparable rate.
February 14, 2014
Moustapha Mounib
11
12. Although the risk of pulmonary and other cancers
never declines to the rate of nonsmokers, it falls by
50% after a decade of abstention. Even smokers who
quit at age 65 years can anticipate 4 additional years
of life than their counterparts who are unable to quit. In
addition to extra years of life, quality of life is another
important benefit of cessation.
February 14, 2014
Moustapha Mounib
12
14. Why is it so difficult to quit smoking? The physiologic actions
of nicotine are numerous and include central nervous system
effects (pleasure, arousal, improved task performance, and
anxiety relief), cardiovascular effects (increased heart rate,
cardiac output, and blood pressure, as well as coronary and
cutaneous vasoconstriction), appetite suppression, and
increased metabolic rate.
February 14, 2014
Moustapha Mounib
14
15. Distribution in the body is rapid: nicotine can reach
the brain within 11 seconds after inhaling cigarette
smoke. Nicotine triggers the release of multiple
neurotransmitters, most critically dopamine.
Nicotine absorption is pH-dependent; at
physiologic pH levels, it is well absorbed, but in
more acidic media, absorption is inhibited.
February 14, 2014
Moustapha Mounib
15
16. Most nicotine is metabolized in the liver, and the
major metabolite, cotinine, is excreted in the
urine. Long-term exposure to nicotine results in
up-regulation of nicotine receptors in the nucleus
accumbens and ventral segmental areas of the
midbrain.
February 14, 2014
Moustapha Mounib
16
17. Tolerance develops after long-term nicotine use,
but in smokers sensitivity is restored overnighthence, the appeal of the first morning cigarette,
which serves to restore nicotine levels in the
brain. Smokers can self-regulate nicotine intake
by the frequency of cigarette consumption, the
intensity of inhalation, and the degree to which
vents and other filtering devices on cigarettes
are manually obstructed. To maintain a given
nicotine level, smokers generally titrate their
smoking to achieve maximal stimulation and
avoid withdrawal symptoms.
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18. The symptoms of nicotine withdrawal are profound:
anger and irritability, anxiety, cravings, decreased
concentration, hunger and weight gain,
restlessness, drowsiness, fatigue, impaired task
performance, and sleep disturbance. Assessing the
extent of addiction helps in planning an appropriate
treatment strategy and monitoring progress.
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20. There are 5 basic ways to help smoking quit:
increase the price of a pack of cigarettes by
increasing taxes; pass clean indoor air legislation
that bans smoking in public places; create and
disseminate effective counter-marketing messages
about smoking-in the media or as graphic package
displays; ban tobacco advertising and promotion;
and provide cessation aids.
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24. The gold standard for initiating smoking cessation
treatment is the 5 As:
Asking about tobacco use,
Advising tobacco users to quit,
Assessing readiness to make a quit attempt,
Assisting with the quit attempt,
Arranging follow-up care.
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25. What are the four R’s of motivational
interventions
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26. 1-Relevance; information should be provided that is
relevant to the patient’s sociodemographic
characteristics, disease status, health concerns, and
social situation.
2-Risks; acute, long term, and environmental risks
should be discussed with the patient.
3-Rewards; the clinician should highlight potential
rewards of stopping that seem relevant to the
patient.
4-Repetition; the motivational intervention should be
repeated every time an unmotivated smoker visit the
clinic.
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29. The odds of a smoker quitting are increased both
by counseling and by pharmacological
treatment. Cognitive therapy aims to reframe the
way a patient thinks about smoking. Smokers
are taught techniques of distraction, positivism,
relaxation, and mental imagery and are offered
encouragement and motivation.
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30. In contrast, behavioral therapy helps smokers
avoid stimuli that trigger smoking, such as alcohol,
first morning coffee, stress, and associating with
other smokers. Behavioral strategies also attempt
to alter the usual smoking routine, anticipate
cravings, and address the consequences of
nicotine withdrawal, such as oral needs, weight
gain, and cravings. Intensive counseling is
associated with a 22% rate of quitting, and even
minimal (<3 minutes) counseling is associated with
a 13% quit rate.
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31. Pharmacotherapy
Two general classes of drugs are approved by
FDA for cessation:
1-Nicotine replacements products (NRTs)
2-Psychotropic drugs.
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32. Available Forms of Nicotine Replacement Therapy
1-Gum;
2 mg and 4 mg doses
Recommended for up to 12 weeks
2-Patch;
Seven strengths 5, 7, 10, 14, 15, 21, and 22 mg
16 or 24 hour release
3-Lozenge;
2 mg and 4 mg doses
1 lozenge to be used every 1 to 2 hours while awake
Recommended for up to 12 weeks
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33. 4- Nasal spray;
0.5 mg per spray
1 to 2 doses every hour
Not to exceed 40 doses per day
Can be used for 3 to 6 months
5- Inhaler;
4 mg per cartridge
1 cartridge to be used every 1 to 2 hours while awake
6 to 16 cartridges per day
Can be used up to 6 months
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34. Nicotine Replacement
The choice of an NRT product should be individualized,
based on patient preference, tolerance of adverse effects,
and smoking habits. Higher doses are more likely to be
effective but also to produce adverse effects. Increasingly;
patients with severe nicotine addiction are prescribed
combination NRT, a patch plus one of the short-acting
formulations. Higher -than –recommended doses may be
indicated in smokers with severe addiction, and failure to
respond may reflect inadequate dosage, incorrect usage, or
both.
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35. The nicotine patch is emerging as a mainstay for
pharmacological treatment of smoking cessation, often
in combination with other forms of nicotine replacement
and psychotropic medications. Its major advantages
are consistent levels of nicotine delivery, easy use and
concealment, and good compliance.
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36. Disadvantages include insomnia (greater with the 24
-hour patch), inability to titrate dose, allergic reactions
to the patch adhesive (patients with dermatological
conditions are advised against its use), and morning
nicotine cravings with the 16- hour release form.
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37. In general, greater levels of smoking call for
higher-dose patches, and morning cravings
necessitate the use of the 24-hour formulation.
Patch sites should be rotated to avoid skin
reactions. Most patients can tolerate the skin
irritation, which topical corticosteroids can
ameliorate.
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38. Nicotine gum may satisfy oral cravings, may delay
weight gain after cessation, and lends itself to titration
for control of withdrawal symptoms. Its major
disadvantages include that its use may not be socially
acceptable, it may adhere to dental work such as
fillings and bridges, and it must be used properly to
be effective.
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39. The Nicotine lozenge, like the gum, can satisfy
oral cravings and also lends itself to titration of
nicotine delivery. It is easy to use and to
conceal, and, thus, may be more socially
acceptable than the gum. In many patients,
the lozenge is well tolerated, but heavy users
may note adverse effects of hiccups, nausea,
dyspepsia, and flatulence.
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40. Using Nasal spray to deliver periodic doses of
nicotine more closely mimics the act of smoking. Its
advantages include rapid absorption, ease of titrating
doses to attain desired nicotine levels, and similarity
to the act of smoking. Disadvantages include a high
rate of nasal and throat irritation (generally tolerated
by users), the risk of dependence, and the need to
wait up to 5 minutes before driving because of local
reactions and sneezing. Patients with chronic nasal
disorders or reactive airway disease should not use
the spray.
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41. Finally, the Nicotine inhaler, like the nasal spray,
mimics the act of smoking and permits titration of
nicotine. It also can cause local irritation and
should be used cautiously in patients with
bronchospastic disease. Slow inhalation lessens
the chance of such irritation.
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42. Psychotropic Medications
The only psychoactive drug currently recommended
by the FDA for cessation is Bupropion, an atypical
antidepressant thought to affect levels of various
brain neurotransmitters, including dopamine and
norepinephrine. Prescribed in 150-mg doses as a
sustained-release capsule, bupropion seems to act
by decreasing both the craving for cigarettes and the
symptoms of nicotine withdrawal.
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43. Given the high prevalence of smokers who are
depressed, bupropion has the added advantage of
treating both conditions simultaneously. It is easy to
use and can be taken in combination with NRT.
Because bupropion may forestall the weight gain
that so commonly accompanies cessation, it is
particularly appropriate for smokers with weight
concerns.
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44. The drug should be started at least 1 week before
the cessation date to achieve stable blood levels.
Initially, the patient should take 1 pill each morning
for 3 days, increasing to twice a day if tolerated
although once a day may suffice in some patients.
Treatment usually is recommended for 2 to 3 months
after the cessation date, but in selected cases it may
be taken for up to a year.
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45. Bupropion is contraindicated for patients with
seizure disorders or conditions that might predispose
to seizures (brain tumors, head trauma, other
medications that lower seizure thresholds, bulimia,
and anorexia nervosa) . Adverse reactions among
those without risk of seizure include insomnia
(mitigated by taking the second dose in late afternoon
rather than at bedtime) and dry mouth.
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46. The US Public Health Service has
recommended as second-line agents for cessation
2 centrally active medications currently used for
other conditions; Nortriptyline, a tricyclic
antidepressant, and Clonidine, a centrally active
α−agonist. Neither is approved by the FDA for
smoking cessation.
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47. For the heavily addicted smoker, triple therapy is
advocated: the nicotine patch plus a short-acting
NRT plus bupropion. Clinicians should reserve this
option for smokers who can tolerate the combined
risk of adverse effects and who are unlikely to quit
with a simpler regimen.
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48. Future Medication Options
Several potential new medications for cessation are
currently in field tests and not yet approved by the
FDA. Rimonabant is a cannabinoid receptor inhibitor
that blocks the reinforcing effects of nicotine and also
suppresses appetite. Now in phase 3 trials, it has
already receive much attention for its potential to
attack 2 major public health epidemics; smoking and
obesity.
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49. Nicotine vaccine produces antibodies to nicotine and
thus reduces nicotine levels. Whether it will discourage
smokers or stimulate more aggressive smoking to
overcome the blockade is yet unclear.
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50. Another psychotropic drug, Varenicline, may offer
an alternative to bupropion. Finally, Cytochrome
P246 inhibitors decrease the action of the
cytochrome P246 liver enzyme that metabolizes
nicotine, thus giving smokers a higher level of
nicotine per cigarette. These drugs could be used
to help smokers who are not ready to quit cut
back on their smoking levels, as well as to
increase the potency of NRT.
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52. Electronic cigarettes ( e-cigarettes )
are marketed as potentially reduced
tobacco products. The product resembles,
but is not, a cigarette in design or function
and is marketed as “ safer “ than a
conventional cigarette.
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53. Because e-cigarettes do not
contain or burn tobacco, they do not
appear to deliver the known toxins
found in conventional cigarette smoke.
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54. Conversely, US Food and Drug
Administration (FDA ) analyses have
indicated that e-cigarettes contain a number
of toxins and carcinogens, including
tobacco-specific nitrosamines, diethylene
glycol, and other components suspected of
being harmful to humans.
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56. The study aimed to assess whether using
an e-cigarette for 5 min has an impact on the
pulmonary function tests and fraction of
exhaled nitric oxide ( FENO ) of healthy adult
smoker.
Using an e-cigarette for 5 min led to an
immediate decrease in FENO, and an increase
in of total respiratory impedance at 5 Hz,
increase in flow respiratory resistance at 5Hz,
10 Hz and 20 Hz.
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57. E-cigarettes were found to have immediate
adverse physiologic effects after short time
use that are similar to some of the effects
seen with tobacco smoking ; however, the
long term health effects of e-cigarette use
are unknown but potentially adverse effects
are worthy of further investigation.
February 14, 2014
CHEST 2012 ; 141 (6) 1400-1406.
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58. MPOWER
February 14, 2014
M onitor tobacco use.
P rotect people from tobacco
use.
O ffer help to quit tobacco
use.
W arn about the damages of
tobacco .
E nforce bans on tobacco
advertising, promotion and
sponsorship.
R aise taxes on tobacco
products,
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