Prepared by: Dr. Mohammad Shaikhani University of Sulaimani College of Medicine. Dept of Medicine.

Prepared by: Dr. Mohammad Shaikhani

University of SulaimaniCollege 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 stopArrange 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: overall2 approaches proven effective:Pharmacotherapy Nonpharmacologic interventionsBest 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.