Poisoning smoking 2012 +MCQs.

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.

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.

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
• 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.