SUD2023 Flashcards

1. students grade 7-12

2.all canadians ages 15 or older(2017)

(17% vs 13% females)

canadians 12 and older

is 7%

22%

- Associated with an increased risk of
- Lung cancer (80% of LC deaths due to smoking)
- The more and longer a person smokes, the higher their risk
-Macular degeneration
- Heart disease
- Oral/throat cancer
- COPD (primary cause of COPD)

cancers,

CV disease,

respiratory diseases

Responsible for more deaths than obesity, physical inactivity, or hypertension.

Second-hand smoked caused 831 deaths in Canada in 2002

cigarettes

pipe tobacco

cigars

smokeless/chewing tobacco(in tin cans)

e-cigarette an Increase from 13% (3.9 million) in 2013

CTADS 2017 results:

may or may not vontain nicotine

-glycerol

-flavours

-propylene glycerol

-nicotine

Average age of onset of vaping = 16 years old
 On average, those identifying as male vaped more than those identifying as female.

27.8% had NEVER tried tobacco
57.6% had tried tobacco but didn’t use it at time of survey
14.6% used tobacco at time of survey

Came into effect April 1, 2020
• Survey result: almost half of youth
surveyed said they would quit vaping
if flavoured juice was not available
• Flavours available after ban:
• Plain
• Tobacco

The stages of change:
1. Pre-contemplation: not thinking about quitting→ may be defensive about quitting
2. Contemplation: thinking about it, but not ready to quit→ considering quitting in
the next 6 months or so
3. Preparation: getting ready to quit→ decision made, pros of quitting outweigh the
cons
4. Quitting: actively trying to stop smoking, with or without smoking cessation aid
5. Maintenance: staying a non-smoker

50%,

Tmax 15 mins
Distribution:
<5% protein bound
Readily crosses placenta
Rapidly distributes to brain
Vd 2-3L/kg

Metabolism:
Primarily metabolized in the liver by CYP 2A6, 1A1, and 1A2 (important for certain drug interactions

T1/2 elimination with oral inhalation = 1-2 hours.

nicotinic cholinergic receptors (nAChRs) in the brain
-Leads to neurotransmitter release
- NE, ACh, GABA, Serotonin, Endorphins
- AND dopamine release in areas all over the brain, including the nucleus acumbens
(aka THE REWARD PATHWAY)
-This leads to a pleasurable sensation→ reinforcing the use of the drug

neuroadaptation (AKA TOLERANCE)
-Also leads to increased # of nAChRs→ need to use more nicotine to achieve same result
-Cravings occur when these newly increased receptors are quickly vacated

Dose-dependent response to counselling→ increased time = increased quit time.

<3 mins counseling = 13.4% abstinence

>10mins counseling = 22% abstinence

Optimal total contact time found to be 91-300 mins -Leads to abstinence rates of ~28%

-Set a target quit date
- Get professional help
- Enlist social support
- Use problem-solving techniques to help deal with cravings and remain smoke-free.

habitrol

thrive

nicorette quick mist

nicorette gum

nicoderm patch

Evidence:
-Cochrane review: NRT reduces smoking rates by 50-70%
- Combining patch with short acting gum, lozenge, or spray can increase those rates
- Sort of like “basal/bolus” insulin but with nicotine

Due to long term safety and efficacy data
-Most evidence is for 8-12 weeks of use
- Many smokers will need it for longer
- Little evidence that use beyond 24 weeks provides any additional benefit

-Specific products will have slightly different recommendations
- # depends on amount smoked
- Slowly reduce # of doses/day over the next 6 months or so until D/C

10-20 pieces/doses per day (one each time a craving occurs)

 “Bite, bite, park.”

 Park, tingle, move, park, tingle etc

-Open mouth and spray
- Absorbed through buccal mucosa-no need to inhale

-Oral: Tingling in mouth
- Patch: allergic reaction to adhesive

- Immediately post MI
- CVD→ though technically safer than smoking

Don’t swallow too much with gum or chew the lozenges→ nicotine doesn’t absorb
in GI tract so it won’t work but will cause ++nausea
-Acidic drinks/foods before using oral NRT will reduce absorption→ avoid x 15 mins before using NRT

NDRI→ Norepinephrine, dopamine reuptake inhibitor

-Thought to mimic the effects of nicotine on the brain, thus allowing the patient to stop using nicotine.

-Start taking 1-2 weeks before selected quit date
- 150mg PO OD x 1-3 days then
- 150mg PO BID x 7-12 weeks

zyban (bupropion)

Inhibits CYP 2D6→ beware drug interactions

-Superior to placebo- OR 1.86 (95% CI 1.63-2.1)
- About equal to NRT- OR 0.99 (0.86-1.13)

Varenicline (champix)

- Stimulation
- Agitation
- Insomnia
- Anorexia

Alpha4beta2
-nicotinic receptor partial agonist

Binds to nicotine receptors fully
-Only turns them on partially
- Takes up the binding site so nicotine can’t bind, but turns it on a bit so
withdrawal/cravings don’t happen

-0.5mg PO OD x 3 days then
- 0.5mg PO BID x 4 days then
- 0.5-1mg PO BID x 12 weeks
- You may see some patients on it for much longer than 12 weeks due to recent evidence that longer is needed

Vs Placebo: OR 2.88 (2.40-3.47)
Vs Single NRT: OR 1.57 (1.29-1.91)
Vs Bupropion: OR 1.59 (1.29-1.96)
Vs Combo NRT: OR 1.06 (0.75-1.48)→ not better than combo NRT

same as zyban tolerability dictates use:
-Mood changes, thoughts of self-harm or harm to others
-Hx of psychiatric illness-use with caution
-However, studies have shown it is safe in stable schizophrenia→

Mental illness ≠ CI
-++nausea if not taken with food and a full glass of water

1: 1.68(nicotene gum)

1: 1.9(nicotene transdermal patch)

1: 2(nicotene inhaler, nicotene lozenges or mouth spray)

1: 1.85(bupropion)

1: 2.7(patch plus prn inhaler, lozenge or mouth spray)

1: 2.89 (varenicline (champx))

“on a scale of 1-10, how ready
are you to quit?”--- “why was that
answer not a 1”
• This forces the patient to list off
the reasons they want to
quit/pros for quitting

-start with 2mg gum: 1 piece q 1-2 hrs prn max 20 pieces a day