Tobacco Use and Dependence

More Presentations from Dr.Naina Mohamed Pakkir Maideen

Ø Tobacco use is the largest single preventable cause of illness and premature deaths.

Ø Tobacco is consumed in many forms including…

§   Smokeless Tobacco

o  Chewing Tobacco

o  Snuff

o  Creamy Snuffs

o  Dipping Tobaccos

o  Gutka

o  Snus

§   Burned Tobacco

o  Cigarette Smoking

o  Cigar Smoking

o  Beedi (Bidi) smoking

o  Kreteks

o  Hookah

Ø Harmful health effects of Smokeless tobacco include:

§   Mouth, tongue, and throat cancer

§   Cancer of Esophagus, Stomach, Pancreas, etc.

§   Increased risk of heart disease, heart attacks, and stroke

§   Nicotine addiction

§   Leukoplakia (white sores in the mouth that can become cancer)

§   Receding gums (Gums slowly shrink from around the teeth)

§   Bone loss around the roots of the teeth

§   Abrasion (scratching and wearing down) of teeth

§   Tooth loss

§   Stained and discolored teeth

§   Bad breath

Ø Health risks of Burned tobacco include:

§   Cardiovascular disease (including myocardial infarction and sudden death)

§   Cerebrovascular disease (Stroke)

§   Peripheral vascular disease (Claudication, etc)

§   Chronic obstructive pulmonary disease

§   Asthma

§   Cancers of the Lung, Larynx, Oral cavity, Esophagus, Bladder, Kidney, Pancreas, and Uterine cervix.

§   Reduced Fertility

Ø Adverse health effects of Second hand smoke include:

§   Cancer (Increased lung cancer risk (by 20–30%))

§   Asthma

§   Respiratory infections

§   Reduced lung growth in children

§   Reductions in postnatal pulmonary function

§   Increased heart disease risk (by 25–30%)

§   Chronic otitis media

Ø Negative effects to babies due to Smoking during pregnancy, include:

§   Low birth weight

§   Premature birth (Being born too early)

§   Still birth (Being born dead)

§   Respiratory complications

§   Congenital heart defects

§   CNS effects

§   Fetal death

§   Infant death

Ø Negative effects to mothers due to Smoking during pregnancy, include:

§   Difficulty getting pregnant

§   Placental Abruption (Early seperation of Placenta )

§   Placenta previa (Placenta covers the cervix)

§   Premature rupture of membranes (Early breaking of water)

§   Ectopic pregnancy (Pregnancy occurs outside the womb)

Ø Health consequences of Youth smoking, include:

§   Nicotine addiction

§   Associated risk of other drug use like Alcohol, Marijuana, Cocaine, etc.

§   Reduction of the rate of lung growth and lung function

§   Chronic lung diseases, like emphysema and bronchitis

§   Shortness of breath

§   More production of phlegm

§   Elevated resting heart rates

§   Blood vessel disease, which can lead to heart attacks or strokes at a young age

§   Increased risk of lung cancer and other smoking-related cancers

§   More frequent headaches

§   Worst cold and flu symptoms

§   Reduced physical fitness

§   Worst overall health

§   Gum disease and tooth loss

§   Hearing loss

§   Vision problems, such as macular degeneration, which can lead to blindness

§   Excessive emotional or psychological complaint

§   Increased risky behaviors, such as fighting and engaging in unprotected sex.

Ø Health benefits of Smoking cessation, include:

§   Better sex

§   Improved fertility

§   Younger looking skin

§   Whiter teeth

§   Better breathing

§   Longer life

§   Less stress

§   Improved smell and taste

§   More energy

§   Healthier loved ones

Ø 5 A’s to offer smokers:

§   Ask about tobacco use

§   Advise to quit

§   Assess willingness to make a quit attempt

§   Assist in quit attempt

§   Arrange for follow-up

Ø TIPS to quit smoking:

§   Hide the matches, lighters, and ashtrays.

§   Designate the home a non-smoking area.

§   Ask people not to smoke around you.

§   Drink fewer caffeinated beverages which may stimulate the urge to smoke.

§   Avoid alcohol which may also increase the urge to smoke.

§   Change the habits connected with smoking.

§   Keep mints or gum (preferably sugarless) on hand to suppress urge to smoke.

§   Stay active to keep the mind off smoking and help relieve tension.

§   Take a walk, exercise, read a book, brush your teeth, take a shower, take a deep breath or try a new a hobby.

§   Make a list of reasons why you want to quit.

§   Carry this with you at all times. When you have an urge for a cigarette, read your list and it will help strengthen your resolve.

§   Look for support from others. Join a support group or smoking cessation program.

§   Do not go places where many people are smoking such as bars or clubs, and smoking sections of restaurants.

§   Find someone who can support you, for example a family member, friend or doctor.

Ø TIPS to get away from Second hand smoke:

§   Make the home and car smoke-free.

§   Ask the people not to smoke around you and your children.

§   Make sure that your children’s day care center or school is smoke-free.

§   Choosing restaurants and other businesses that are smoke-free.

§   Thank businesses for being smoke-free.

§   Teach children to stay away from other people’s smoke.

§   Avoid all smoke.

§   Learn as much as you can by talking to your doctor, nurse, or health care provider more about the dangers of other people’s smoke.

Ø Nicotine dependence may be treated by the following…

§   Nicotine replacement Therapy (NRT)

o  Over-the-counter (e.g., nicotine patch, gum, lozenge)

o  Prescription (e.g., nicotine inhaler, nasal spray)

§   Non-nicotine Prescription medications

o  Bupropion SR (Zyban^®)

o  Varenicline tartrate (Chantix^®)

Ø Complementary health approaches for smoking cessation, include:

§   Meditation

§   Hypnotherapy

§   Yoga

§   Acupuncture

§   Tai chi

Effects of Stress:

More Presentations from Dr.Naina Mohamed Pakkir Maideen

·       The Physiological effects of stress include…

Ø Tension Headache

Ø Back Ache

Ø Salivary secretion

Ø Diarrhoea

Ø Stomach Complaints

Ø Rapid Breathing

Ø Excessive Sweating

Ø Elevated Heart rate

Ø Increased Pulse rate

Ø Blood Pressure elevation

Ø Increased risk of Type 2 Diabetes

Ø Erectile Dysfunction

Ø Infertility

Ø Irregular menstrual cycle

Ø Weakening of Immune System

Ø Sleep Deprivation

Ø Fatigue

·       The Psychological effects of stress include…

Ø Anxiety

Ø Restlessness

Ø Depression

Ø Lack of motivation or focus

Ø Irritability or anger

Ø Sadness or depression

·       The Behavioural effects of stress include…

Ø Overeating or Undereating

Ø Angry Outbursts

Ø Smoking

Ø Alcohol or Drug abuse

Ø Social Withdrawal

Stress:

 

More Presentations from Dr.Naina Mohamed Pakkir Maideen

Stress is the human response to excessive demands (Stressor) which disturb physiological, social and psychological systems.

Ø The stress can be either Negative stress (Distress) or Positive stress (Eustress) depending on the stressor.

Ø The stressors could be either internal (Anxiety, fear and personality traits) or external (Family stressors, Social stressors, Work stressors, Change stressors, Chemical stressors, Disease stressors, Environmental stressors, etc.)

Ø There are three sorts of stress such as Acute stress, Episodic stress and Chronic stress.

Ø Acute stress occurs only at a very short period of time.

Ø Emotional symptoms of Acute stress include anger, anxiety, irritability and acute periods of depression.

Ø Physical symptoms of Acute stress include headache, pain, stomach upset, dizziness, heart palpitations, shortness of breath, hypertension and bowel disorders.

Ø The acute stress which is suffered too frequently is termed Episodic stress.

Ø The symptoms of Episodic stress include Ceaseless worrying, Longer periods of intermittent depression, anxiety disorders and emotional distress, Persistent physical symptoms similar to those found in acute stress and Coronary heart diseases, or other heart problems.

Ø Chronic stress is dangerous and unhealthy.

Ø Chronic stress is caused by long-term exposure to stressors, such as unhappy marriage, traumatic experiences, unwanted career or job, stress of poverty, chronic illnesses, relationship conflicts, political problems, and dysfunctional families.

Ø Chronic stress can induce serious illnesses like stroke, heart attack, cancer, and psychological problems such as clinical depression and post-traumatic disorder.

Ø The Physical signs and symptoms of chronic stress include Dry mouth, Difficulty in breathing, Pounding heart, Stomach ache, Headache, Diaphoresis, Frequent urination and Tightening of muscles.

Ø The Mental signs and symptoms of chronic stress include Sudden irritability, Tension, Problems with concentration, Difficulty in sleeping, Narrowed perception and Frequent feelings of fatigue.

Ø Physiological response to stress occurs as Immediate responses to stress, through the Stimulation of Sympathetic adrenomedullary system and General Adaption Syndrome.

Ø The release of Epinephrine and Norepinephrine occurs from adrenal medulla as an immediate response to stress.

Ø Stimulation sympathetic system leads to Acceleration of heart and lung action, Paling or flushing, Vasoconstriction in many parts of the body, Liberation of nutrients for muscular action, Inhibition of the lacrimation and salivation, Dilation of pupil, Relaxation of bladder, Inhibition of erection, Auditory exclusion (Loss of hearing), Tunnel vision (Loss of peripheral vision) and Shaking.

Ø The Stages of GAS include Alarm Stage, Resistance Stage and Exhaustion Stage.

Ø Psychological response to stress occurs as Direct Action and Indirect Action.

Ø Direct action to stress may occur as Freezing (Anticipation of Threat), Aggression (Fight), Escape (Flight), Learned helplessness or Hopelessness (Depression).

Ø Indirect action to stress may occur as Displacement, Repression, Denial, Projection, Rationalisation, Intellectual Isation or Reaction formation.

FDA approves Evolocumab (Repatha) to treat high cholesterol:

More Presentations from Dr.Naina Mohamed Pakkir Maideen

©   On 27^th Aug 2015, the U.S. Food and Drug Administration approved Evolocumab (Repatha) injection to treat high cholesterol.

©   Evolocumab is the second PCSK9 (Proprotein Convertase Subtilisin Kexin type9) inhibitor.

©   Evolocumab (Repatha) is approved to treat adult patients with…

Ø Heterozygous familial hypercholesterolemia (HeFH)

Ø Homozygous familial hypercholesterolemia (HoFH)

Ø Who require additional lowering of LDL cholesterol (i.e Whose cholesterol is not controlled by diet and Statin treatment)

©    The recommended dose of Evolocumab for adults, is 140 mg every two weeks or 420 mg once a month.

Mechanism of Action:

©   Evolocumab (Repatha) binds to a protein called Proprotein Convertase Subtilisin Kexin type 9 (PCSK9) and inhibits its binding to low density lipoprotein receptors (LDLR) at the surface of hepatocytes. When PCSK9 binds to cell surface LDLR, lysosomal degradation of LDLR occurs. But, inhibition of PCSK9 binding to LDLR by Evolocumab prevents the lysosomal degradation and increases the number of LDLR available to clear LDL particles leading to lowering of LDL cholesterol.

Adverse Drug Reactions:

©  The most common ADRs noted in the clinical trial participants being treated with Evolocumab, include Nasopharyngitis, Upper respiratory tract infection, Flu like symptoms, Back pain, Redness, pain, or bruising  at the injection site and Allergic reactions (Rash and hives).

FDA approves Flibanserin (Addyi) to treat Hypoactive Sexual Desire Disorder (HSDD):

 

More Presentations from Dr.Naina Mohamed Pakkir Maideen

Ø On 18^th Aug 2015, The U.S. Food and Drug Administration approved Flibanserin (Addyi) to treat acquired, generalized Hypoactive Sexual Desire Disorder (HSDD) in premenopausal women.

Ø Flibanserin (Addyi) is the first FDA-approved treatments for sexual desire disorders in men or women.

Proposed Mechanism of Action:

Ø Flibanserin activates 5-HT_1A receptors in the prefrontal cortex and improves the balance between excitatory (Dopamine and Norepinephrine) & inhibitory (Serotonin) neurotransmitter systems, at prefrontal cortex leading to regulation of sexual response.

Adverse Drug Reactions:

Ø The most common ADRs noted in the clinical trial participants being treated with Flibanserin, include Dizziness, Somnolence (Sleepiness), Nausea, Fatigue, Insomnia and Dry mouth.

Drug Interactions:

Ø Flibanserin can interact significantly with Alcohol, CYP3A4 Inhibitors, CYP3A4 Inducers, CYP2C19 Inhibitors, Digoxin or other P-gp Substrates and Other CNS Depressants.

Contraindications:

Ø Alcohol consumption

Ø Concomitant use of CYP3A4 Inhbitors such as Macrolide Antibiotics (Erythromycin, Clarithromycin, Telithromycin, etc.), Azole Antifungals (Ketoconazole, Fluconazole, Itraconazole, etc.), Antiretroviral protease inhibitors (Saquinavir, Ritonavir, Indinavir, Nelfinavir, Amprenavir, etc.), Ciprofloxacin, Verapamil, Grapefruit juice, etc.

Ø Hepatic Impairment

                             

FDA approves Alirocumab (Praluent) to treat high cholesterol:

More Presentations from Naina Mohamed Pakkir Maideen

©  On 24^th July 2015, the U.S. Food and Drug Administration approved Alirocumab (Praluent) injection to treat high cholesterol.

©   Alirocumab is the first PCSK9 (Proprotein Convertase Subtilisin Kexin type9) inhibitor.

©   Alirocumab(Praluent) is approved to treat adult patients …

Ø With Heterozygous familial hypercholesterolemia (HeFH)

Ø Who require additional lowering of LDL cholesterol (i.e Whose cholesterol is not controlled by diet and Statin treatment)

©    The usual starting dose of Alirocumab is 75 mg/2 weeks.

Mechanism of Action:

©   Alirocumab (Praluent) binds to a protein called Proprotein Convertase Subtilisin Kexin type 9 (PCSK9) and inhibits its binding to low density lipoprotein receptors (LDLR) at the surface of hepatocytes. When PCSK9 binds to cell surface LDLR, lysosomal degradation of LDLR occurs. But, inhibition of PCSK9 binding to LDLR by Alirocumab prevents the lysosomal degradation and increases the number of LDLR available to clear LDL particles leading to lowering of LDL cholesterol.

Adverse Drug Reactions:

©  The most common ADRs noted in the clinical trial participants being treated with Alirocumab, include Nasopharyngitis, Itching, swelling, pain, or bruising at injection site, Flu like symptoms, Urinary tract infection, Diarrhea, Bronchitis, Myalgia, Muscle spasms, Sinusitis, Cough and Allergic reactions.

FDA approves Entresto (A new Heart Failure Drug):

More Presentations from Naina Mohamed Pakkir Maideen

©  On 07^th July 2015, the U.S. Food and Drug Administration approved Entresto tablets for the treatment of heart failure.

©  Entresto is a crystalline complex composed of 2 molecular moieties…

Ø Sacubitril (Neprilysin inhibitor )

Ø Valsartan (Angiotensin Receptor Blocker)     

Mechanism of Action:

©  Sacubitril blocks the degradation of endogenous vasoactive peptides (ANP, BNP, bradykinin, and Adrenomedullin), by inhibiting Neprilysin enzyme.

©  Valsartan decreases vasoconstriction and sodium retention by blocking the binding of Angiotensin II to the AT 1 receptors (Vascular smooth muscle and the adrenal gland).

Adverse Drug Reactions:

©  The most common ADRs noted in the clinical trial participants being treated with Entresto include Hypotension, Hyperkalemia, Cough, Dizziness and Renal Impairment.

Contraindications:

©  Entresto is contraindicated in patients taking Aliskiren and ACEIs and in patients with a history of angioedema related to previous ACE inhibitor or ARB therapy.

Drug Interactions:

©  Entresto may interact significantly with drugs such asACE Inhibitors, Aliskiren, ARB, Potassium-sparing diuretics, NSAIDsandLithium.

Pregnancy:

©  Use of Entresto should be discontinued as soon as possible, if pregnancy is detected.

Lactation:

©  Use of Entresto or Breastfeeding should be discontinued.

FDA approves Cangrelor (A new Antiplatelet drug):

More presentations from Naina Mohamed Pakkir Maideen

©  On 22.06.15, The U.S. Food and Drug Administration approved Cangrelor (Kengreal) which is a new intravenous antiplatelet drug could be used with Percutaneous coronary intervention (PCI) for the treatment of stable angina or acute coronary syndromes (ACS, or myocardial infarction (MI) and unstable angina (UA)).

©  Cangrelor (Kengreal) is an intravenous (IV), direct acting, reversible competitive inhibitor of P2Y12 receptor.

Mechanism of Action:

©  Cangrelor blocks P2Y12 receptors of Platelet cell membranes causing inhibition of release of ADP and other mediators such as TxA2 and inhibition of activation of Glycoprotein IIb/IIIa which result in to the inhibition of Platelet activation and aggregation.

Adverse Drug Reactions:

©  The ADRs such as Dyspnea, Vomiting, Nausea, Headache and Hypotension have been noted with Cangrelor use.

Contraindications:

Cangrelor is contraindicated in patients with significant active bleeding and patients with known hypersensitivity (e.g., anaphylaxis) to cangrelor.