Nicotine

1
Smoking/Air Pollution
2
Intro

• Prevalance
• Native American/Alaskan 47
• African American 27
• Caucasian 26
• Deaths related to smoking
• Overall its 1 in 6
• Smoking is directly responsible for 87 of lung
  cancers
• Promotes 21 of deaths from CAD and 19 of
  strokes
• Directly responsible for 82 of COPD
• Linked to slower wound healing, infertility, and
  peptic ulcers

3
Composition of Smoke

• Cigarettes contain 43 different cancer causing
  chemicals and a total of gt2000 chemicals
• Tobacco is derived from the nightshade family of
  plants and is influenced by the soil, climate,
  and how its processed after harvesting
• Nicotine is an addictive chemical the stimulates
  the brain and relaxes the bodyits found in all
  tobacco products, not just cigarettes
• There is 500mg of smoke per cigarette containing
• 5-10 particulates (nicotine, pesticides, phenol,
  tar)
• 12-15 CO2
• 3-6 CO
• Other gases acetaldehyde, ammonia, benzopyrene,
  formaldehyde, hydrocyanide, urethane, vinyl
  chloride

4
Smoke

• The toxicity depends on the amount and depth of
  inhalation and the duration of smoking
• Low yield cigarettes decrease the risk of lung
  CA, but most people compensate by smoking more
  cigarettesthere is less coughing and mucus
  production, though
• Smoking during pregnancy accounts for 30 of low
  birth weight babieshealthy full-term babies of
  smokers have narrowed airways and decreased lung
  function
• The most potent predictor of a decline in lung fx
  from smoking is the cumulative exposure to smoke

5
Nicotine

• Immediate effects
• Increased BP
• Increased HR
• Thickening of blood
• Narrowing of arteries
• Decreased skin tem
• Increased resp rate
• CNS stimulation
• Diarrhea/vomiting

6
Nicotine

• Long term effects
• High BP
• Blockage of blood vessels
• Depletion of vitamin C
• Decreased immune system
• Cancer
• Bronchitis/emphysema
• Ulcers
• Weight loss
• Dryness/wrinkling of skin
• Abnormal sperm production

7
Nicotine

• Withdrawal symptoms
• Decreased HR
• Decreased BP
• Sleep disturbance
• Slower reactions
• Tension
• Restlessness
• Depression
• Irritability
• Constipation
• Difficulty concentrating
• Cravings

8
Cardiovascular Dx and Smoking

• CV disease associated with smoking
• Coronary artery disease
• Cerebrovascular accident
• Peripheral vascular disease
• The most prevalent and lethal consequence of
  smoking is premature coronary artery
  diseasesmokers have 50 more atherosclerosis
  than non-smokerssmoke alters plasma lipoprotein
  levels
• Smoke damages vascular endothelial cells,
  enhances mitosis of fibroblasts and promotes
  platelet activation this increases the risk of
  clots
• If you stop smoking, the heart dx risks will
  decrease10 yrs after stopping, the death rates
  of former smokers will be about equal to that of
  non-smokers

9
Airway Dx and Smoking

• Since the 1960s weve known that theres a link
  between smoking and chronic bronchitis/COPDsmokin
  g increases the cough and decreases lung function
• The effect of smoke on the lungs is influenced by
  childhood infections, occupational exposures, and
  protease phenotypes
• Lost lung function cant be regained if you quit,
  but you can slow the decline back to the normal
  rate of decline
• The best predictor of survival in persons with
  COPD is the postbronchodilator FEV1
• Second hand smoke increases the respiratory
  problems of children of smokers (asthma, colds,
  ear infections)

10
Lung CA and smoking

• 28 of all cancer deaths are lung CA
• The work place contributes to 5-30 of lung CA
  deaths
• The lung cancer rate in SC is moderate to high
• The cumulate exposure to smoke, the of
  cigarettes/day, the duration of smoking, and the
  depth of inhalation all contribute to the
  probability of developing lung CAheavy smokers
  have the highest risk
• Pipe and cigar smokers are also at higher risk
  than non-smokers

11
3 more reasons not to smoke

• Less in reserve
• Children of smokers recover more slowly from
  anesthesia and require more oxygen (probably b/c
  of the increase in CO in their bodies)
• Children of smokers have more coughing and
  wheezing when recovering from anesthesia
• Children of smokers have more intra-operative
  complications

12
3 more reasons not to smoke

• Loss of sight/other diseases
• Smokers have 2.5 X more blindness than
  non-smokersthe risk stays up even if you
  quitthe cause is macular degeneration
• Diabetes, obesity, HTN, alcoholism, and vitamin
  depletion are more common in smokers than
  non-smokers
• Irreparable damage
• Benzopyrene in smoke damages sites on the tumor
  suppression gene causing mutations that can lead
  to CA

13
Marijuana

• There is no statistical difference between a
  cigarette smoker and a marijuana smoker
• Acute chest illness are higher in marijuana
  smokers than in cigarette smokers
• 4 times as much tar is deposited in the airways
  of marijuana smokers because of the method of
  smoking
• 3-4 joints per day is the equivalent of 1 pack of
  cigarettes

14
Marijuana

• Microscopic effects
• Loss of cilia from bronchial epithelial cells
• The cells are replaced by goblet cells so more
  mucus is produced and theres less ability to
  remove it
• Alveolar macrophages are impaired
• T-cells and monocytes are affected, further
  decreasing immunity
• Increases the immunosuppression found with AIDS
  and other dx

15
Marijuana and asthma

• Tetrahydrocannabinol (THC) is a mild
  bronchodilator that is anticholinergic
• The smoke effects offset the bronchodilating
  effects, howeveralso THC is a phenol which is
  irritating to the airway
• They are developing a marijuana patch and inhaler
  than are pure THC

16
Medicinal Uses of Marijuana

• Decreases nausea
• Stimulates appetite
• Decreases pressure in the eye
• Decreases pain
• Steadies spastic muscles and decreases seizures
• Marinol is a synthetic THC thats FDA approved
  from chemo and AIDS patients to decrease nausea
  and stimulate the appetite
• 15 patients have gotten government approval to
  smoke marijuana8 are still alive

17
Dangers of THC

• Throat and lung CA
• Disrupts short-term memory
• Suppresses immune defenses
• Chronic bronchitis
• Patients who shouldnt use marijuana
• Asthma patients irritation of the airways
• Immune disorders immunosuppression
• TB accelerates growth of the bacilli

18
Other Marijuana Facts

• Laryngeal, oral, esophageal, and lung CA rates
  are higher
• It doesnt seem to cause the decline in lung fx
  that cigarettes do
• The major risk is chronic bronchitis
• Components of marijuana smoke
• THC
• Hydrocyanic acid (gas chambers)
• Acrolein/aldehydes (smog)

19
Cocaine

• Cocaine is a respiratory irritant because its
  very alkaline
• It increases airway resistance
• Doesnt limit exercise or have any effect on the
  pulmonary vasculature
• The major effect is increased Raw
• Also suppresses macrophages, decreasing immunity,
  and causes tumors to grow more rapidly