smoki cess update 04 nop 07
DESCRIPTION
Smoke Seminar ParuTRANSCRIPT
Nama : dr. Isnu Pradjoko, Sp.P(K)
TTL : Indonesia, Jumat legi 22 Agustus 1950
Pend. S1 : FK UNAIR 1978
Pend. Spesialis : FK UNAIR 1992
• Bronchoscopy and thoracoscopy course
Perth Royal & Charles Gardner Hospital W.Austrl
Jabatan : Staf Medik SMF Paru FK Unair
Riwayat Pekerjaan :
- Ka Puskesmas Omben & Sampang Kota (1978-1983)
- Direktur RSU Sampang Madura (1983-1986)
Curriculum Vitae
SMOKING CESSATION SMOKING CESSATION &&
NICOTINE NICOTINE REPLACEMENT REPLACEMENT
Isnu PradjokoIsnu PradjokoPULMONARY DEPARTMENTPULMONARY DEPARTMENT
MEDICAL FACULTY AIRLANGGA UNIVERSITY- MEDICAL FACULTY AIRLANGGA UNIVERSITY- DR.SOETOMO GENERAL HOSPITALDR.SOETOMO GENERAL HOSPITAL
SURABAYASURABAYA
SMOKING CIGARETTE ? SMOKING CIGARETTE ?
RokokRokokCerutuCerutuPipaPipaRokok rastaRokok rastaRokok Rokok
“klembak”“klembak”““Horsa”Horsa”““pipa pipa
perdamaian”perdamaian”
ALAT UNTUK MENIKMATI ALAT UNTUK MENIKMATI TEMBAKAUTEMBAKAU
WHY STARTING ??WHY STARTING ??
NikotinNikotinTarTarKarbon monoksidaKarbon monoksidaFenolFenolAsetonAsetonArsenArsenMerkuriMerkuriHidrogen sianidaHidrogen sianidaFormalinFormalin
Direct injuryDirect injury
CIGARETTESCIGARETTES
Indirect injuryIndirect injury
Oxidant damage: Lipids Proteins DNAAldehydes: Lipids Proteins DNAXenobiotics: DNA alterations
Oxidant damage: Lipids Proteins DNAAldehydes: Lipids Proteins DNAXenobiotics: DNA alterations
Inflammation:
Oxidants
Proteases
Toxic peptides
Altered lung structures
Altered cellular responses
Inflammation:
Oxidants
Proteases
Toxic peptides
Altered lung structures
Altered cellular responses
CIGARETTE INJURY
Mild Severe
Survival
Persistent
Necrosis
Inflammation
Apoptosis
DNA damage
CIGARETTESCIGARETTES
The 2007 National Symposia Update on Tuberculosis And Respiratory DisordersBandung, 23rd-25th Marc, 2007
BRONCHIBRONCHITIS TIS CHRONISCHRONIS
EMPHYSEEMPHYSEMA MA
KANKER KANKER >> >> PARU >PARU >
HAMIL -HAMIL - ANAK ANAK ASMA >ASMA >
DIABETEDIABETES M >S M >
AIR WAY AIR WAY DEFENCE DEFENCE MECHANISMMECHANISM!!!!
Soft mucous layerSoft mucous layer Blood vesselBlood vessel Sputum productionSputum production Muco-cilliairMuco-cilliair Muco-cilliair Muco-cilliair
transport to oral.transport to oral.
Cellular-humoral Cellular-humoral defencedefence
Acid-base balanceAcid-base balance
ACCUTE INFECTION ACCUTE INFECTION
CHRONICLE INFECTIONCHRONICLE INFECTION
MALIGNANCYMALIGNANCY
Gb hal 148
PPOK
Gb hal 149
BRONKITIS KRONIK
Miscoding
NicotineOther
carcinogenesDNA
Cigarrette smoker
Metabolicactivation
NormalDNA
Apoptosis
PUTATIVE PATHWAY FROM NICOTINE ADDICTION TOTHE DEVELOPMENT OF COPD
(Martyn R Partridge, Understanding Respir Medcine, 2006)
Genetic mutations
Lung cancer
Repair
Tobacco use
Nonsmokerdeath rate, 10
Ex-smokerdeath rate, 43
Continuing smoker – any tobacco- death rate, 104
Cigar/pipe smokerdeath rate, 52
Number of cigarettes smoked
1-14 per day,death rate 78
15-24 per day,death rate 127
> 24 per day,death rate, 251
(Death rates per 100,000 population)
CORRELATION BETWEEN NUMBER OF CIGARETTES CONSUME AND LUNG DISEASE
(Doll’s and Hill’s Doctors Study, 2006)
Who Scared ??Who Scared ??
Who Scared ?Who Scared ?
BUKAN LELAKI KALAU TIDAK BUKAN LELAKI KALAU TIDAK sundhut tembakausundhut tembakau
Merokok dapat Merokok dapat
menyebabkan ..menyebabkan ..
………………………………………………
Habits Habits
Or Life Style ?Or Life Style ?
DEMO MASSAL??DEMO MASSAL??BLOKIR JALANBLOKIR JALANUNJUK RASAUNJUK RASA DUDUKI AIRPORTDUDUKI AIRPORT
70 % of SMOKERSREPORT WANTING
TO QUIT
THE 5 A’S FOR PATIENTS WILLING TO QUIT
ASK : about tobacco useADVISE : to quitASSESS : willingness to make a quit attemptASSIST : in quit attemptARRANGE : for follow-up
THE 5 R’sFOR TREATING PATIENTS WHO ARE NOT READY
TO MAKE A QUIT ATTEMPT
RELEVANCE : tailor advice & discussion to each patientRISKS : outline risks of continued smokingREWARDS : outline the benefits of quittingROADBLOCKS : identify barriers to quittingREPETITION : reinforce the motivational message at every visit
CLINICAL USE OF PHARMACOTHERAPIES FOR SMOKING CESSATION (with/after COUNSELLING)
•BUPROPION SR•NICOTINE GUM•NICOTINE INHALER•NICOTINE NASAL SPRAY•NICOTINE PATCH•NICOTINE LOZENGES•VARENICLINE
SUGGESTIONPharmacotherapy Precaution/C.I Side
effectDosage
Bupropion SR
Varenicline
Nicotine gum
Nicotine Loz
Nicotine inhaler
Nicotine Nasal spray
Nicotine Patch
-Seizure- Eating disorder
-Insomnia-- dry mouth
- renal impairment - undergoing dialysis
-Insomnia-abnormal dreamNausea Dry mouth
-mouth soreness-dyspepsia
-Nausea--insomnia
-local irritation
- Nasal irritation
Local skin irritationinsomnia
150 mg every morning 3 days. 2 xdaily .(start 1-2 weeks before quit date)
Day 1-3 0,5mg tab morningDay 4-7 0,5mg tab 2x/dayDay 8-end 1mg tab 2x/day (1week before
1-24cig/day -2mg gum (>24 /day>25 cig/day 4mg gum (>24 /day)
2mg: >30 min wake– smoke4mg- < 30 min wake- smoke
6-16 cartrides/day
8-40 doses/day
-21 mg/24 hours--14 mg/24 hours-7 mg/24 hours--15 mg/16 hours
SUGGESTIONPharmacotherapy Duration Availability Avg. Cost/day
Bupropion SR
Varenicline
Nicotine gum
Nicotine Loz
Nicotine inhaler
Nicotine Nasal spray
Nicotine Patch
7-12 weeks Maintenance >6 mo
R/ only -Zyban SR-Wellbutrin SR
-1 box/60 tab. 150 mg.-- Zyban $185.99. Wellbutrin $167.99-- generic $101,99
3 – 6 month Chantix ???Varies $115/mo
> 12 weeks
> 12 weeks
> 6 month
3 - 6 month
-4 weeks -Then 2 weeks-Then 2 weeks-- 8 weeks
OTC only.nicoderm CQ.nicotrol.genericR/only-generic (Legend)
21mg.box 0f 7-Nicoderm : $29.00-- generic $21.9914 mg box of 7:-Nicoderm $29.00--generic $21.99
R/ only - Nicotrol NS
1 metered dose dispenser 40 ml $190.99
R/ only- Nicotrol inhaler
1 box of 168 cartridges : $166.99
-Commit loz--generic(Nicabate
2mg – 48 loz- Commit $29.994mg- 48 loz- Commit $29.99
-Nicorette-Nicorette mint
2mg-1box/50 pieces$29.99/22.994mg-1 box/50 pieces $ 32.99
AKIBAHARA CORNERAKIBAHARA CORNER
????
Gb hal 241
PNEUMOTORAKS