Smoki Cess Update 04 Nop 07
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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
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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
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SMOKING CIGARETTE ? SMOKING CIGARETTE ?
RokokRokokCerutuCerutuPipaPipaRokok rastaRokok rastaRokok Rokok
“klembak”“klembak”““Horsa”Horsa”““pipa pipa
perdamaian”perdamaian”
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ALAT UNTUK MENIKMATI ALAT UNTUK MENIKMATI TEMBAKAUTEMBAKAU
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WHY STARTING ??WHY STARTING ??
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NikotinNikotinTarTarKarbon monoksidaKarbon monoksidaFenolFenolAsetonAsetonArsenArsenMerkuriMerkuriHidrogen sianidaHidrogen sianidaFormalinFormalin
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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
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Mild Severe
Survival
Persistent
Necrosis
Inflammation
Apoptosis
DNA damage
CIGARETTESCIGARETTES
The 2007 National Symposia Update on Tuberculosis And Respiratory DisordersBandung, 23rd-25th Marc, 2007
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BRONCHIBRONCHITIS TIS CHRONISCHRONIS
EMPHYSEEMPHYSEMA MA
KANKER KANKER >> >> PARU >PARU >
HAMIL -HAMIL - ANAK ANAK ASMA >ASMA >
DIABETEDIABETES M >S M >
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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
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ACCUTE INFECTION ACCUTE INFECTION
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CHRONICLE INFECTIONCHRONICLE INFECTION
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MALIGNANCYMALIGNANCY
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Gb hal 148
PPOK
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Gb hal 149
BRONKITIS KRONIK
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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
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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)
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Who Scared ??Who Scared ??
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Who Scared ?Who Scared ?
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BUKAN LELAKI KALAU TIDAK BUKAN LELAKI KALAU TIDAK sundhut tembakausundhut tembakau
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Merokok dapat Merokok dapat
menyebabkan ..menyebabkan ..
………………………………………………
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Habits Habits
Or Life Style ?Or Life Style ?
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DEMO MASSAL??DEMO MASSAL??BLOKIR JALANBLOKIR JALANUNJUK RASAUNJUK RASA DUDUKI AIRPORTDUDUKI AIRPORT
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70 % of SMOKERSREPORT WANTING
TO QUIT
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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
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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
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CLINICAL USE OF PHARMACOTHERAPIES FOR SMOKING CESSATION (with/after COUNSELLING)
•BUPROPION SR•NICOTINE GUM•NICOTINE INHALER•NICOTINE NASAL SPRAY•NICOTINE PATCH•NICOTINE LOZENGES•VARENICLINE
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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
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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
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AKIBAHARA CORNERAKIBAHARA CORNER
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????
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Gb hal 241
PNEUMOTORAKS