generic pharmacy talk
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The Pharmacist’s Role in Ending the Tobacco
Pandemic
Alan Blum, MDAuburn University
Harrison School of Pharmacy February 18, 2011
DEATHS FROM CIGARETTE SMOKING IN US SINCE 1964
12,000,000
Smoking Prevalence
CAUSES OF DEATH
1. Heart disease2. Cancer3. Stroke4. COPD5. Accidents6. Diabetes
MARLBORO’S MYOCARDIAL MAYHEM
• ↑ oxygen demand• ↓ angina threshold• ↓ exercise performance• ↑ recurrent infarction
CAMEL’S CORONARY CONSEQUENCES
• Adverse lipid profile• Altered hematologic factors• Direct arterial wall effects• Elevated blood pressure
Cancer Death Rates for Men, US, 1930-2005
Cancer Dea th Ra tes fo r Women, US , 1930 -2005
COPD
• 5% of US population• 80% caused by smoking• 4th leading cause of death
DIABETES:
3x Cardiovascular Mortality
SMOKING + DIABETES:
11x Cardiovascular Mortality
OTHER TOBACCOGENIC PROBLEMS
• Osteoporosis• Hip fractures• Early menopause• Macular degeneration• Peptic ulcer disease
SECONDHAND SMOKE
• Lung cancer: 3,000 deaths/year• Heart disease: 40,000 deaths/year• Asthma: 2 million visits/year
SMOKING IN PREGNANCY
• Low birthweight• Preterm labor• Spontaneous abortion• Abruptio placenta• Placenta praevia• Premature rupture of membranes
EFFECTS ON CHILDREN
• SIDS• Asthma• Bronchitis• Otitis media• Pneumonia
INFLUENCES
• Peers• Parents• Propaganda
SMOKING CESSATION
• 44.5 million smoke• 77% want to stop• 40% try each year• 5% succeed
MARKERS OF ADDICTION
• >20 Cigarettes /day• Smoke upon awakening• Psychiatric condition• Alcohol dependence
BEHAVIOR MODIFICATION• Identify situations• Choose oral substitutes• Do five-minute plan:
PostponeInhaleReconsider
SMOKING’S MYTHS
•Relieves stress•Keeps weight down•Low-tar, filters, are safer
THE PRODUCT
•Filter•Low tar•Lights•Menthol
MONEY LOST
Number of packs/dayx Cost/packx 365 days/yearX Number of years smokingTotal cash lost (plus interest)
INHALATION COUNT
Number of cigarettes/dayx 10 inhalations/cigarettex 365 days/yearx Number of years smokingTotal inhalations
BENEFITS OF STOPPING
• 1 day: ↓ MI risk• 1 year: ↓ Stroke risk 50%• 10 years: Stroke risk of non-smoker• 15 years: CHD risk of non-smoker
COSMETIC BENEFITS
• Fresher breath, clothing• Whiter teeth, nails• Endurance
NICOTINE REPLACEMENT THERAPY
• Gum (Nicorette)• Transdermal patch (Nicoderm)• Inhaler (Nicotrol)• Lozenge (Commit)• Electronic cigarette?
ADJUNCTIVE PHARMACOTHERAPY
• Bupropion• Clonidine• Nortriptyline• Verenicline• Rimonabant
SMOKING PREVENTION
• Increase cigarette taxes• Restrict teen access• Clean indoor air laws• Ban advertising• Educate on TV, radio, internet
SHIFTING THE FOCUS
• Substance → Product• Effects → Promotion• User → Pusher
AMERICAN TOBACCO COMPANIES
1. Philip Morris USA2. Reynolds-American Inc.3. Lorillard Inc.4. United States Smokeless Tobacco5. Liggett Vector Brands Inc.6. Swedish Match7. Imperial Tobacco
CANCER’S 7 WARNING SIGNS
1. Philip Morris USA2. Reynolds American Inc3. Lorillard Inc.4. United States Smokeless Tobacco5. Liggett Vector Brands Inc.6. Swedish Match7. Imperial Tobacco
Alan Blum, M.D.Professor and Gerald Leon Wallace Endowed
Chair in Family Medicine, College of Community Health Sciences, School of Medicine, The University of Alabama
Director, The University of Alabama Center for the Study of Tobacco and Society
STRATEGIC WEAPONS
•Map•Calendar•Camera
Alan Blum, M.D.Professor and Endowed Chair in Family
Medicine, The University of Alabama
Director, The University of Alabama Center for the Study of Tobacco and Society