Table 5: Nicotine Replacement Therapies NRT Advantages
Disadvantages
Side Effects
Precautions
Bupropion SR Simple to use; may help with depression; combined with patches
More possible side effects than other medicines; cannot be used if history of bulimia/anorexia; or recently took MAO inhibitor; requires a prescription
Nausea, dizziness; insomnia; constipation, dry mouth, rash, seizures, changes in mood or behavior; anxiety
History of seizures; do not take with bulimia/ anorexia; taking MAO inhibitor; liver disease, pregnant or breastfeeding; < age 18 years
E-cigarettes/vaping Vaping was new to the U.S. market in 2007 with the introduction of the first electronic cigarette (e-cigarette) as a form of smoking cessation therapy. At the time, it was available by prescription only. Devices containing both nicotine and tetrahydrocannabinol (THC) became available, and the popularity of this delivery device soared. 56 Use of vape products doubled between 2017 and 2019, prompting U.S. government policy makers to introduce age restrictions and ban the use of flavored e-cigarettes due to the concern for the general health of the young adults who were increasingly using these products. 144 Unfortunately, there is not enough data to determine short-term or long-term effects or the type of components that are to blame. Vaping is a delivery system similar to a nebulizer; however, the vaping system coats the lungs in harmful chemicals masked in a variety of flavorings and aromatic additives. Vitamin E is often used as part of the delivery system and thickening agent in the e-liquid, which is thought to be an irritant to the lungs. Other common substances found in the e-liquid include (1) diacetyl, which is a food additive (buttery taste in microwave popcorn) known to damage small passages in the lungs; (2) formaldehyde, which contributes to lung and heart disease; and (3) acrolein, which is used as a weed killer and can also damage lungs. Several lung diseases listed subsequently are associated with vaping. 57 ● Bronchiolitis obliterans (popcorn lung) is a rare condition resulting from damage of the small airways from diacetyl. Inhaling this additive causes coughing, wheezing, chest pain, and shortness of breath. Symptomatic treatment is available; however, there is no lasting treatment. ● Vaping-related lipoid pneumonia develops when fatty acids enter the lungs from the oily substances found in the e-liquid. This induces inflammatory responses in the lungs demonstrated by chronic
cough, shortness of breath, and blood-tinged mucus. The single most important treatment is to eliminate vaping while the lungs heal themselves. ● Primary spontaneous pneumothorax may develop due to vaping due to the development of bullous lung disease. Rapid lung growth found in adolescence makes this complication more common. The development of lung bullae is typically painless as opposed to the symptoms associated with pneumothorax that include sharp chest or shoulder pain along with dyspnea. ● E-cigarette/vaping associated lung injury (EVALI) presents as an acute respiratory illness with nonspecific symptoms such as cough, shortness of breath, and chest pain, and may produce hemoptysis. Gastrointestinal symptoms, fever, fatigue, and weight loss may occur over days to weeks after starting to use vaping products. EVALI is strongly associated with vitamin E, which is found in lung fluid of individuals with EVALI but not in those without EVALI. EVALI is a diagnosis of exclusion and is considered strongly when pulmonary infiltrates are found on imaging of the lung in patients with recent initiation of these vaping delivery systems. Laboratory tests should be guided by clinical findings as well as practice guidelines. Community-acquired pneumonia and influenza present with similar symptoms, and EVALI is difficult to differentiate from these diagnoses. 58 Rapid recognition is critical to reduce severe outcomes. During a comprehensive review of systems, the clinician should ask about recent use of e-cigarettes or vaping. If confirmed, ask about the type of substance (THC, nicotine) utilized. Treatment is supportive, and corticosteroids have shown to be effective, but further study is warranted. 146
MARIJUANA
Marijuana refers to the dried leaves, flowers, stems, and seeds from the Cannabis sativa or Cannabis indica plant. The plant contains tetrahydrocannabinol (THC) and other similar compounds. Extracts can also be made from the cannabis plant. Cannabinoids exert various physiological effects by interacting with specific cannabinoid receptors (CB receptors) present in the brain and periphery. 59 People smoke marijuana
in hand-rolled cigarettes (joints) or in pipes or water pipes (bongs). They also smoke it in blunts—emptied cigars that have been partly or completely refilled with marijuana. Marijuana is mixed in food ( edibles ), such as brownies, cookies, or candy, or brewed as a tea. A popular method of use is smoking or eating different forms of THC-rich resins or gummies. Cannabis is known to have behavioral and physiological effects. Behavioral effects include
Page 58
Book Code: MDCO1025
Powered by FlippingBook