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y Definition- A substance that comes from the plant nicotiana tabacum, which can be smoked, chewed, or sniffed.
Tobacco contains nicotine, which is a powerful and highly addictive substance.
behavioural dimensions – Tobacco use triggers the release o associated with feelings of pleasure. y A cigarette is a
cut tobacco leaves wrapped in a cylinder of thin paper for smoking.
y The addictive agent found in the cigarettes is called nicotine. y Statistically each cigarette smoked shortens the user's lifespan by 11 minutes. About h tobacco-related diseases y Contains over 4000 chemicals y About half are found naturally in the leaf and half from chemical reactions when it is burnt y Some introduced during the curing process y Some added for flavour or ‘quality' Early Health Warnings Dr. Raymond Pearl re ports that smokers do not live as long as non-smokers y 1939 Franz Muller finds a link between smoking and y First report on health and smoking by the Surgeon General i n 1964

Have you ever thought about how many cigarettes are smoked each year? y 5.6Trillion cigarettes are smoked annuallyy 38% in China ( 2.1 Trillion cigarettes)y The next 10 largest consuming countries make up about 32% of the global cigarettes burnt: Turkey, , US, Russia, Japan I India, Korea, Italy ( 1.7 Trillion cigarettes) Tobacco – the deadly killer y Although Tobacco Deaths rarely make headlines, tobacco use kills 5.4 million people a year – an average of one person every six seconds.
20th century. If current trends continue, their will be up to one billion deaths in the 2oth century.
y The epidemic is shifting to the developing world as more than 8o % of the world's smokers live in low y By 2030, 70% of all deaths from tobacco will occur in developing countries.

Number of Deaths: Developed and Developing Countries Source: adapted by CTLT from Mathers, C. D., and Loncar, D. (2006).
Most Recent Scientific Evidence: Active Smoking y Coronary heart disease is increased by 2 to 4
y Smoking causes coronary heart disease y Cigarette smoking causes narrowing of the the blood vessels (arteries){ reduced circulation and risk for developing peripheral vascular disease (pain to tissue loss or gangrene) y Smoking causes abdominal aortic aneurysm (a swelling or weakening of the main artery of the body Smoking increases risk of: y Stroke by 2
y 90% of lung cancer deaths in meny 80% of all lung cancer deaths in womeny Smoking damages the airways and alveoli (small air { Chronic airway obstruction Smoking increases the risk of: developing
lung cancer
by 23 times
and women
by 13
The Head and Skin { non contagious, inflammatory skin condition { Itchy, oozing red patches all { Ageing due to depletion of { Carbon Monoxide binds to blood more readily than { Decreased blood causes loss { Increased fractures { Longer healing time – up to y Ulcers – smoking reduces the resistance to b t ability to neutralise acid which e lining causing ulcers y Discoloured fingers y Deformed sperms { Miscarriage and birth defects ecrease sperm count y Decreased flow to the Women - Pregnancy y Smoking can lead to fertility problems y Complications during pregnancy and child birth y Low birth weight babiesy Miscarriages – 2 to 4 times more common due to deprivation of oxygen and abnormal placenta (CO y Lowers oestrogen levels - premature menopause What Is Secondhand Smoke (SHS)? Mainstream Smoke (MS):
Sidestream Smoke (SS):
The smoke emitted from through the mouthpiece the smoldering cigarette of the cigarette when Secondhand Smoke
2006 Surgeon General's Report: Major Conclusions Secondhand smoke causes premature death and disease in children and in adults who do not smoke 2. Children exposed to secondhand smoke are at increased risk for: acute respiratory infections more severe asthma decreased lung growth Source: U.S. Surgeon General's Report. (2006).
Diseases and Adverse Health Effects Caused by SHS Image source: adapted by CTLT from U.S. Surgeon General's Report. (2006).
Health Effects of Secondhand Smoke in Children y Sudden infant death syndrome (SIDS) { Risk factors: Active maternal smoking { Prematurity and low birth weight: both associated with airways and respiratory infection Text source: U.S. Surgeon General's Report. (2006); image source: Hemera Photo-Objects copyright-free image CD.
Preventative measures y Educate yourself- As they say "prevention is better than any cure" individuals including pharmacist should know why tobacco is so dangerous, if they are to be involved in cessation programs related activities.
Caribbean Tobacco Control Project y The Heart Foundation of Jamaica (for the Jamaica Coalition for Tobacco Control) has received a grant from Bloomberg Global Initiative in order to ensure th package warnings on Tobacco products sold in four countries.
y Trinidad and Tobago Framework Convention on Tobacco Control y The World's First Public Health Treaty negotiated under the auspices of the WHO.
y It was adopted by the World Health Assembly on the February 2005.
y it has grown to become one of the most widely
embraced Treaties in UN history and, as of today has
172 Parties.
Globalization of the Tobacco epidemic which kills some 5.4 million Article 11
y Article 11 of the WHO's Framework Convention on Tobacco Control requires parties to the Convention to implement Large, Rotating Health Warnings on Packaging and Labeling.
y Guyana has accepted and ratified the Treaty on 15 th September 2005 as have many of the other ean Countries, i l
e Pro ect states.
y The warnings should be in the Country's main languages covering areas of cigarette packages with a recommended covering of at least 50%. "Cessation – options available" y Smoking cessation is not a defined event but a process that involves a change in key characteristics including lifestyle, values, patterns etc.
y Most researchers agree that individual users of tobacco y Pharmacologic and behavioural characteristics that determine tobacco addiction are similar to those that determine addiction to drugs such as heroin and cocaine. Surgeon General of the United States, 2000.
Cessation- Conventional practices ptions can be divided:
y Nicotine replacement products (NRT) y Non-nicotine replacement products y Nicotine patches-A nicotine patch
is a transdermal patch that releases nicotine into the body through the skin. It is used as an aid in nicotine replacement therapy (NRT), a smo ng cessation.
y Nicotine gum-
is a chewing
g gum that delivers
nicotine to the body.
y The nicotine is delivered to the bloodstream via absorption by the tissues of the mouth.
y Nicotine content is usually either 2 or 4 mg of cigarettes, with the appropriate content and dosage depending o Popular brands include Nicoderm/Nicorette and Nicotinell.
y Nicotine Nasal Spray -The nicotine nasal spray is the strongest
form of nicotine replacement therapy, which i s particularly useful and effective for highly dependent heavy smokers who cannot give up by any other means.
y One dose with this form of NRT is two sprays, one into each nostril. Each spray is the equivalent of 0.5 mg of nicotine; so one spray into each nostril gives a total amount of 1 mg of nicotine, which is about As the nicotine is administered into each nostril, it is inhaled and rapidly absorbed into the bloodstream through the lining of the the nicotine reaches the brain, the user receives a nicotine "rush" that is very similar to the rush obtained from smoking a cigarette.
y Nicotine Inhaler -The nicotine inhaler is a cigarette-
type device made up
of a c
cartridge containing
nicotine with menthol, and a mouthpiece.
y The absorption of nicotine is slower than from a
occurring 10 to 15 minutes after the end of puffing.
Each puff contains about 10 times less nicotine than
a puff of a cigarette. The best results have been
eve b f
requent pu ng for 20 or more
y You can use from 6 to 16 cartridges throughout the
day t
relieve withdrawal symptoms
to control
the urge to smoke. The initial use of less than two
cartridges a day was associated with a lesser
likelihood of success.
Non-nicotine replacement products y Bupropion hydrochloride (Zyban)- This is simply
ta e to reduce your cravi
ng or tobacco-
it is most effective when used in conjunction with
nicotine replacement thera
y It is unique in that it does not contain nicotine -
You begin taking Bupropion daily, 1 to 2 weeks before smoking. This builds y It's main effect is the reduction of cravings and
oms- upropi
on s approved f or use in people who smoke 10 or more cigarettes a day and are at least 18 years old.
Treatment and Rehabilitation Services for Drugs
Out-Patient Treatment Facilities:
Georgetown Public Hospital Corporation Compound (Below the Male
Street, Georgetown Every Tuesday afternoon from 15:00hrs to 17:00hrs msterdam
Outpatient Clinic Every Monday afternoon from 15:00hrs to 17:00hrs Smythfield Drop-in Center
New Amsterdam
Every Thursday afternoon afternoon from 14:00hrs to Every Wednesday afternoon from 13:00hrs to 15:00hrs PHARMACISTS SAVE LIVES HELP GUYANA BECOME


Microsoft word - advances in veterinary medicine hill rag july 2010.doc

Living Longer and Better: Advances in Veterinary Medicine By Dr. Gary Weitzman The days of a general practice physician coming to your house to treat everything that ails you are over. Frankly, so too are the days of a veterinary generalist. Today, there are as many specialties in veterinary medicine as there are in human medicine and surgery. From cardiology, to ophthalmology, from dermatology to radiation oncology, veterinary medicine has changed dramatically. The James Herriot days which lured us veterinarians into this field are over. Recent advances include stem cell treatments for arthritis, complicated orthopedic repairs that would have been inconceivable a decade ago, limb prosthetics, and medical protocols so sophisticated that they take a team of doctors—and at least a few checkbooks—to administer. Clients, by and large, welcome these changes and even expect veterinary medicine to be equal in sophistication to human medicine. Yet few will happily pay for it. While we expect and accept astronomical fees for human health care, many of us still deeply resent the expenses that stem from providing comprehensive, advanced care for our animals. That's a paradox. And then there's the convenience factor. Remember the daily heartworm tablets? Now, that was inconvenient. Or what about the days of dipping your dog or—Horror!—cat in flea dip? Now we complain because the monthly application of flea medication that is so quickly and easily applied onto one small spot on our pet's neck may not work the full four weeks. We've become accustomed to progress and convenience. Fortunately, veterinary medicine is doing its best to keep up. But to keep up, we veterinarians have had to learn more, continue longer training under huge debt, and seek board certification, like our human physician counterparts. Today's veterinary school graduate is predominantly female, has had at least eight years of post-high school education, and is in debt well into the six figures for her education. Then, there is the year of internship and at least three years of residency training, followed by specialty fellowships and board examinations. That's another half to full decade of training to get through—and pay for. What that means is, we can do so much more for you and your pet than the previous generation of general practice veterinarians could. But as in human medicine, these advances affect the very nature of health care. It's no longer reasonable to expect quick answers from your primary veterinarian. Or a rapid cure. With the scope of today's diagnostic tools and medicinal options, treatments may take time. Not everything we try may work, or even work the same way between one patient and the next. Given today's many advances in veterinary medicine, it should be more understandable than ever that your vet may not be able to diagnose and treat every disease quickly and at a minimal cost. Consider, for a moment, the dental service we offer. These days there are new machines, dental x-rays, and entire dental suites to aid in keeping our best friends' teeth and gums healthy and


Am J Physiol Heart Circ Physiol279: H2994–H3002, 2000. Effects of exercise training on cardiac function,gene expression, and apoptosis in rats HONGKUI JIN,1 RENHUI YANG,1 WEI LI,1 HSIENWIE LU,1 ANNE M. RYAN,2ANNIE K. OGASAWARA,1 JOHN VAN PEBORGH,1 AND NICHOLAS F. PAONI11Department of Cardiovascular Research and 2Department of Pathology,Genentech Incorporated, South San Francisco, California 94080