Nicotine + anemia

smoking death

major risk COPD, about 1/3 cardio, ½ lung cancer/pulm each,

smoking consequences

increased infect,diabetes, fractures,ulcers, reproductive, pneumonia

nicotine absopotion

weak base, 1mg in 10-20sec

withdrawal timeline

start 1-2 days, resolve in 4 wks except cravings,appetite,weight

5As

Ask, advise to quit, assess willing, assist, arrange follow-up

Precontemplation

NOt ready to quit in a month, risk reward, roadblock, relevance, repeat

Contemplation

Thinking to quit in a month, assess current history

contraind nrt

recent mi, arrythmia,angina

nicotine gum-20min to peak threshold

25cig or in first 30 min = 4mg, prefer min 9

nicotine gum dosing

q1-2 hr for first 6 wk, then2-4h, then 4-8h max 24 per day

lozenge, min 9

can cause heartburn, hiccup, nausea, headache, max 20 daily

nicotrol 1 dose = 2 spray

1-2 dose per hour, up to 5 hourly, don’t sniff or inhale

patch side effects - can use 16hr

insomnia, vivid dreams, skin reactions (use hydrocortisone)

patch contraindicate

recent mi, liver impairment

chantix

partial nic receptor ag, causes nv, insomnia, abnormal dreams

chantix dosing

start 1week before quit or 8-35 days or 50/25 taper in weeks 4 + 8

zyban contraind

seizure, eating disorder, maoi, no effect by week 7

anemia definition

decreased hb/rbc, <13 male, <12 fem

iron def risks

adolescent girls, preg, <2, >65

iron def cause

decrease absorb, increased need or loss

iron symptoms

tongue pain, pica, spoon nails, decreased saliva, hair loss

IDA labs

all low except tibc, ferritin starred

Taking iron

empty stomach or every other day or with vit c

drugs that decrease iron absorb

ppi, cyclines, pepcid, cholestyramine, antacid

drugs reduced by iron

dopa, synthroid, cipro, penicillamine

dont take food with iron

calcium, tea, cereal

b12/folic risks (folic has drugs)

vegan, alcohol, carb diet, metofmin, ppi, loss of IF

b12 issues

parasthesia, neuro stuff

ida peds

no cows milk before 12m, limit 24oz daily