rawatan nikotine

download rawatan nikotine

of 161

Transcript of rawatan nikotine

  • 7/28/2019 rawatan nikotine

    1/161

    Rawatan,Pemulihan

    Penagihan nikotin Oleh:

    Dr Izani Uzair bin Zubair Ketua Penolong Pengarah(Perubatan)

    Jabatan Kesihatan Negeri Pulau Pinang

  • 7/28/2019 rawatan nikotine

    2/161

  • 7/28/2019 rawatan nikotine

    3/161

  • 7/28/2019 rawatan nikotine

    4/161

    SMOKERS TRAP FOR LIFE

  • 7/28/2019 rawatan nikotine

    5/161

  • 7/28/2019 rawatan nikotine

    6/161

  • 7/28/2019 rawatan nikotine

    7/161

  • 7/28/2019 rawatan nikotine

    8/161

    Individual

    active

    passive

    preference

    dependence

    experience

    regular / irregular

  • 7/28/2019 rawatan nikotine

    9/161

    I want to do something about my smoking

    Happy smokers 30%

    Dissonant smokers, 70%

    I ncreasing dissonance

  • 7/28/2019 rawatan nikotine

    10/161

    Brief Interventions - The 5A

    The essential features;

    Ask ( tanya )

    Advise ( nasihat )

    Assess ( nilai )Assist ( bantu )

    Arrange ( atur )

  • 7/28/2019 rawatan nikotine

    11/161

  • 7/28/2019 rawatan nikotine

    12/161

    Is smoking anADDICTION ?

    Addiction - criteria :

    Psychological and physical

    dependence

    Withdrawal ( gian )

    Compulsive drug use

  • 7/28/2019 rawatan nikotine

    13/161

    Is smoking an addiction

    A highly controlled or compulsive pattern of

    drug use

    Psychoactive or mood altering effects,involved in the pattern of drug taking :

    mood -altering , anxiety reducing

    and stimulating effects.

    Drug functioning as a reinforcer to

    strengthen behaviour and lead to further

    drug ingestion.

  • 7/28/2019 rawatan nikotine

    14/161

  • 7/28/2019 rawatan nikotine

    15/161

    EPIDIOMIOLOGY

  • 7/28/2019 rawatan nikotine

    16/161

    A heterogeneous market including one thi rd of the populat ion

    1,1 bn smokers in the world47% men

    12% women

    Consumption stable

    300 m in developed countries

    42% men

    24% women

    Consumption declining

    Smoking

    MARKET

  • 7/28/2019 rawatan nikotine

    17/161

    3 million deaths per year

    If current smoking patterns persist500 million people presently alive

    (9% of the worlds population) willbe killed by tobacco

    250 million deaths fromchildren who will start

    smoking

    250 m i l l ion deaths

    from exis t ing

    smokers

    Smok ing is the single largest preventable cause o f death and disease

    MARKET

    Tobacco causes

  • 7/28/2019 rawatan nikotine

    18/161

    Smoking Statistics (NHMS)

    1986 1996

    Overall 21.5% 24.8%

    Male 40.9% 49.2%

    Female 4.1% 3.5%Urban 19.2% 21.7%

    Rural 22.7% 28.6%

    Malay 23.7% 27.9%

    Chinese 17.7% 19.2%

    Indian 15.2% 16.2%

    Others 32.8% 32.4%

  • 7/28/2019 rawatan nikotine

    19/161

    * Number of smokers Estimates

    2000 2025

    Population 22 m 30 m

    Population ( < 15 years) 7.5m (34%) 7.2m (24%)

    Population ( > 15 years) 14.5m (66%) 22.8m (76%)Prev. adult smokers :

    Male smokers 49% 30%

    Female smokers 4% 10%Overall adult prev. 25% 20%

    Number of adult smokers 3.6 m 4.6 m

  • 7/28/2019 rawatan nikotine

    20/161

    Youth smoking statistics

    People age 18 years and < Prevalence

    1996 - 16.9%

    (male : 30.7%, female : 4.8%)1999 - 18.2%

    (males : 29%, females : 8%)

    Daily, 45 - 50 youths start to take upsmoking

    SURVEY IN SCHOOLS MALAYSIA

  • 7/28/2019 rawatan nikotine

    21/161

    SURVEY IN SCHOOLS MALAYSIA

    GLOBAL YOUTH TOBACCO SURVEY 2003

  • 7/28/2019 rawatan nikotine

    22/161

    5 principal causes of all medically

    certified deaths(Govt. Hosp.1998)

    1. Heart diseases & diseases of

    pulmonary circulation

    14.09%

    2. Septicaemia

    12.54%

    3. External causes 9.67%4. Cerebrovascular diseases

    9.36%

    5. Malignant Neoplasm

    8.91%

  • 7/28/2019 rawatan nikotine

    23/161

    HEART DISEASES

    More than 100 000 people suffer as a result of heart conditions

    in year 1998 with more than 12,000 deaths ( inclusive of privatehospital )

    Total Admission and Death of Heart

    Conditions CVD in Govt Hospital Malaysia

    (1988 - 1998)

    0

    20,000

    40,000

    60,000

    80,000

    100,000

    120,000

    1988

    1989

    1990

    1991

    1992

    1993

    1994

    1995

    1996

    1997

    1998

    Admission Deaths

  • 7/28/2019 rawatan nikotine

    24/161

  • 7/28/2019 rawatan nikotine

    25/161

  • 7/28/2019 rawatan nikotine

    26/161

  • 7/28/2019 rawatan nikotine

    27/161

  • 7/28/2019 rawatan nikotine

    28/161

    Withdrawal symptoms

    Psychic

    Craving/missingcigarettes

    Dysphoria

    Difficulties inconcentrating

    Irritability, anger,

    aggressiveness

    Drowsiness,tiredness,sleepiness

    Nervousness,tenseness, anxiety

    Vivid dreaming

    Sociability

    Restlessness

    ImpatienceInsomnia

  • 7/28/2019 rawatan nikotine

    29/161

    Withdrawal symptomsSomatic

    Sweating

    Dizziness

    Blisters/ulcersmouth and throat

    Obstipation

    Swelling of jointsand pain

    Creeping sensationsin or beneath theskin

    Tremor

    Hunger/weight gain

    Disturbed vision

  • 7/28/2019 rawatan nikotine

    30/161

    Broader useI want to cope when not

    allowed to smoke

    I want to cut down

    I want to quit completely

    STRATEGIES

  • 7/28/2019 rawatan nikotine

    31/161

    STRATEGIES

    TOTALABSTINENCE

    QUIT

    relapse

    prevention

    Cessation

    +Motivation

  • 7/28/2019 rawatan nikotine

    32/161

    TOTAL

    ABSTINENCE

    relapse

    prevention

    Cessation

    Reduction

    +

    CUT DOWN

    completereduction

    partial

    reduction

    Motivation

    QUIT

  • 7/28/2019 rawatan nikotine

    33/161

    CONTROLCRAVINGS

    TOTALABSTINENCE

    QUIT

    relapse

    prevention

    CUT DOWN

    completereduction

    partial

    reduction

    partial

    reduction

    controlledsmoking

    Temporary

    abstinence

    Cessation

    Reduction

    +Motivation

  • 7/28/2019 rawatan nikotine

    34/161

    Individuality

    active

    passive

    preference

    dependence

    experience

    regular / irregular

  • 7/28/2019 rawatan nikotine

    35/161

  • 7/28/2019 rawatan nikotine

    36/161

    REGISTRATION

  • 7/28/2019 rawatan nikotine

    37/161

    REGISTRATION

    REGISTRATION CARD

  • 7/28/2019 rawatan nikotine

    38/161

    REGISTRATION CARD

  • 7/28/2019 rawatan nikotine

    39/161

    BODY MASS INDEX

    Weight & Height

  • 7/28/2019 rawatan nikotine

    40/161

    ASSESSEMENT & CREATING INTEREST

  • 7/28/2019 rawatan nikotine

    41/161

    WHEN SMOKERS QUIT..Within 20 minutes of smoking that last cigarette,

    the body begins a series of changes

    AT 20 MINUTES AFTER QUITTINGBlood pressure decreasesPulse rate drops

    Body temperature of hands and feet increases AT 8 HOURS

    CO level in blood drops to normalO2 level in blood increases to normal

    AT 24 HOURSChance of a heart attack decreases

    AT 48 HOURSAbility to smell and taste is enhanced, nerve endings

    start

    growing

  • 7/28/2019 rawatan nikotine

    42/161

    New clue to why smokers look older

    ASSOCIATED PRESS

    March 22

    Theres a new wrinkle in the old question

    of why smokers faces are prematurelylined. A report in The Lancet medicaljournal this week suggests smoking

    switches on a gene involved indestroying collagen, the structuralprotein that gives skin its elasticity.

  • 7/28/2019 rawatan nikotine

    43/161

  • 7/28/2019 rawatan nikotine

    44/161

  • 7/28/2019 rawatan nikotine

    45/161

  • 7/28/2019 rawatan nikotine

    46/161

    ARSENIC

    Arsenic boleh menyebabkan bibir

    anda terbakar dan menyebabkan

    nafas anda berbau busuk.

    BENZOPYRENE

    Bahan ini terdapat di dalam asap

    rokok dan merupakan satu bahan kimia

    yang boleh menyebabkan kanser.

    METHOPRENE

    Bahan kimia ini digunakan di dalam

    kebanyakan racun serangga khususnya

    kntuk menghapuskan kutu.

    ACETONE

    Bahan kimia ini digunakan sebagai

    bahan utama untuk membuat

    penanggal pewarna kuku.

    LEADKeracunan atau pendedahan kepada Lead dalam

    satu tempoh masa yang panjang boleh

    menyebabkan tumbesaran terbantut. Ia juga

    boleh menyebabkan kerosakan otak.

    FORMAL DEHYDE

    Bahan kimia ini boleh menyebabkan kanser,

    merosakkan paru-paru, kulit dan sistem

    penghadaman. Ianya seringkali digunakan untuk

    mengawet mayat.

    CADMIUM

    Bahan kimia ini boleh menyebabkan

    kerosakan ginjal, hati dan otak

    PROPYLENE GLYCOL

    Bahan ini udahkan nikotin menyerap kedalam

    sistem tubuh khususnya ke otak.

  • 7/28/2019 rawatan nikotine

    47/161

    Role of Nicotine

    ACTION

    Release ofanepinephrine from

    adrenal cortex

    Fuses with

    acetylcholinen in the

    brain

    Release of dopamine

    EFFECT

    causes fatique &excitement due to

    excessive release ofglucose.

    Effect on mood,alertness

    Pleasure sensation

  • 7/28/2019 rawatan nikotine

    48/161

  • 7/28/2019 rawatan nikotine

    49/161

    SHORTNESS OF BREATH

  • 7/28/2019 rawatan nikotine

    50/161

  • 7/28/2019 rawatan nikotine

    51/161

  • 7/28/2019 rawatan nikotine

    52/161

  • 7/28/2019 rawatan nikotine

    53/161

  • 7/28/2019 rawatan nikotine

    54/161

    SVCObstruction

    Lung Cancer

  • 7/28/2019 rawatan nikotine

    55/161

  • 7/28/2019 rawatan nikotine

    56/161

  • 7/28/2019 rawatan nikotine

    57/161

    Mouth cancer

  • 7/28/2019 rawatan nikotine

    58/161

    Emphysema

    Bronchietasis

  • 7/28/2019 rawatan nikotine

    59/161

    Chronic Obstructive Airways Disease

  • 7/28/2019 rawatan nikotine

    60/161

    Peripheral

    Vascular

    Disease

  • 7/28/2019 rawatan nikotine

    61/161

  • 7/28/2019 rawatan nikotine

    62/161

  • 7/28/2019 rawatan nikotine

    63/161

    Women 'suffer more

    from smoking'November 15, 2000Web posted at: 6:13 AM EST (1113 GMT)

    LONDON, England --Women suffer more from

    smoking than men because oftheir generally smaller lungs,scientists say.Women are more vulnerablethan men to the breathingproblems and other harmfuleffects of smoking, Norwegiandoctors found during two yearsof study.

  • 7/28/2019 rawatan nikotine

    64/161

    BREAST CANCER

  • 7/28/2019 rawatan nikotine

    65/161

    CANCER CERVIKS

  • 7/28/2019 rawatan nikotine

    66/161

    abortion

    INFANT

    cacat

    Female smokers has

    risk of 3X forabortion duringpregnancy

  • 7/28/2019 rawatan nikotine

    67/161

    PREMATUREDELIVERY

    LOW BIRTHWEIGHT

  • 7/28/2019 rawatan nikotine

    68/161

  • 7/28/2019 rawatan nikotine

    69/161

    EXAMINATIONS - PHYSICAL& GENERAL IX

    TEST

  • 7/28/2019 rawatan nikotine

    70/161

    LUNG FUNCTION TEST

  • 7/28/2019 rawatan nikotine

    71/161

    LUNG FUNCTION TEST

    PULMONARY EXPIRATORY FLOW RATE

  • 7/28/2019 rawatan nikotine

    72/161

    PULMONARY EXPIRATORY FLOW RATE

  • 7/28/2019 rawatan nikotine

    73/161

    FAGERSTROM TEST

  • 7/28/2019 rawatan nikotine

    74/161

    How soon after you wake up do you

    smoke your first cigarette?

    Do you find it difficult to refrain from

    smoking in places where it is

    forbidden e.g. in church, at the library,

    in cinema, etc.?

    Which cigarette would you hate mostto give up?

    How many cigarettes do you smoke

    per day?

    Do you smoke more frequently during

    the first hours after waking thanduring the rest of the day?

    Do you smoke if you are so ill that you

    are in bed most of the day?

    1.

    2.

    3.

    4.

    5.

    6.

    Within 5 minutes

    6-30 minutes

    31-60 minutes

    After 60 minutes

    Yes

    No

    The first one in the morning?

    All others?

    10 or less

    11-20

    21-30

    31 or more

    Yes

    No

    Yes

    No

    3

    2

    1

    0

    1

    0

    1

    0

    0

    1

    2

    3

    1

    0

    1

    0

    Fagerstrms test for nicotine dependenceQuestions: Answers: (mark your alternative)

    Minimum score 0Maximum score 10Average score 4

    Total

    EXAM OF PUPILS

  • 7/28/2019 rawatan nikotine

    75/161

    EXAM OF PUPILS

  • 7/28/2019 rawatan nikotine

    76/161

    EXAM OF FLEXORS

    EXAM OF FOOT

  • 7/28/2019 rawatan nikotine

    77/161

    EXAM OF FOOT

    BURGERS DISEASE

    Chest Xray : COAD

  • 7/28/2019 rawatan nikotine

    78/161

    MRI

  • 7/28/2019 rawatan nikotine

    79/161

    Smoker Non-smoker

    C11-Nicotine

    MRI

    BLOOD PRESSURE

  • 7/28/2019 rawatan nikotine

    80/161

    BLOOD PRESSURE

    DENTAL EXAMINATION FOR

  • 7/28/2019 rawatan nikotine

    81/161

    DENTAL EXAMINATION FOR

    NICOTINE

  • 7/28/2019 rawatan nikotine

    82/161

    FITNESS TEST

    FITNESS TEST (STAMINA)

  • 7/28/2019 rawatan nikotine

    83/161

    FITNESS TEST (STAMINA)

  • 7/28/2019 rawatan nikotine

    84/161

  • 7/28/2019 rawatan nikotine

    85/161

    SMOKING SUE

  • 7/28/2019 rawatan nikotine

    86/161

    SMOKING SUE

    GENERAL INFORMATIONSPECIFIC TOWARDS SELF &

  • 7/28/2019 rawatan nikotine

    87/161

    SPECIFIC TOWARDS SELF &

    WIFE AND CHILDREN

    RISK MALES VS FEMALES

  • 7/28/2019 rawatan nikotine

    88/161

    RISK MALES VS FEMALES

  • 7/28/2019 rawatan nikotine

    89/161

  • 7/28/2019 rawatan nikotine

    90/161

  • 7/28/2019 rawatan nikotine

    91/161

  • 7/28/2019 rawatan nikotine

    92/161

  • 7/28/2019 rawatan nikotine

    93/161

  • 7/28/2019 rawatan nikotine

    94/161

  • 7/28/2019 rawatan nikotine

    95/161

  • 7/28/2019 rawatan nikotine

    96/161

  • 7/28/2019 rawatan nikotine

    97/161

    MESEJ HATI

  • 7/28/2019 rawatan nikotine

    98/161

    MESEJ HATI

  • 7/28/2019 rawatan nikotine

    99/161

  • 7/28/2019 rawatan nikotine

    100/161

  • 7/28/2019 rawatan nikotine

    101/161

  • 7/28/2019 rawatan nikotine

    102/161

  • 7/28/2019 rawatan nikotine

    103/161

  • 7/28/2019 rawatan nikotine

    104/161

  • 7/28/2019 rawatan nikotine

    105/161

  • 7/28/2019 rawatan nikotine

    106/161

    SAVINGS

    Expenditure daily

    2 box of cig RM 8.00

    Nicorette (2mg) 5 tab 0.56 X 5 2.80 Nicorette (4mg) 5 tab 0.68 X 5 3.40

    (SAVE RM 150.00 a MONTH

    RM 1800.00 YEAR

    RM 18,000.00 10 YEARS

  • 7/28/2019 rawatan nikotine

    107/161

    Nicotine Replacement Therapy

  • 7/28/2019 rawatan nikotine

    108/161

    Nicotine Replacement Therapy

    AS STIPULATED IN CLINICAL

    PRACTICE GUIDELINES OF

    MALAYSIA

  • 7/28/2019 rawatan nikotine

    109/161

    Benefi ts Toxici t iesNicot ine

  • 7/28/2019 rawatan nikotine

    110/161

    Fig.7. Benefits and toxicities of (-)-nicotine

    Nicotine

    Cognitive

    EnhancementHypothermia

    Vigilance/Antipsychotic

    Gastrointestinaldistress

    AnalgesiaRespiratory

    Paralysis

    Anxiolysis Emesis

    Neuroprotectio

    n

    Seizures

    Cerebro-vasodilation

    Hypertension

    Benefi ts Toxici t iesNicot ine

  • 7/28/2019 rawatan nikotine

    111/161

    Rawatan

    farmakologikal

  • 7/28/2019 rawatan nikotine

    112/161

    Nico t ine rep lacment therapy

    NRT GUM (Nico rette Gum )

    Flexible dosing to meet individual and

    situational needs

    Two strengths: 2mg for low- and medium-

    and 4mg for high-dependent smokers

    Some behavioral replacement (oral

    gratification)

    Good for relapse prevention

  • 7/28/2019 rawatan nikotine

    113/161

    Dosage Guide

    Allow the smoker to control how much nicotineis used, and when it is used.

    Nicorette comes in different strengths so it is

    important to prescribe the correct strength tosuit the persons individual smoking pattern.

    ALWAYS ENCOURAGE FIRST TI ME USER TO CHEW ONE

    PIECE OF THE NICORETTE GUM IN FRONT OF YOU TOENSURE THE RIGHT CHEWING TECHNIQUE IS USED.

    D G id

    http://e/CPG.ppt
  • 7/28/2019 rawatan nikotine

    114/161

    Dosage Guide

    Most people use 10-15 pieces of Nicorettegums a day.

    However, they should not chew more

    than 60mg (30 pieces of 2mg or 15 pieces

    of 4mg) in a day Nicorette should be used

    for at least 3 months before gradually

    reducing the number of pieces chewed.

    ALWAYS ENCOURAGE FIRST TI ME USER TO CHEW ONEPIECE OF THE NICORETTE GUM IN FRONT OF YOU TO

    ENSURE THE RIGHT CHEWING TECHNIQUE IS USED.

    Dosage Guide

  • 7/28/2019 rawatan nikotine

    115/161

    The level of nicotine dependence based on Fagerstrom Nicotine

    Dependence Questionnaire (FNDQ)

    Nicorette 4mg -for heavy, highly dependent smokers

    (e.g. smoke more than 25 or more cigarettes a day

    & FNDQ score 6 & above)

    Nicorette 2mg -for occasional and regular smokers of less than

    10 cigarettes or irregular smokers of 10-25

    cigarettes a day & FNDQ score below 6.

    ALWAYS ENCOURAGE FI RST TI ME USER TO CHEW ONE

    PIECE OF THE NICORETTE GUM IN FRONT OF YOU TO

    ENSURE THE RIGHT CHEWING TECHNIQUE IS USED.

    Dosage Guide

  • 7/28/2019 rawatan nikotine

    116/161

    Dosage Guide

    Nicorette gum is not an ordinary gum and should

    not be chewed in the ordinary way.

    To make sure the user get the most from their gum,

    they should follow the special Nicorette chewing technique:

    (Chew Rest Chew Technique)

    CHEW Chew Nicorette Gum slowly until taste becomes strong.

    REST Rests Nicorette Gum between the gum and cheek.

    CHEW Chew Nicorette Gum again once the taste has faded

    The process is repeated for approximately 20-30mins.

    ALWAYS ENCOURAGE F IRST TIME USER TO CHEW ONE

    PIECE OF THE N ICORETTE GUM IN FRONT OF YOU TO

    ENSURE THE RIGHT CHEWING TECHNI QUE IS USED.

    (Chew Rest Chew Technique)

  • 7/28/2019 rawatan nikotine

    117/161

    (Chew Rest Chew Technique)

  • 7/28/2019 rawatan nikotine

    118/161

    (Chew Rest Chew Technique)

  • 7/28/2019 rawatan nikotine

    119/161

    ( q )

    CHEWChew Nicorette Gum slowly

    until

    taste becomes strong.

    (Chew Rest Chew Technique)

  • 7/28/2019 rawatan nikotine

    120/161

    REST

    Rests Nicorette Gum

    between the gum and

    cheek.

  • 7/28/2019 rawatan nikotine

    121/161

    (Chew Rest Chew Technique)

  • 7/28/2019 rawatan nikotine

    122/161

    (Chew Rest Chew Technique)

    CHEWChew Nicorette Gum again

    once the taste has faded

  • 7/28/2019 rawatan nikotine

    123/161

    Park it.(slow down if

    you start feeling

    uncomfortable)

    (Chew Rest Chew Technique)

  • 7/28/2019 rawatan nikotine

    124/161

    After about 1 hour- safely discard it

    (Chew Rest Chew Technique)

    Treatment is divided into two phases:Phase One

    http://e/CPG.ppt
  • 7/28/2019 rawatan nikotine

    125/161

    - Help smokers to overcome the psychological

    dependence on Nicotine- Duration of treatment is 3 months.

    - Smokers are advice to use a fixed amount of Nicorette

    gums

    e.g. 8-10 pieces a day for 3 months.

    Phase Two

    - Help smokers to overcome the physical

    dependence on Nicotine.- Duration of treatment is 4-6 weeks.

    - Smokers are advice to reduce the intake of

    Nicorette gum gradually.

    e.g. reduce one piece each week.

  • 7/28/2019 rawatan nikotine

    126/161

    Penampal NRT

  • 7/28/2019 rawatan nikotine

    127/161

    p

    Dipakai sepanjang hari semasaterjaga.

    Rawatan sekali dalam sehari.

    Didapati dlm 3 jenis dos-5mg,10mgdan 15 mg

    Sesuai untuk tahap nikotin dari tahap

    sederhana hingga tinggi Mulakan dengan menampal 15mg dan

    seterusnya ke dos yang lebih rendah.

  • 7/28/2019 rawatan nikotine

    128/161

    Nico rette Inhaler

    Combines nicotine and behavioral

    replacement

    Flexible dosing to meet individual andsituational needs

    Good for relapse prevention

    Ni tt I h l

  • 7/28/2019 rawatan nikotine

    129/161

    Nicorette InhalerCharacteristics Unique NRT form that provides nico t ine

    saturated in air via oral inhalat ion

    As air is inhaled, it is saturated w ithvapor ised nicot ine

    Amount of nico t ine released depends on thevo lume of air pass ing through the nico t ineimpregnated-plug and the temperature

    One inhalation del ivers 13mg at RT, 10inhalat ion = 1 puff on a cigarette

    The only dosage form to add ress the phys icalas wel l as the behaviou ral dependency

    Nicorette Inhaler

  • 7/28/2019 rawatan nikotine

    130/161

    Nicorette InhalerPharmacokinetics

    Absorption occurs mainly via the buccal mucosa for

    shallow puffing and pulmonary mode for deep inhalation

    Nicotine release not affected by the inhalation technique;

    comparable Css

    T < 15oC - nicotine evaporates more slowly and need to

    inhale more frequently

    Inhaler use represents 35% nicotine substitution (within

    recommended range for replacement therapy)

  • 7/28/2019 rawatan nikotine

    131/161

    Nicorette InhalerDosage and administration The nicot ine vapour can be inhaled ad l ib i tum

    either by deep inhalat ion o r by shallow

    puf f ing Each 10 mg cartr idge provides up to 5 mg of

    nicot ine, released over 20 m ins of act ive &

    con t inuou s puf f ing

    8-2-2 ru le

    6-12 catridges for 8 weeks, then

    3-6 catridges for 2 weeks, then

    1-3 catridges for 2 weeks

    Ni tt I h l

  • 7/28/2019 rawatan nikotine

    132/161

    Nicorette Inhaler

    Safety

    No serious system ic AE

    Most common : headache, heartburn ,nausea, mou th and throat irr i tat ion

    Ni t i i t i f f t

  • 7/28/2019 rawatan nikotine

    133/161

    Keeps the weight under control

    Controls alertness

    Controls feelings

    Enhance cognitive functionEnhance mobility

    Can provoke euphoria

    Decrease smoking cravingsBlocks or decreases abstinence

    Nico t ine; posi t ive effects

    DIETITIAN

  • 7/28/2019 rawatan nikotine

    134/161

    DIETITIAN

  • 7/28/2019 rawatan nikotine

    135/161

    STRESS MANAGEMENTOCCUPATIONAL THERAPIST

  • 7/28/2019 rawatan nikotine

    136/161

    OCCUPATIONAL THERAPIST

  • 7/28/2019 rawatan nikotine

    137/161

  • 7/28/2019 rawatan nikotine

    138/161

  • 7/28/2019 rawatan nikotine

    139/161

    QUALITY INDICATORSCRITERIA QUIT

  • 7/28/2019 rawatan nikotine

    140/161

    CRITERIA QUIT

    1. URINE TEST NEGATIVE2. QUIT 6 MONTHS

    3. NON DEPENDENCE NRT

    REWARDS

  • 7/28/2019 rawatan nikotine

    141/161

    Blood Screening(4th week)

    ECG(6th week)

    CX Ray(8th week)

    Scaling & Peridontal Rx

    (Quit)

    Medical Examination

    (quit)

    REWARDS

    *ACHIEVEMENTS QUIT

    1998 2003(A )

  • 7/28/2019 rawatan nikotine

    142/161

    1998 -2003(Aug)

    22%

    33%

    43%

    50%53% 53%

    0%

    10%

    20%

    30%

    40%

    50%

    60%

    QUIT(%)

    1998 1999 2000 2001 2002 2003(Aug)

    *

  • 7/28/2019 rawatan nikotine

    143/161

    0

    50

    100

    150

    200

    250

    1998 1999 2000 2001 2002 2003

    malay

    indian

    chinese

    *

  • 7/28/2019 rawatan nikotine

    144/161

    98%

    2%

    0%

    20%

    40%

    60%

    80%

    100%

    MALE FEMALE

    *

  • 7/28/2019 rawatan nikotine

    145/161

    0%

    10%

    20%

    30%

    40%

    50%

    60%

    61

    40

  • 7/28/2019 rawatan nikotine

    146/161

  • 7/28/2019 rawatan nikotine

    147/161

    THOSE WHO

    QUITAND SMOKE

    AGAIN

  • 7/28/2019 rawatan nikotine

    148/161

  • 7/28/2019 rawatan nikotine

    149/161

  • 7/28/2019 rawatan nikotine

    150/161

  • 7/28/2019 rawatan nikotine

    151/161

  • 7/28/2019 rawatan nikotine

    152/161

  • 7/28/2019 rawatan nikotine

    153/161

  • 7/28/2019 rawatan nikotine

    154/161

    FINAL TAKEAWAY MESSAGE

    ARTICLES IN LOCAL PAPERS

  • 7/28/2019 rawatan nikotine

    155/161

  • 7/28/2019 rawatan nikotine

    156/161

  • 7/28/2019 rawatan nikotine

    157/161

  • 7/28/2019 rawatan nikotine

    158/161

  • 7/28/2019 rawatan nikotine

    159/161

  • 7/28/2019 rawatan nikotine

    160/161

    A smoke freeworld

  • 7/28/2019 rawatan nikotine

    161/161

    TERIMA KASIHTHANK YOU