Quit Smoking Now or Suffer the Consequences

JULY 26, 2016
An estimated 40 million adults currently smoke cigarettes in the United States, according to the CDC. Cigarette smoking is the top cause of preventable disease and death, accounting for more than 480,000 US deaths per year, or 1 in every 5 deaths.
The starting age for smoking is getting lower and lower, with more than 3200 individuals younger than 18 years having their first cigarette. Of those kids, 2100 of them become daily smokers.
This article discusses the effects smoking has on the body and medications, and it outlines both nonpharmacological and OTC pharmacological smoking cessation options.

Cigarette prices are increasing with demand as more and more individuals in the United States continue to smoke, causing harm to not only themselves, but also those around them. Cigarette smoke contains about 4800 compounds, including the addictive substance nicotine. Nicotine induces psychoactive effects by stimulating dopamine in the midbrain immediately after inhalation, which causes a rewarding sensation that leaves individuals wanting more. After a few uses, tobacco dependence develops, leading the individual to use even more.

How Smoking Affects the Body
Your patients might not realize smoking contributes to many health conditions. It doesn’t merely damage the lungs; it also can wreak havoc on multiple body parts and systems.
For instance, cigarette smokers have a higher risk of developing cardiovascular disease. When someone smokes a cigarette,  blood pressure rises immediately. High blood pressure stretches out the arteries, which in turn leads to scarring. Bad cholesterol then gets stuck in the scar tissue in combination with white blood cells, leading to the formation of clots.
According to the American Heart Association, smoking also contributes to the buildup of fatty substances in the arteries and increases stroke risk. Smoking increases the strain on both the arteries and veins, which further raises the risk of an aortic aneurism. Smokers will likely see a decline in their good cholesterol, find exercising extremely difficult, suffer from slow and poor wound healing, and possibly even die 10 years sooner than they might if they were nonsmokers.

Smoking not only damages the heart, but is also the leading cause of cancer and related death. Long-term cigarette smoking can cause cancers of the lung, bladder, esophagus, mouth, larynx, kidney, throat, liver, stomach, pancreas, cervix, rectum, and colon, as well as acute myeloid leukemia, which is a cancer in the bone marrow. Another little-known fact is that smoking cigarettes makes it harder for women to get pregnant. Moreover, if a woman gets pregnant and continues to smoke, she’s at greater risk of a having a miscarriage, ectopic pregnancy, baby with a low birth weight or cleft lip/palate, or early delivery. Men’s reproductive health is also affected by smoking, which plays a part in sexual dysfunction, leading to increased risk of erectile dysfunction.

How Smoking Affects Medications
Some chemicals contained in cigarettes induce liver enzymes. For instance, polycyclic aromatic hydrocarbons are products of incomplete combustion and potent inducers of liver cytochrome P-450 isoenzymes 1A1, 1A2, and to a lesser degree 2E1. Cigarettes contain several other compounds that interact with these enzymes, like nicotine, benzene, and acetone, although their effects are far less significant.
Many medications are substrates for the hepatic enzyme CYP1A2, and their metabolism can be induced by smoking, which will result in a significant decrease in the medication’s effect. Consequently, many smokers require larger doses of medications. Furthermore, individuals often don’t admit to smoking when asked during a physical examination or office visit, which could mean they’re not receiving the adequate dosage of the medications they need.

One example of a common medication affected by smoking is insulin. Smoking decreases subcutaneous absorption and can lead to insulin resistance, requiring the patient to take a higher dosage. Another common prescription medication hampered by cigarette smoking is any oral contraceptive, as heavy smoking (eg, more than 15 cigarettes a day) increases the risk of stroke, myocardial infarction, and thromboembolism. Smoking cigarettes also tends to lower the effects of many opioids, leaving patients prescribed routine doses still in pain. Several of these medications would need their doses reduced if the patient were to quit smoking in order to avoid toxicity, so it’s very important to track your patients’ smoking behaviors.

Shelby Leheny, Pharm D, B.S
Shelby Leheny, Pharm D, B.S
Shelby Leheny received her Doctor of Pharmacy Degree from Lake Erie College of Osteopathic Medicine (LECOM) and her Bachelor's of Science degree at the University of Pittsburgh. She is a pharmacist at CVS.