1. [6]

2. * 2 ( ) : . * 2 : .^^

3. .

4. addiction

5. CEO. House Energy subcommittee in April 1994 are (from left) Robert Sprinkle III (American Tobacco), Donald Johnston (American), Thomas Sandefur Jr. (Brown and Williamson), Edward Horrigan Jr. (Liggett), Andrew Tisch (Lorillard), Joseph Taddeo (U.S. Tobacco), James Johnston (Reynolds) and William Campbell (Philip Morris). (AP Photo) All swore, under oath that nicotine was not an addictive drug!

6. 1 : 1/6 2 : 1/2

7. : 1/6 : = * : 42,000, 120 * : 17,700, 50

8. (Ramstrom LM, 1997) 1: 2: / 3: / . 4: / .

9.

10. 1. 2. 1) 2) bupropion 3)

11. : . . 97% .

12. All smokers ~70% 1 ~30% 2 ~23% 3 1. Bridgwood et al, General Household Survey 1998. 2. West, Getting serious about stopping smoking 1997. 3. Arnsten, Prim Psychiatry 1996.

13. , , () - 7 3 , 1-2 . (1) (Tolerance), - . - , . (2) (Withdrawal), - . - .

14. , (3) , (4) , . (5) ( , ), ( .), (6) , . (7) , , , .

15. , - : . - : . - : . - : , . - : , .

16. Plasma nicotine (ng/ml) 25 Cigarette 20 15 Spray 10 Gum/Inhaler/Tablet 5 Patch 0 0 10 20 30 40 Time (minutes) Adapted from: Tobacco Advisory Group of the Royal College of Physicians 2000. 50 60

17. (Nicotine Replacement Therapy, NRT) nicotine patch), (nicotine gum), (nicotine nasal spray), (nicotine inhaler), (nicotine lozenge)

18. : 6~8 24 . . . . .

19. (30%), (28.4%), (18.5%), (18.1%)

20. : 2mg - 8 . 30 .

21.

22. (bupropion, Wellbutrin) FDA

23. 8 6 150mg 1-8 150mg , 8 -15 8

24. Bupropion , (MAO inhibitor) ,

25. , , 3 , . .

26. : 19 6 (264 ) : 13 6

27. . , . , .

28. . .

29. . .

30. . ->

31. Varenicline (Champix) (Mesolimbic Dopamine System) nucleus accumbens 42 . 35

32. Nucleus Accumbens (NAcc) Ventral Tegmental Area (VTA) NIC 4 2 2 2 4 42 NIC 36

33. , ~300% . 37

34. Nucleus accumbens Foulds (2006) Int. J Clin. Prac 38

35. Partial agonist, specifically designed to bind with high affinity & selectivity to the 42 receptor So it mimics nicotine and stimulates moderate dopamine release reducing the severity of craving and withdrawal symptoms But also partially blocks the receptors so nicotine from cigs. can not stimulate the receptor 39

36. Pharmacological Properties: Steady-state reached within 4 days :~24 hours 40

37. : 5A (ask) (assess) (advise) (assist, ) (arrange follow-up)

38. Fagerstrm test for nicotine dependence 1. ? 60 31-60 5-30 5 2. ? 3. ? Classification of dependence 0-2 : Very low 10 11-20 21-30 31 3-4 : Low 5. ? 5: Moderate 6-7 : High 8-10 : Very high 6. ? 4. ? Heatherton, et al., 1991 Park, et al., 2004

39. 12 , 4 2 . ? ? ? .

40. Three Important Points: (To Drive Home) 1. Nicotine does not cause Cancer! Nicotine does not cause Heart Disease! 2. Nicotine does not cause Lung Disease! 3.

41. Smokerlyzer Micro IV CO (HbCO) CO COHb 15

42. Cotinine / Urine Test kit for Tobacco Use Nicotine 80~90% . ; cotinine, 1-N-nicotine oxide ; nicotine (2hrs), cotinine (13hrs) Heavy smoker; 304 cotinine .

43. ? , , , 36%(3 1) . !

44. ? ? -> . FDA 6 1 :

45. ? Mayo clinic , 12 3 71%, 6 58% : (26%), (24%) .

46. ? ,, , . 8 . . .

47. ? . : , . , , (, ,) .

48. ? . , , . . (FDA class : C)

49. ? ? 3, 1, 2 . ,

50. ? 11 2009 . : ,

51. (6/22) FDA : , 10 . '' '' . . FDA . FDA . . 10 305 . . 2012 1/3 FDA