( نإلطالع ). (7) up Facts about the benefits of smoking giving 1-In 20 minutes, blood pressure and pulse rate return to normal.

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1 College of Pharmacy. Fourth Year. Clinical Pharmacy Smoking and Nicotine Replacement Therapy (NRT) Tobacco use remains the single largest preventable cause of mortality (2). Cigarette smoke is a complex mixture of an estimated 4800 compounds (3) (further reading 1). Three compounds of real clinical importance have been identified in tobacco smoke, these are: 1-Tar-based products: which have carcinogenic properties (about 43 carcinogenic compounds). 2-CO: which reduce the O2 carrying capacity of RBCs. 3-Nicotine: which produce dependence (4). Nicotine acts on the central nervous system to induce a range of ػهى انتذخ. effects such as pleasure, euphoria, relaxation, cognitive enhancement, appetite suppression, learning and memory enhancement, and reduction of anxiety and tension (3,5). Withdrawal symptoms of anxiety, difficulty in concentrating and irritability are relieved by the next cigarette (5). Nicotine is readily absorbed through the oral mucosa and the lungs. Peak blood concentrations are achieved within 30 seconds of a puff of a cigarette (6). Light and ultra light cigarettes may deliver the same amount of nicotine as regular cigarette regardless of the reported nicotine content, and are not safer than regular cigarette (13). All forms of tobacco use (pipe tobacco, cigars and hookah) have harmful effects (13). Health risks from smoking (7) Cigarette smoking substantially increases the risk of (1) Cardiovascular diseases such as stroke, sudden death, and heart attack. (2) Nonmalignant respiratory diseases including asthma and chronic obstructive pulmonary disease (COPD). (3) Lung cancer, and other cancers (e.g., mouth, pharynx, larynx, esophagus, stomach, pancreas, uterus, cervix, kidney, ureter, and bladder). In addition there are many compounds in tobacco that induce hepatic enzyme causing increase in the clearance (reduce half life) of many drugs e.g. (theophylline clearance increased by about %). Passive Smoking (second-hand smoke) Nonsmokers are affected by side-stream smoke and become passive smokers (2). There is an increased risk of lung cancer and Ischemic Heart Disease caused by passive smoking (7). Childhood asthma, middle ear diseases, sudden infant death syndrome (cot death) and other diseases are strongly linked to parent smoking (7). ( نإلطالع ). (7) up Facts about the benefits of smoking giving 1-In 20 minutes, blood pressure and pulse rate return to normal. 1 ص ذنت سز ز ت و. د: ض اء جبار ستههك انؼزاق حىان ان ه ار)أنف يه ى ( ػهبت سكائز س ى ا و فك يا مزب ي ان ه ى دوالر ىي ا

2 2-In 8 hours, CO level reduce by half and oxygen level returns to normal. 3- After: 1 day lung start to clear the mucus. 2 days, the sense of taste and smell improve 3 days, breathing become easier and bronchioles begin to relax weeks, circulation improves. 3-9 months, lung function increase by up to 10 %. 5 years, the risk of heart attack falls to half that of smoker. 10 years, the risk of lung cancer falls to half that of smoker and the risk of heart attack falls to the same as someone who never smoked. Research has shown that people who stop smoking before the age of 35 years survive about as well as lifelong non-smokers. Physiological effect of giving up (7) 1-Cough may initially worsen as ciliary's clearance begins. 2-Some people feel light headed or dizzy as the O2 supply to the brain increase. 3-Improved peripheral circulation may cause tingling in the hand and the feet. 4-Diarrhea and constipation may occur. 5-Mood swing and irritability are common. (2, 13) Theoretical Model of Smoking Cessation The essential feature of this model is the five stages of behavioral change smokers undergo before, during, and after the smoking cessation process. These stages are precontemplation, contemplation, preparation, action, and maintenance. 1-Precontemplation : During the precontemplation stage, smokers are not seriously considering smoking cessation in the next six months. They overestimate the benefits of smoking, underestimate the risks. In this stage, providing patients with awareness of the adverse effects of smoking is helpful (2). Empower patients with belief in their ability to quit (13). 2- Contemplation: during this stage patients intend to change within the next six months but have not set a quit date. They recognize that the risks of smoking outweigh the benefits. In this stage, it is important to emphasize the adverse effects of smoking to the patient (2). Provide encouragement and positive reinforcement (it is great that you are thinking about quitting. This is the first step towards success) (13). 3-Preparation: In the preparation stage, there is intent to take action within the next month, but no action has been taken at this point (2). During this stage, assistance in 2

3 moving the patient toward smoking cessation (by giving NRT) is useful (2). Help patients set quit date (ideally within the next 2 weeks) (13). 4-Action: Smokers move into this stage when they take steps to stop smoking. Interventions that prevent relapse are most effective in this stage and help reduce the high initial relapse rate. Suggest strategies to deal with craving (e.g., distraction such exercise), suggests avoiding triggers (by removing ashtrays فبػبد, lighters لذازبد ) from the home and vehicle and cleaning areas to remove the smell of smoke. Continue to provide reinforcement (13). 5-Finally, after six months in the action stage, patients move into the maintenance phase. Typically, patients are more confident in their smoking cessation and are at less risk of relapse, compared to patients in the action stage. Nicotine Replacement Therapy (NRT) Nicotine produce dependence rapidly, therefore, once plasma nicotine level fall below a threshold, patient begin to suffer nicotine withdrawal symptoms and will crave another cigarette. Treatment is therefore bases on maintaining plasma nicotine just above this threshold using NRT (4) which provide much lower doses of nicotine than are obtained by smoking and are not complicated by the additional toxic effects of tar and CO generated in tobacco smoke (1). NRT is formulated as a Gum, Lozenges, Patches, Nasal spray, Inhalator, and sublingual tablets (4). Notes : 1-Low dependency smokers (fewer than 10 cigarettes /day) who are highly motivated to give up probably do not need any kind of NRT (1). 2-There is a little difference in efficacy overall between the various forms of NRT, but a particular strength or dosage form may be best suited to a particular type of smokers (1). 3-Smokers should stop smoking completely while using any NRT product, although some products are licensed for use for smoking reduction before a quit attempt (6). (Between cigarettes to prolong the smoke-free period) (4). 4-Different NRT presentations should not be used together (6). A-Nicotine patches: 1-Transdermal patches have the convenience of a once-daily application and may be most suitable for people in whom the behavioral aspects of smoking are less important (8). All brands are available in three strengths to allow for a smooth reduction in nicotine intake. 2-The recommended starting strength is generally the highest (step 1), except for light smokers for whom the medium (step 2) strength should be used first (6). (Patients smoking more than 10 cigarettes daily begin with Step 1, and those smoking 10 or fewer daily begin with Step 2) (9). 3

4 3-The recommended treatment period and the length of time on each strength varies between Brands. The total maximum recommended course is usually 10 to 12 weeks, depending on the brand (8). 4-Used patches should be folded in half with the adhesive side inwards and disposed carefully, as they still contain enough nicotine to poison a child (8). 5-Patches should be applied on waking to dry, non hairy skin on chest, upper arm, And during application, apply firm pressure to the patch with the palm of the hand for 10 seconds to increase adhesion (4, 9). 6-The application site for the patch should be rotated daily, with each site being used only once per week to avoid skin irritation. After use, a slight redness at the site of the patch may occur. If erythema persists for more than four days, or if swelling or a rash develops at the site, the patient should be told to discontinue use of the patch and contact a health care provider (10). 7-See further reading or-24 h patches? There are two types, both changed daily: one left on for 24 hours and the other used for 16 hours (6). A 16 h patch will be suitable for most patients, however, if a patients required a cigarette within the first 20 to 30 minutes of waking then a 24-h patch should be given.if sleep disturbances are experienced with the 24-h patch then the patients can switch to a 16-h patch or alternatively remove the 24 h patch at bed time (4). B-Nicotine Gum 1-The contents of a piece of gum are intended to be released over about 30 minutes. Chewing can be a behavioral substitute for smoking so that a piece of gum is chewed whenever there is an urge to smoke (8). 2-Individuals who smoke fewer than 20 cigarettes each day should use 2-mg strength. Individuals who smoke more than 20 cigarettes each day should use the 4-mg strength (12). 3-Chewing technique and product use : See further reading 3 (3). 4- Also, patients should rinse their mouths out with water prior to using this product if they have recently consumed acidic drinks or foods (cola, fruit juices, coffee, wine, citrus fruits, tomatoes, or vinegar-containing foods), since the ph shift caused by these substances may interfere with the absorption of nicotine across the mucosal layer (10). 5-The recommended starting strengths and maximum number of pieces that can be chewed per day differ according to the brands available (8). 4

5 6-Unlike the tapering process used with patch strengths, Nicorette Gum was never tapered on the basis of the strength of the product, but on the number of pieces chewed daily (8). C-Nicotine Sublingual Tablet: 1-One sublingual tablet is bioequivalent to one piece of nicotine 2mg chewing gum, and the recommended dosage is comparable. Like lozenges, sublingual tablets may be a useful method for smokers who do not like or have difficulty in chewing gum (8). Placed under the tongue, the tablet slowly disintegrates in about 30 minutes (8). See further reading 4 D-Nicotine Lozenges(2 and 4 mg): 1-Lozenges may be preferred by those who do not like or have difficulty chewing gum, such as denture wearers (8). 2-Commit Lozenges use a different index for the initial choice. Those who smoke their first cigarette more than 30 minutes after waking should begin with the 2-mg lozenge, and those who smoke their first cigarette within 30 minutes of waking up should begin by using the 4-mg lozenge (11). يالزظخ : ثؼغ ان ز خبد نجؼغ انششكبد لذ رغزخذو زا ان م بط )يز ز ب ل ا ل ع كبسح ) زز ثبن غجخ نهؼهكخ...ك ب ا ثؼغ ان ظبدس ككزبة ال BNF ال ؼز ذ ػه زا ان م بط ا ب ػه انؼذد ك ب انسبل يغ انؼهكخ... Individuals who smoke less than 20 cigarettes each day should usually use the lowerstrength lozenges; Individuals who smoke more than 20 cigarettes each day should use the higher-strength lozenges (12). وف كم األحىال تى االػت اد ػهى ان شزة انذوائ ت انخاصت بان تج نكم شزكت 3-The lozenges should be allowed to dissolve slowly in the mouth and should occasionally be rotated to different areas in the mouth to avoid discomfort (10). 4-The lozenges typically take about 30 minutes to dissolve and should not be chewed or swallowed. Patients should follow the same guidelines regarding use of the lozenges with food and beverages as they would with nicotine gum (10). 5- See further reading 5 E-Inhalation Cartridge: 1-The device is composed of a two-part plastic mouthpiece and holder, into which is inserted a cartridge impregnated with nicotine.the inhaler is intended to address both the physical and behavioural components of smoking ( i.e. hand-to-mouth movement) as it involves putting the inhaler to the mouth, as in smoking, and inhaling as desired (1, 8). 2-It may be particularly useful for the highly behaviour-dependent smoker. The plug is flavoured with menthol, and the disappearance of the flavour indicates that the nicotine is exhausted (1, 8). See further reading 6. 5

6 F-Nicotine Nasal Spray This presentation provides a fast acting and flexible method of nicotine delivery for highly dependent smokers (more than 20 cigarettes /day) (8). Side effects, including nose and throat irritation, watering eyes and coughing, are fairly common especially in the first couple of weeks (8). See further reading 7. Cautions and contraindications (6). Note : NRT products provide much lower doses of nicotine than are obtained by smoking, are free from the toxic effects of tar and carbon monoxide, and can be supplied without prescription to people in the following risk groups: 1-Pregnant and breastfeeding women. 2-Adolescents aged years. 3-Smokers with underlying disease such as cardiovascular, hepatic and renal disease, diabetes mellitus and those taking concurrent medication. They should be used with caution in these groups. 1-Smokers with any chronic or serious skin condition should avoid patches as there is a possibility of localized skin reactions. 2-Nicotine can exacerbate symptoms of peptic ulcer or gastritis, particularly with gum or lozenges, as nicotine may enter the stomach directly. Note: Transfer of dependence from smoking to NRT products is unlikely, but possible (12). Interactions (6). Tobacco smoke reduces serum levels of a wide range of drugs and dose adjustment may be necessary when smokers have given up, particularly with theophylline, beta-blockers, adrenergic agonists, nifedipine, tricyclic antidepressants, phenothiazines, benzodiazepines and insulin. Notes 1-Electronic cigarettes: electronic cigarettes look and behave like cigarette but they contain battery powered mechanism to heat and vaporize a liquid chemical mixture composed of varying amount of nicotine, propylene glycol, and other chemicals (13). This following are 3 myths about e-cigarettes (14) A-Myth 1: e-cigarettes Are Safer than Conventional Cigarettes B-Myth 2: e-cigarettes Can Help Individuals Trying to Quit Smoking C-Myth 3: e-cigarettes Do Not Produce Harmful Secondhand Smoke 2-Varenicline (Champix Tablet) and Bupropion (Zyban tablet) are POM products for (12, 13) smoking cessation 6

References 1-Nathan A. Non-prescription medicines. 3rd edition. London: Pharmaceutical Press; 2010. 2-Geoffrey C. Wall. Therapeutic Strategies in Smoking Cessation. US pharmacist. July 2006.

fasttrack. Managing Symptoms in the Pharmacy. Pharmaceutical Press; 2008. 7-Health promotion for pharmacists, by Alison Blenkinsopp, 2 nd edition, 2003. 8- Nathan A.Aiming for a smoke-free year.

7 References 1-Nathan A. Non-prescription medicines. 3rd edition. London: Pharmaceutical Press; Geoffrey C. Wall. Therapeutic Strategies in Smoking Cessation. US pharmacist. July Handbook of Non-prescription drugs Community Pharmacy. Symptoms, Diagnosis and Treatment.By Paul Rutter and Applied therapeutics :the clinical use of drugs Nathan A. fasttrack. Managing Symptoms in the Pharmacy. Pharmaceutical Press; Health promotion for pharmacists, by Alison Blenkinsopp, 2 nd edition, Nathan A.Aiming for a smoke-free year. Chemist and Druggist 23/30 December 2006 pages: Helping Patients Quit Smoking With Nicotine Replacement Products 10-John R. White. Treating Nicotine Addiction with OTC Products. US Pharm. 2007;32(7) W.Steven Pray. Nonprescription Options for Smoking Cessation. US pharmacist Vol. No: 28:02 Posted: 2/15/03 12-BNF. 13-CPhA. CTMA: Compendium of Therapeutics for Minor Ailments E-Cigarettes: Clearing the Air. Pharmacy times Further reading 1-Approximately 500 compounds are present in the vapor phase, including carbon monoxide, ammonia, hydrogen cyanide, and benzene. The remaining constituents of tobacco smoke, including nicotine, are found in the particulate phase. The particulate fraction, excluding the nicotine and water components, is collectively referred to as tar. Numerous carcinogens have been identified in the tar fraction of tobacco smoke (3). 2-patch Example: Nicorette patches (4) :(5 mg, 10 mg, and 15 mg patches) (Releasing approximately 5mg, 10 mg or 15 mg / 16 hours respectively)) 7

Start with 15 mg patch daily for about 8 weeks-------10 mg patch for 2 weeks-------5 mg patch for 2 weeks. The NicoDerm CQ 24 h patch.

< 10 cigarettes/day: 14 mg/day x 6 weeks;-------------7 mg/day x 2 weeks. 3- Examples :Nicorette gum ( 2 mg and 4 mg) (3).

8 Start with 15 mg patch daily for about 8 weeks mg patch for 2 weeks mg patch for 2 weeks. The NicoDerm CQ 24 h patch.(7 mg, 14 mg, and 21 mg patches) (3) > 10 cigarettes/day: 21 mg/day x 6 weeks; mg/day x 2 weeks; mg/day x 2 weeks. < 10 cigarettes/day: 14 mg/day x 6 weeks; mg/day x 2 weeks. 3- Examples :Nicorette gum ( 2 mg and 4 mg) (3). 4-Example :( Nicorette 2 mg (4, 12) ) Dose: individuals smoking 20 cigarettes or less daily, sublingually, 2 mg each hour. Individuals smoking more than 20 cigarettes daily, 4 mg (i.e. 2 tablets) each hour. Max. 80 mg daily (i.e. 40 tablets); treatment should be continued for at least 3 months followed by a gradual reduction in dosage; max. Period of treatment should not exceed 6 months. Treatment should be stopped when daily consumption is reduced to 1 or 2 tablets daily. 5- A-Depending on how heavily a person smokes, one or two tablets are used per hour to an absolute maximum of 40 per day. The full dose should be maintained for three months, then gradually reduced to zero over the next three months (8). B-In a similar manner, Commit lozenges are never tapered in regard to the strength used (e.g., 2 mg versus 4 mg). Rather, the patient tapers the number of pieces used daily, in a schedule identical to that used for Nicorette Gum (1 piece of every 1-2 hours for 6 weeks; 1 every 2-4 hours for 3 weeks ; 1 every 4-8 hours for 3 weeks) (11). 6-Example Nicorette inhalator 8

9 Dose: inhale when urge to smoke occurs; initially use between 6 and 12 cartridges daily for up to 8 weeks, then reduce number of cartridges used by half over next 2 weeks and then stop altogether at end of further 2 weeks; Note 1: each cartridge lasts about 20 minutes. Note 2 :Patient with severe asthma or chronic bronchitis may find inhalation from the inhaler difficult, and should therefore avoid this product (1). 7-Example: Nicorette nasal spray (nicotine 500 micrograms/metered spray). Dose: One metered spray is inhaled into each nostril when necessary to relieve craving, with a maximum two doses per hour and 64 sprays (32 into each nostril) in 24 hours for 8 weeks, then reduce gradually over next 4 weeks (reduce by half at end of first 2 weeks, Stop altogether at end of next 2 weeks); max. Treatment length 3 months (12). لا ى يكافحت انتذخ ف انؼزاق انذي الز يجهس ان ىاب انفصم االول انتؼار ف واالهذاف وانىسائم ان بدح 1 مظذ ثبنؼجبساد انزبن خ الغشاع زا انمب ان ؼب ان ج خ اصاء ب: ا ال ان صاسح : صاسح انظسخ. ثب ب ان ص ش: ص ش انظسخ ثبنثب انزذخ : رؼبؽ ي زدبد انزجغ ثد غ أ اػ ب كبنغ دبسح انش شخ انغه. سثؼب انزذخ انغهج ا انزذخ انالاساد : ر فظ دخب رجغ االخش. خبيغب انزجغ : جبربد انزجغ ثد غ ا اػ ب اخضائ ب ي خز س ا ساق ث بس ثز س خؼشاء يدففخ. ان بدح -2- ذف زا انمب إن ز ب خ األشخبص ي أخطبس انزذخ انظس خ انج ئ خ االلزظبد خ االخز بػ خ رمه م غجخ ان ذخ ي خالل ػغ يؼب ش ن كبفسخ انزذخ. ان بدح -3- رز ن ان صاسح ثبنز غ ك يغ ان صاساد اند بد ر اد انؼاللخ رسم ك أ ذاف زا انمب ثبن عبئم ا ر خ: أ ال رؼ ان ب ح انذساع خ انجشايح انزؼه خ انزشث خ ث اد رج يد م األػشاس ان زشرجخ ػه انزذخ خط سر ػه ان ذخ غ ش ان ذخ. ثب ب البيخ انجشايح انزثم ف خ ثشايح انز ػ خ انذ س خ ف ان ؤعغبد انزؼه خ انزشث خ د س انؼجبدح ان ؤعغبد انظس خ انثمبف خ ف عبئم االػالو ان خزهفخ ػ اػشاس انزذخ ف اؽبس خطخ ؽ خ ع خ. ثبنثب ؽجغ ر ص غ يهظمبد ي غ انزذخ انزسز ش ي اػشاس ف االيبك انؼبيخ ان سظ س انزذخ ف ب. ساثؼب ر ظ ى ثشايح ر ػ خ نه ضاسػ نضساػخ يسبط م يف ذح نه دز غ ثذال ي صساػخ انزجغ. انفصم انثا حظز انتذخ ف األياك انؼايت ان بدح 4 غ انزذخ ف االيبك انؼبيخ االر خ : ا ال- داخم يجب ان آد انشئبع خ ان صاساد انذ ائش ان ؤعغبد انزؼه خ انزشث خ انظس خ ان طبساد انششكبد ان ظب غ ف ان سبفظبد كبفخ. ثب ب- ان غبسذ د س انؼشع انف بدق ان اد ان طبػى لبػبد االخز بػبد ان بعجبد يكبرت انؼ م األع اق انزدبس خ. ثبنثب عبئؾ ان مم انؼبو انخبص اند بػ خ انجش خ انجسش خ اند خ ف انشزالد انذاخه خ انخبسخ خ. ساثؼب يسطبد ان ل د كبفخ. ان بدح 5 رخظض ي الغ خبطخ نهزذخ ف االيبك ان ظ ص ػه ب ف انج ذ )ا ال( )ثب ب( ي ان بدح )4( ي زا انمب ث اطفبد رسذد ب رهك اند بد ثؼ ذا ػ ر اخذ غ ش ان ذخ ان بدح 6 ا ال أ غ انزش ح نهزذخ ثظ سح يجبششح ا غ ش يجبششح. ة غش زكى انفمشح ( أ ) ي زا انج ذ ػه عبئم االػالو ان شئ خ ان غ ػخ ان مش ءح ان ؤعغبد انثمبف خ انش بػ خ د س ان شش انز ص غ يكبرت انذػب خ االػال. ثب ب غ انظغ ش انسذس ي انزذخ ا ي بسعخ ي خ ث غ ششاء انزجغ يشزمبر. 9

10 ػه ان سالد انز ر بسط ث غ انغكبئش ا انزجغ ػغ ن زبد رزؼ انزسز ش انظس ف يكب ثبسص. ثبنثب ان بدح 7 غ ط غ رذا ل اعز شاد شؼبساد ي زدبد انزجغ يشزمبر ػه ي زدبد اخش كبنمجؼبد انم ظب االك بط ان ظالد ا ال االشبساد ان ش س خ انالفزبد انذػبئ خ ث خزهف ا اػ ب. غ ؽالء أ خضء ي عبئؾ ان مم ا اندذسا ا اندغ س ث ب شيض ال ع ي ا اع انزذخ. ثب ب رم و انششكبد ان ظ ؼخ ان غز سدح ثبصانخ انذػب خ ان ظ ص ػه ب ف انج ذ )ا ال( ي ز ان بدح خالل يذح ال رض ذ ػه )6( عزخ ثبنثب اش ش ي ربس خ فبر زا انمب. ر ثم دػب خ نهزذخ. غ اعز شاد ا رظ غ يمهذاد ي زدبد انزجغ ا أ ي اد ان بدح 8 انفصم انثانث حظز است زاد وتص غ وب غ انتبغ ان بدح 9 ا ال سظش اعز شاد ا ث غ ا رظ غ أ ع ي أ اع انزجغ ا ي زدبر رض ذ غجخ ان ك ر ف ػ )1.8( يهغى انمطشا ػ )12( يهغى ث بء ػه رمش ش طبدس ػ خ بص انزم ظ انغ طشح ان ػ خ. ثب ب رز ن ان صاسح ػغ ي اطفبد دل مخ نهزظ غ االعز شاد ثزؼه بد رظذس ب ن زا انغشع رؼ رخف غ اػشاس انزذخ رز ن ثبنز غ ك يغ اند بد ان ؼ خ انشلبثخ ػه ر ف ز ب. ثبنثب رز ن صاسح انزدبسح اطذاس اخبصاد اعز شاد انزجغ ي زدبر نهسذ ي االعز شاد ان خبنف نهسذ االد ي انشش ؽ ان سذدح ن اطفبد اعز شاد ز ان بدح. ساثؼب رز ن انششكبد ان ظ ؼخ ان غز سدح رشر ت ا ػبػ ب ي زدبر ب فك ان اطفبد ان ظ ص ػه ب ف انج ذ )ثب ب( ي ز ان بدح خالل )6( عزخ اش ش ي ربس خ فبر زا انمب. ان بدح 11 ا ال- ػه اند خ ان ظ ؼخ ػغ رسز شاد طس خ يكز ثخ ثبنهغز انؼشث خ انكشد خ رسز شاد طس خ ط س خ ػه ػهت ي زدبد انزجغ ان ظ ؼخ يسه ب ث خزهف أ اػ ب رثج ذ غت يك بر ب. ثب ب غ اعز شاد أ ع ي ا اع ي زدبد انزجغ انز ال رس م رسز شاد طس خ ا غت ان ك ر انمطشا ان ظ ص ػه ب ف انج ذ )ا ال( ي ان بدح )9( ي زا انمب. ان بدح 11 ال د ص إػفبء ط بػبد انزجغ ي انؼشائت انشع و ال ر ر االيز بصاد ان ظ ص ػه ب ف لب االعزث بس سلى )13( نغ خ 2116 ا أ لب آخش. انفصم انزابغ انؼمىباث ان بدح 12 أ ال ؼبلت كم ي ط غ ا اعز سد ا ثبع انزجغ ا ي زدبر خالف ان اطفبد ان مشسح ث خت إزكبو زا انمب ثغشايخ ال رمم ػ ) ( خ غخ ػشش يه د بس ػشال ال رض ذ ػه ) ( خ غ يه د بس ػشال يظبدسح انك خ ان خبنفخ إرالف ب. ثب ب رغست إخبصح االعز شاد ا انزظ غ ا ث غ ي زدبد انزجغ ي لجم اند خ يب سخ األخبصح ف زبنخ ركشاس ان خبنفخ ثبإلػبفخ ان انغشايخ ان ظ ص ػه ب ف انج ذ ا ال ي ز ان بدح. ان بدح 13 رظبدس أ ك خ ي انزجغ ا ي زدبر رذخم أساػ خ س خ انؼشاق ثظ سح غ ش لب خ ؼبلت انشخض ان شة ثغشايخ ال رمم ػ ) ( خ غ يه د بس ػشال ال رض ذ ػه ) ( يئخ يه د بس ػشال يغ ػذو اإلخالل ثؤ ػم ثخ اشذ ر ض ػه ب انم ا ان بفزح. ان بدح 14 رؼبلت عبئم االػالو انثمبفخ د س ان شش انظسف ان دالد ان طبثغ يكبرت انذػب خ انز رش ج نهزذخ ث ب ؤر : ا ال اإلغالق ن ذح ال رض ذ ػه )31( ثالث يب ثغشايخ ال رمم ػ ) ( خ غخ يال د بس ػشال ال رض ذ ( ( ػششح يال د بس ػشال. ثب ب اإلغالق ن ذح )61( عز يب ثغشايخ ال رمم ػ ) ( ػششح يال د بس ػشال ال رض ذ ػه ) (ػشش يه د بس ػشال ف زبنخ ركشاس ان خبنفخ ان ظ ص ػه ب ف ز ان بدح. ان بدح 15 رظبدس اػذاد انظسف ان دالد انكزت ان ششاد االخ ج خ ان خبنفخ الزكبو زا انمب غ دخ ل االػذاد انالزمخ ن ذح ال رض ذ ػه )31( ثالث يب. ان بدح 16 ؼبلت ثغشايخ ال رمم ػ )251111( يئز خ غ انف د بس ػشال ال رض ذ ػه ) ( يه د بس ػشال كم ي خبنف إزكبو انج ذ )ثبنثب( ي ان بدح )6( ي زا انمب ف زبنخ ركشاس ان خبنفخ غهك ان سم ن ذح )31( ثالث يب. ان بدح 17 ؼبلت ي ذخ ف االيبك انؼبيخ ان سذدح ف ان بدح )4( ي زا انمب ثغشايخ لذس ب )11111( ػششح االف د بس. ان بدح 18 رؼبلت اند بد ان سظ س انزذخ ف ب ان ظ ص ػه ب ف ان بدح )4( ي زا انمب ثغشايخ لذس ب )251111( يئزب خ غ انف د بس ػشال ف زبنخ ػذو رخظ ض يكب نهزذخ فمب الزكبو ان بدح )5( ي زا انمب. 11

Smoking and Nicotine Replacement Therapy (NRT) Lec:5

Smoking and Nicotine Replacement Therapy (NRT) Lec:5 Tobacco use remains the single largest preventable cause of mortality. Cigarette smoke is a complex mixture of an estimated 4800 compounds. Approximately