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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_5536_Библиотеки_им_академика_М_И_Перельмана.pdf
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- •EDITORIAL BOARD
- •TABLE OF CONTENTS
- •Glossary of Selected Terms
- •Preface
- •Introduction
- •Basic concept of Drug Related Health Issues
- •Definitions of Drug and Alcohol Problems
- •Overview of Alcohol
- •References
- •Introduction
- •Alcohol Intoxication
- •References
- •Introduction
- •Basic Concept of Tobacco
- •Pharmacology
- •Chronic System Toxicity
- •Smoking Cessation Strategies
- •References
- •Introduction
- •Overview on Cannabis
- •Pharmacology
- •Amphetamines
- •References
- •Introduction
- •History of Drug Addiction and Drug Abuse
- •What is Drug Abuse and Addiction?
- •What does a Drug and Alcohol Abuse Counselor do?
- •Alcohol Abuse Careers
- •Drug and Alcohol Worker
- •References
- •Index

Tobacco
the body perceives pleasure. These effects of drug addiction are because the drug
repeatedly floods the brain with the chemicals dopamine and serotonin during drug
use. The brain adapts and comes to expect, and depend on, these drug-induces highs.
Physical effects of drug addiction are also seen in babies of drug abusers as well as
in mortality statistics. One effect of drug addiction is: children born to drug-using
mothers can be cognitively affected throughout life. Regarding mortality, one-infour deaths are due to the effects of drug addiction.
addiction include:
■ Contraction of HIV, hepatitis and other illnesses
■ Heart rate irregularities, heart attack
■ Respiratory problems such as lung cancer, emphysema and breathing
problems
■ Abdominal pain, vomiting, constipation, diarrhea
■ Kidney and liver damage
■ Seizures, stroke, brain damage
■ Changes in appetite, body temperature and sleeping patterns
4
Other physical effects of drug
189
Acute System Effects
Acute toxicity describes the adverse effects of a substance that result either from
a single exposure or from multiple exposures in a short period of time. To be
described as acute toxicity, the adverse effects should occur within 14 days of the
administration of the substance
■ Central nervous system (CNS) — headache, insomnia, dreams
■ Gastrointestinal (GI) — nausea, vomiting, heartburn, diarrhoea
■ Musculoskeletal system (MSS) — myalgia, arthralgias L
Local Toxic Effects
These effects are mainly associated with nicotine replacement therapy (NRT):
■ sore mouth, mouth ulcers (nicotine gum)
■ local itching, erythema, burning (nicotine patches)
■ nasal irritation, sneezing, watery eyes (nicotine spray)

190
Illustrated Handbook of Drugs & Alcohol Related Health Issues
Citation: https://www.danintranet.org/media/adimg/12201.jpg
CHRONIC SYSTEM TOXICITY
Chronic toxicity is a property exhibited by toxins which can be dangerous over a
prolonged period of exposure. This is in contrast with acute toxicity, characterized
by a high level of toxicity after a single exposure. Understanding chronic toxicity is
important, because substances which appear safe may actually cause the development
of toxicity over time in organisms which are exposed to them.
There are two ways in which a substance can cause chronic toxicity. Some toxins
work by damaging the body through a series of small exposures. A classic example
is tobacco. A single cigarette is unlikely to have a toxic effect on someone, but
smoking numerous cigarettes over the course of an entire lifetime will result in
the development of toxicity. Other toxins work by lingering in the body. Radium,
for example, will persist in the bones over an extended period of time, causing
lingering health problems and chronic toxicity.
Organisms can be exposed to compounds which result in chronic toxicity in a
number of ways. Many are ingested through air, water, and food products. Others
may be absorbed, as in the case of compounds which emit harmful radiation

Tobacco
that penetrates the body or compounds which can be absorbed through the skin.
Someone working in a chemical plant, for example, might develop chronic toxicity
as a result of not wearing the appropriate safety gear and slowly absorbing low
doses of toxins over time.
Citation: http://images.wisegeek.com/drunk-woman-with-alcohol-poisoning.jpg
Some harmful substances which cause chronic toxicity can also cause acute toxicity,
if the exposure is high enough. Alcohol is an excellent example. Many of the health
problems associated with alcohol consumption are the result of chronic toxicity, with
the patient developing problems over time as a result of drinking regularly. However,
people can also develop alcohol poisoning from drinking too much alcohol too
quickly, potentially dying or becoming very ill as the result of a single exposure.
191
When compounds are researched to determine whether or not they are safe, a
chronic toxicity study may be performed. Initial research may demonstrate that the
substance does not cause acute toxicity, or that the dose required for acute toxicity
is so high that it is not a cause for concern. A chronic toxicity study can reveal
problems with long term exposure which may not be immediately evident in the
results of shorter studies. The study of toxicity as a result of prolonged exposure is
also an ongoing topic, with researchers looking for trends in the general population
and seeing if they can be traced back to specific exposures.
Physical and Chemical Characteristics of Tobacco Smoke
Tobacco smoke is a complex mixture of toxicants and the chemical properties
change rapidly in some cases as smoke ages. Toxicants measured at one point in
time may not be what the smoker actually experiences. It is estimated that there are
more than 2,000 chemical constituents of tobacco. Almost twice that number results
when tobacco is burned incompletely during smoking. Three kinds of smoke can be
described, each differing in terms of toxicant concentration, size of particles, effects
of temperature, and a host of other characteristics. Mainstream smoke (MS) is what
emerges from the “mouth” or butt end of a puffed cigarette. Sidestream smoke (SS)

192
is what arises from the lit end of a cigarette, mostly between puffs. Environmental
tobacco smoke (ETS), smoke present in air, consists of exhaled mainstream smoke
and sidestream smoke.
Illustrated Handbook of Drugs & Alcohol Related Health Issues
Citation: http://physrev.physiology.org/content/physrev/89/2/649/F2.large.jpg
Smoking machines are used to analyze mainstream smoke. A set of parameters has
been agreed on by various international organizations. These parameters are 35-cm3
puff volume, 2-second puff duration, once per minute puff interval, and smoking
to a butt length of 23 mm for nonfiltered or 3 mm above the filter overlap for
filter-tipped cigarettes. The “yields” of toxicants in the MS are frequently reported
by the standard-setting organization. The two most well known organizations are
the U.S. Federal Trade Commission (FTC) and the International Organization of
Standardization (ISO).
Mainstream smoke is pulled through the mouth end of the cigarette and then
through a “Cambridge filter pad.” Aerosol particles in the smoke larger than 1 µm
in diameter are trapped with 99% efficiency. The material is referred to as cigarette
smoke condensate or total particulate matter (TPM). “Tar” is the weight of TPM minus
nicotine and water. The material that passes through the filter pad is the gas or
vapor phase of cigarette smoke. In general, the vapor phase consists predominantly
of compounds with a molecular weight <60 and the particulate phase consists of
compounds with a molecular weight >200.

Tobacco
193
Citation: http://images.wisegeek.com/man-in-suit-smoking.jpg
The yields of MS increase with successive puffs as the cigarette is machine-smoked
due to the decrease in filtration provided by the cigarette rod itself. However,
smoking behavior studies coupled with yield measurements suggest that yields remain
consistent from first puff to last when assessed under real-life smoking conditions.
When tobacco is heated, moisture and volatile material are distilled, and combustion
leads to the generation of volatile gases and the residual, carbonized char. Char
reacts with oxygen in the air during puffing and smoldering, producing volatile
gases (carbon dioxide, carbon monoxide, and water) and the inorganic material
known as ash.
The highest temperature reached during the burning of tobacco is approximately
800°C in the center of the burning zone during smolder. During puff, a solid-phase
temperature of approximately 910°C is reached at the burning zone periphery,
while the gas temperatures are lower. They vary between 600 and 700°C as
the puff progresses. After the puff ends, solid-phase temperatures rapidly cool to
approximately 600°C. This greatly influences particle formation, particle size, and
toxicant formation. These temperatures contrast with that achieved with a newly
marketed cigarette-like device, Eclipse, that combusts differently than conventional
cigarettes and aerosolizes nicotine and glycerin.
The chemical nature of MS changes as smoke ages. The burning zone generates
a highly concentrated vapor that is drawn down the cigarette to form mainstream
smoke. The vapor cools quickly due to diluting air. Less volatile compounds quickly
condense, mostly in airborne state. A combination of physical size and concentration
affects both thermal and mechanical properties, which influence the number of

194
particles in smoke. Droplets of less than about 0.1 µm will attach to the tobacco
through which they pass or to other particles, which continue on into MS. Particles
with sizes around 1 µm are “filtered” out by depositing onto the tobacco surface.
MS is a highly concentrated aerosol mixture. Smoke particles are liquid, consisting
of approximately 20% water by volume. The particles vary from less than 0.1 to
1.0-µm diameter. The small size and high concentration promote rapid coagulation,
leading to decreased concentration and increased size of the resulting particles
within less than a second. The size of particles also increases due to absorption of
water, which is relevant for human smoking because of the high relative humidity
of the human respiratory tract.
Sidestream smoke particles are smaller than MS particles initially. However, the
aging of SS over a few minutes leads to an increase in particle size of ETS due to
coagulation of particles and removal of smaller particles that attach to surfaces in
the environment. Particle size in smoke is important, because it influences where
within the respiratory tract a toxicant is deposited. Smaller particles, in general,
deposit further down into the lungs.
Inhaled particles of the size found in tobacco smoke would be predicted to deposit
mainly in the alveolar region of the lung. However, cigarette smoke-induced
tumors are more prevalent in the bronchial region, suggesting that smoke particles
deposit higher up in the respiratory tract than would be predicted from the initial
particle size. (Recent increases of adenocarcinomas in lower airways of smokers are
hypothesized to be due to so-called smoking compensation of low-yield products.
Illustrated Handbook of Drugs & Alcohol Related Health Issues
What’s in a Cigarette & Disease: Chemicals, Cancer and Heart Disease
The main ingredient in cigarettes is tobacco. Tobacco is a green, leafy plant that
is grown in warm climates. Farmers use many chemicals to grow tobacco. They
use fertilizers to make the soil rich and insecticides to kill the insects that eat the
tobacco plant.
After the tobacco plants are picked, they are dried, and machines break up the
leaves into small pieces. Artificial flavorings and other chemicals are added. Some
chemicals are put in cigarettes to keep them burning; otherwise, they would go out.
There are over 4,000 chemicals in cigarettes. 51 of them are known to be carcinogenic.
A carcinogen is something that causes cancer. Cancer is a disease that often kills
those who have it. There are many types of cancer: breast, lung, larynx, stomach,
prostrate, kidney, leukemia (cancer of the blood), etc. In all kinds of cancer, the
cells keep dividing and forming new, abnormal cells. These cells are not normal
or healthy.
Our bodies are made up of thousands of cells. In a healthy person, new cells are
made only when the body needs them. In a person with cancer, the abnormal cells
destroy the normal cells, invading them like an army. If cells divide when new cells
are not needed, a growth or hard mass forms. It could be small like a pea or large

Tobacco
195
like a grapefruit. A cancerous growth is called a malignant tumor.
Cancer usually kills a person when it spreads to other parts of the body. Sometimes
cancer cells break away from a malignant tumor and find their way into the
bloodstream. They travel to another part of the body or organ like a kidney or
lung. There they start multiplying and dividing and form new cancerous tumors.
For example, if a woman who has a malignant tumor in her breast does not have
it removed while it is small, part of the tumor might break away and go into her
bloodstream. From there it may travel to her brain and give her brain cancer.
Chemicals in cigarettes and cigarette smoke are known to cause not only cancer
but also other serious health problems. Many of the chemicals are poisonous. If a
person ate one pack of cigarettes, he/she would die.
Familiar Chemicals in Cigarettes
Chemical Found in:
carbon
monoxide
nicotine bug sprays
tar material to make roads
arsenic rat poison
ammonia cleaning products
hydrogen
cyanide
cyanide deadly poison
acetone nail polish remover
butane cigarette lighter fluid
DDT insecticides
formaldehyde to preserve dead bodies
sulfuric acid car batteries
cadmium used to recharge batteries
freon damages earth’s ozone layer
geranic acid a fragrance
methoprene a pesticide
maltitol a sweetener not permitted to
car exhaust
gas chamber poison
be used in foods in the U.S.
hree of the most widely known chemicals are nicotine, tar, and carbon monoxide.
Nicotine is a strong poisonous drug. It is the main ingredient in insecticides or bug
sprays. In its pure form, just one drop on a person’s tongue would kill him/her.
Tar is the oily material which remains after tobacco passes through the filter. When
a smoker inhales, a lot of the tar sticks to and blackens the lungs.

196
Carbon monoxide is a poisonous gas. A smoker inhales this gas which is also found in
the exhaust of a car. This gas interferes with our respiratory (breathing) and circulatory
(heart, arteries, and veins) systems. When we breathe in air through our nose and mouth,
the air passes down the windpipe (trachea) and bronchial tubes into the lungs. The cilia
which are made up of small hairs and mucous (a sticky fluid also found in the nose) help
to clean this air as it moves down and into the lungs. The cilia remove small pieces of
dirt, dust, and germs.
Illustrated Handbook of Drugs & Alcohol Related Health Issues
Citation: http://healthliteracy.worlded.org/docs/tobacco/Unit4/1whats_in.html
We each have two lungs. They are protected by the ribs and separated by the heart.
In a healthy nonsmoker, the lungs are made up of soft, spongy, pinkish-gray tissue.

Tobacco
197
Citation: http://healthliteracy.worlded.org/docs/tobacco/Unit4/1whats_in.html
The lungs also have hundreds of air sacs that fill with air when we inhale or breathe
in. They are elastic like rubber bands.
One of the jobs of the lungs is to take oxygen in from the air. This oxygen is carried
in the blood to the heart. The heart pumps the oxygen rich blood throughout the
body by arteries. Arteries are large tubes with thick, strong walls. Oxygen is used
by all cells of the body to do their work.
The lungs also must get rid of carbon dioxide which is the waste product of the
cells’ work. When we exhale, breathe out, we are getting rid of the carbon dioxide
from the body.
When a person smokes cigarettes, the carbon monoxide in the smoke gets into
his/her blood stream. This reduces the amount of oxygen going to the heart. In
addition, the chemicals in cigarette smoke narrow the walls of the arteries. With
less oxygen passing through the arteries, the heart must work harder. Blood pressure
also goes up.

198
Illustrated Handbook of Drugs & Alcohol Related Health Issues
Citation: http://healthliteracy.worlded.org/docs/tobacco/Unit4/1whats_in.html
The result is that the heart may not receive enough oxygen rich blood. When this
happens, the heart may stop beating, and part or all of the heart muscle may die.
This is called a heart attack or coronary arrest. If a large enough part of the heart
muscle stops working, the person dies.
Cardiovascular Disease
Cerebrovascular disease (CVD) is a family of medical conditions which concern
the supply of blood to the brain. The presence of an uninterrupted blood supply is
critical for brain function, so cerebrovascular disease is a cause for major concern
when it manifests. Conditions which interfere with blood supply to the brain
can be identified and addressed in a number of ways. Elderly people, smokers,
diabetics, and people with high blood pressure are all at increased risk of developing
cerebrovascular disease.
For people who know their Latin roots, this medical term can be recognized by
its parts: “cerebro” refers to the brain, while “vascular” refers to veins and blood
vessels. CVD includes conditions which effect the supply of blood to the brain,
and the blood supply within the brain. Left untreated, a cerebrovascular condition
can lead to a stroke or aneurysm, which could cause brain damage or even death,
depending on the location and the severity of the event.
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