Brainscape's Knowledge GenomeTM

Browse over 1 million classes created by top students, professors, publishers, and experts.


See full index

Self Care > 1- Tobacco Cessation > Flashcards

1- Tobacco Cessation Flashcards

1
Q

Describe nicotine absorption at buccal (oral) mucosa

A

pH in mouth is 7.0, in acidic media (ionized -> poorly absorbed) and alkaline (nonionized -> well absorbed) so cigs are poorly absorbed in oral mucosa and pipes, cigar, spit tobacco, and oral nicotine are well absorbed

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
2
Q

Describe nicotine absorption at the skin and GI tract

A

nicotine is readily absorbed through intact skin, well absorbed through the GI but low bioavailability due to first pass metabolism

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
3
Q

Describe nicotine absorption at the lung

A

lung pH 7.4 and nicotine is readily absorbed, approximately 1 mg of nicotine is absorbed from each cig

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
4
Q

What effects does nicotine have on the central nervous system?

A

-pleasure
-arousal, enhanced vigilance
-improved task performance
-anxiety relief

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
5
Q

What effects does nicotine have on the cardiovascular system?

A

-increased HR
-increase cardiac output
-increased BP
-coronary vasoconstriction
-cutaneous vasoconstriction

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
6
Q

What factors contribute to tobacco use?

A

-individual
-environment
-pharmacology

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
7
Q

Describe the 2-part problem of tobacco dependence

A

-physiological (addiction) -> medication for cessation
-behavioral (habit) -> behavioral changes
treatment should address both aspects

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
8
Q

How many cigs are in a pack?

A

20

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
9
Q

What are non-pharmacological methods to treat tobacco cessation?

A

-cold turkey
-unassisted tapering
-assisted tapering (QuitSTART App)
-formal cessation programs
-acupuncture
-hypnotherapy
-message therapy

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
10
Q

What are the 3 FDA-approved first-line therapy options for smoking cessation?

A

-nicotine replacement therapy (NRT)= nicotine gum, patch, ect.
-psychotropics= sustained-release bupropion
-partial nicotine receptor agonist= varenicline

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
11
Q

What is the rational for use of nicotine replacement therapy (NRT)?

A

-reduces physical withdrawal from nicotine
-eliminates the immediate, reinforcing effects of nicotine by smoking
-allows patient to focus on behavioral and psychological aspects of tobacco cessation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
12
Q

What are the nicotine replacement products (NRT)?

A

-gum (nicorette)
-lozenge (nicorette)
-transdermal patch (nicoderm)
-nasal spray (nicotrol)
-inhaler (nicotrol)

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
13
Q

What are some precautions that should be considered when recommending NRT?

A

patients with underlying cardiovascular disease (recent MI (2 weeks), serious arrhythmias, serious or worsening angina) NRT could be appropriate for these patients if they are under medical supervision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
14
Q

What are the available doses of gum?

A

2 mg, 4 mg

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
15
Q

How is a dose of nicotine gum recommended to a patient?

A

-2mg = if first cig is smoked within 30 minutes
-4mg = if first cig is smoked after 30 minutes of waking up

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
16
Q

What is the dosing schedule for nicotine gum?

A

-weeks 1-6= 1 piece every 1-2 hours
-weeks 7-9= 1 piece every 2-4 hours
-weeks 10-12= 1 piece every 4-8 hours
do NOT use more than 24 pieces/day
at least 9 pieces/day needed
no food or beverage 15 mins before use or during

17
Q

Instructions for use: Nicotine Gum

A

-chew slowly
-stop chewing at the first sign of peppery taste then park it in the cheek
-resume chewing when peppery taste is gone
-resume process until taste is gone (about 30 mins)

18
Q

What are patient counseling points for nicotine gum?

A

-use at least 9 pieces a day
-chewing gum will not provide the same satisfaction as smoking
-chewing to quickly might result in lightheadedness, N/V, irritation of throat and mouth, hiccups, indigestion
-side effects: mouth soreness, hiccups, dyspepsia, jaw muscle pain

19
Q

What are the patient counseling points for nicotine lozenges?

A

-do NOT use more than 20 pieces per day
-at least 9 pieces per day for first 6 weeks
-do not chew
-do not eat or drink 15 minutes before or during
-side effects: nausea, hiccups, cough, heartburn, headache, flatulence, insomnia

20
Q

What is the dosing of nicotine patch for a patient that has >10 cigs a day?

A

-STEP 1: 21mg x 6 weeks
-STEP 2: 14 mg x 2 weeks
-STEP 3: 7mg x 2 weeks

21
Q

What is the dosing of nicotine patch for a patient <10 cigs a day?

A

-STEP 2: 14mg x 6 weeks
-STEP 3: 7mg x 2 weeks

22
Q

What are the patient counseling patient points for nicotine patch?

A

-water will not harm patch
-do not cut patches
-keep out of reach of children and pets
-remove patch for MRI
-fold sticky parts of patch into self for disposal
-side effects: mild itching, burning, tingling, vivid dreams (may wish to remove during sleep), headache
-avoid in patients with dermatologic conditions
-skin may appear red for 24h, contact doctor if lasts 4 days

23
Q

What is the dosing of nicotine nasal spray?

A

-one dose (1 mg nicotine)= 0.5mg spray in each nostril
-start with 1-2 doses per hour
-maximum dose 5 doses/hr or 40 doses/day
-best results is 8 doses a day for 6-8 weeks then taper for an additional 4-6 weeks

24
Q

What are the instructions for use of nicotine nasal spray?

A

-prime the bottle before first use
-tilt head back and breath in through mouth while administering (do NOT sniff or inhale through nose!)
-wait 2-3 minutes before blowing nose

25
Q

What are the side effects of nicotine nasal spray?

A

-hot peppery feeling in the back of throat or nose
-sneezing
-coughing
-watery eyes
-runny nose

26
Q

What is the dosing of nicotine oral inhaler?

A

-start with 6 cartridges a day during the first 3-6 weeks
-max 16 cartridges a day
-generally 1 cartridges every 1-2 hours
-therapy 3 months
-gradually reduces dose for remaining 6-12 weeks

27
Q

What are the patient counseling points for nicotine inhaler?

A

-inhale into back of throat or puff in short breaths
-cartridges depleted in about 20 mins of active puffing- does not need to be used all at once
-side effects: mild irritation of mouth or throat, cough, headache, rhinitis, dyspepsia
-do not eat or drink 15 minutes before use or during

28
Q

How is bupropion SR used for smoking cessation?

A

-non-nicotine, antidepressant, increase levels of dopamine, norepinephrine
-decrease cravings for cigs
-decrease symptoms of nicotine withdrawal

29
Q

What are the contraindications of bupropion SR?

A

-seizure disorder
-current or prior diagnosis of bulimia or anorexia nervosa
-simultaneous abrupt discontinuation of alcohol or benzodiazepines
-cocurrent MOA use(must be stopped 14 before)

30
Q

Warnings for Bupropion?

A

-neuropsychiatric symptoms and risk of suicide (changes in mood, hallucinations)
-patients with increased seizure risk

31
Q

What is the dosing of bupropion for tobacco cessation?

A

-must start 1-2 weeks before quit date
-initially 150mg every morning for 3 days then 150mg BID for 7-12 weeks

32
Q

What are the adverse effects of bupropion?

A

-insomnia
-dry mouth
-nausea
-anxiety/difficulty concentration
-constipation
-tremor
-seizures

33
Q

How does varenicline used for smoking cessation?

A

-non-nicotine, partial nicotine receptor agonist, competitively inhibits binding of nicotine
-decreased symptoms of nicotine withdraw
-blocks dopamine stimulation responsible for reinforcement and reward associated with smoking

34
Q

Warnings for Varenicline?

A

neuropsychiatric symptoms and suicide risk (changes in mood, hallucinations)

35
Q

What is the dosing of varenicline?

A

-patients must begin treatment a week before quit date to decrease side effects of medication
-day 1-3 0.5mg daily, 4-7 0.5mg BID, 8+ 1 mg BID
-quit approaches= fixed quit (1 week after starting treatment), flexible quit (quit day 8-35 days after starting treatment), gradual quit (reduce smoking by 50% every 4 weeks)

36
Q

What are the side effects of varenicline?

A

-nausea
-sleep disturbances
-headache
-constipation/flatulence
-taste alteration
-neuropsychiatric symptoms

37
Q

What are the patient counseling points for varenicline?

A

-take dose after eating with full glass of water
-if nausea or insomnia persist contact doctor
-may experience vivid, unusual dreams
-be cautious driving, drinking until you know how it effects you

38
Q

What treatment option for smoking cessation has the most evidence?

A

combination, NRT and varenicline

39
Q

Combination NRT?

A

nicotine patch + gum/lozenge/inhaler/nasal spray

Self Care (23 decks)

Brainscape helps you reach your goals faster, through stronger study habits.
© 2024 Bold Learning Solutions. Terms and Conditions