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PEBC > 14 - Smoking Cessation > Flashcards

14 - Smoking Cessation Flashcards

1
Q

What enzymes does smoking induce?

A

1A1, 1A2, 2E1

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2
Q

What are the 5 A’s?

A
  • Ask
  • Advise
  • Assess
  • Assist
  • Arrange
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3
Q

What are the 5 evidence based steps required to successfully quit?

A
  • Setting a target quit date
  • Getting professional help
  • Enlisting social support
  • Using medication to quit smoking
  • Using problem-solving methods of counselling to quit and remain smoke-free
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4
Q

What is first line?

A

NRTs (patch, gum, lozenge) - 1st line for many patients because it is so accessible

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5
Q

How long do you use NRTs for?

A

8-12 weeks (can go up to 24 weeks though)

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6
Q

What is varenicline?

A

alpha4beta2 nicotinic receptor partial agonist

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7
Q

How does bupropion work?

A

aminoketone that blocks reuptake of D, NE and S

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8
Q

What therapy has the highest quit rates?

A

varenicline

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9
Q

What kind of boxed warnings did varenicline have?

A
  • boxed warnings for patients with thoughts of harm to self or others
  • caution for those with past or current psych illness and those with CV concerns
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10
Q

Can you combine bupropion with NRT patch?

A

yes

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11
Q

What are two other options for smoking cessation?

A
  • clonidine

- nortriptyline

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12
Q

points about clonidine?

A

good for those with HTN, must be tapered to prevent rebound HTN

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13
Q

points about nortriptyline?

A

used when 1st line therapies are either unaffordable or have not worked

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14
Q

What is the NHP that can be used for smoking cessation?

A

cytisine

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15
Q

Describe cytisine

A

NHP, partial nicotine agonist that demonstrated efficacy over placebo

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16
Q

Limitations of cytisine

A
  • multiple daily doses (9mg/day in 6 doses then gradually tapered until 1.5mg is achieved)
  • set quit date on day 5 after starting therapy
17
Q

Describe smoking cessation in pregnancy

A
  • non-pharms first
  • then low-dose short acting NRT (ex. gum)
  • bupropion may be used (use in pregnancy has not been associated w higher risk of congenital malformations)

Bottom Line: NRTs prob not safe in pregnancy but are safer than smoking

18
Q

Can you use varenicline in pregnancy?

A

prob shouldn’t - data about varenicline in pregnancy is limited

19
Q

If pregnant ppl use the patch, remove at ______

A

night

20
Q

How does smoking affect breastfeeding?

A

smoking reduces production and quality of milk, but amount of nicotine exposure to baby is minimal and overall benefits of breastfeeding outweigh risks of continued smoking

21
Q

Can you use pharmacological therapies in breastfeeding?

A

NRT and bupropion may be used if benefits outweigh the risk

22
Q

Can you use varenicline in breastfeeding?

A

no published safety data for varenicline and breastfeeding mothers

23
Q

Key points for breastfeeding mothers who smoke

A
  • non-pharms first
  • try NRT and buproprion if needed
  • try not to use NRT/smoke right before or during breastfeeding
  • change clothes, frequent handwashing
  • don’t smoke around the baby or in the house
24
Q

Avoid bupropion in severe _____ dysfunction

A

hepatic

25
Q

Bupropion and Champix - start ____ weeks before quit date

A

1-2

26
Q

Varenicline has a high incidence of ____ and _____

A

nausea and insomnia

  • tell patients to take with food and a full glass of water for nausea
  • take 2nd daily dose at suppertime if insomnia is bad
27
Q

How long do you use varenicline for?

A
  • for 12 weeks usually, but can be repeated for another 12 weeks if necessary
  • can also combine with NRT
28
Q

Some counselling points about NRTs?

A
  • avoid coffee or acidic substances while in mouth and 15 mins before
  • inhaler is absorbed buccally, not through the lungs (don’t use for more than 6 months)
  • Quick mist spray has to be primed
  • Gum = bite bite park (Max 20 pieces/day for no more than 12 months
29
Q

Normally the patch is started at 21mg/day. When would you start at 14mg/day?

A

if person has CV disease, weights < 45 kg or smokes < 1/2 pack/day

30
Q

Can you use habitrol when exercising?

A

no, should avoid it

31
Q

Which patch peaks faster than the other?

A

Nicoderm peaks faster than Habitrol

32
Q

When do you start the patch?

A

on the quit date

33
Q

What are the 5 R’s of motivational interviewing?

A
  • Relevance
  • Risks
  • Rewards
  • Roadblocks
  • Repetition

PEBC (130 decks)

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