14 - Smoking Cessation Flashcards
What enzymes does smoking induce?
1A1, 1A2, 2E1
What are the 5 A’s?
- Ask
- Advise
- Assess
- Assist
- Arrange
What are the 5 evidence based steps required to successfully quit?
- 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
What is first line?
NRTs (patch, gum, lozenge) - 1st line for many patients because it is so accessible
How long do you use NRTs for?
8-12 weeks (can go up to 24 weeks though)
What is varenicline?
alpha4beta2 nicotinic receptor partial agonist
How does bupropion work?
aminoketone that blocks reuptake of D, NE and S
What therapy has the highest quit rates?
varenicline
What kind of boxed warnings did varenicline have?
- 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
Can you combine bupropion with NRT patch?
yes
What are two other options for smoking cessation?
- clonidine
- nortriptyline
points about clonidine?
good for those with HTN, must be tapered to prevent rebound HTN
points about nortriptyline?
used when 1st line therapies are either unaffordable or have not worked
What is the NHP that can be used for smoking cessation?
cytisine
Describe cytisine
NHP, partial nicotine agonist that demonstrated efficacy over placebo
Limitations of cytisine
- 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
Describe smoking cessation in pregnancy
- 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
Can you use varenicline in pregnancy?
prob shouldn’t - data about varenicline in pregnancy is limited
If pregnant ppl use the patch, remove at ______
night
How does smoking affect breastfeeding?
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
Can you use pharmacological therapies in breastfeeding?
NRT and bupropion may be used if benefits outweigh the risk
Can you use varenicline in breastfeeding?
no published safety data for varenicline and breastfeeding mothers
Key points for breastfeeding mothers who smoke
- 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
Avoid bupropion in severe _____ dysfunction
hepatic
Bupropion and Champix - start ____ weeks before quit date
1-2
Varenicline has a high incidence of ____ and _____
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
How long do you use varenicline for?
- for 12 weeks usually, but can be repeated for another 12 weeks if necessary
- can also combine with NRT
Some counselling points about NRTs?
- 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
Normally the patch is started at 21mg/day. When would you start at 14mg/day?
if person has CV disease, weights < 45 kg or smokes < 1/2 pack/day
Can you use habitrol when exercising?
no, should avoid it
Which patch peaks faster than the other?
Nicoderm peaks faster than Habitrol
When do you start the patch?
on the quit date
What are the 5 R’s of motivational interviewing?
- Relevance
- Risks
- Rewards
- Roadblocks
- Repetition
