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Pulmonary - Matt > 3.1.1 Smoking Cessation > Flashcards

3.1.1 Smoking Cessation Flashcards

1
Q

What is something that the whole family can enjoy?

A

Smoking

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2
Q

What type of problem is smoking?

A

Global

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3
Q

What are the smoking rates amongst males? females

A

Males: 50% Females: 10%

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4
Q

What is the estimated smoking-related mortality between 2001-2100?

A

1 billion (w/ a b)

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5
Q

What are some of the smoking related morbidities that contribute to the mortality rate?

A

Lung cancer, Ischemic heart dz, COPD, stroke, other cancers

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6
Q

What are some of the efforts to alter the current course of the projected mortality pattern?

A

Prevention effect Prevention and treatment effect

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7
Q

Smoking is a chronic disease. What dependence is associated with smoking?

A

Nicotine dependence

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8
Q

What is the half-life of nicotine?

A

2 hours

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9
Q

What system is responsible for releasing dopamine after stimulation by nicotine?

A

Mesolimbic system

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10
Q

What are some of the perceived benefits of nicotine?

A

Dopamine leading to calmness and pleasure

Suppression of appetite

Temporary improvement of cognitive and motor function

Soothe cognitive symptoms including depression, schizophrenia, ADHD

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11
Q

What are some of the symptoms of nicotine withdrawal?

A

Headache, lightheadedness, hunger cramps, sleep disturbance, stress, anxiety, cravings, irritability, poor concentration, depression

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12
Q

Why is nicotine from cigarettes absorbed so well?

A

Lung alveolar epithelium - provides large area for nicotine absorption (tennis court)

Alkalinized to enhance absorption

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13
Q

What are the 5 A’s of smoking cessation?

A

Ask, Advice, Assess, Assist, Arrange follow-up

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14
Q

What is suggested to increase how often physicians ask about smoking?

A

Treat smoking as a vital sign (current, former, never)

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15
Q

If a patient responds that they’re a smoker, what would be the next step in promoting smoking cessation

A

Advise all smokers to stop!

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16
Q

What are the two factors to elucidate when assessing a smoker?

A
  1. Willingness to quit
  2. Nicotine dependence
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17
Q

What are the four stages of change?

A
  1. Precontemplation
  2. Contemplation
  3. Preparation
  4. Action
18
Q

If a patient is willing to quit, what are the two ways to assist in quitting?

A
  1. Pharmacotherapy
  2. Counseling
19
Q

If a patient is not willing to quit, what are two ways to motivate them to quit?

A

Motivational interviewing

The 5 R’s (Relevance, Risks, Rewards, Roadblocks, Repetition)

20
Q

What is the STAR approach to counseling?

A

Set a quit date

Tell family and friends

Anticipate challenges and plan for them

Remove tobacco products

21
Q

What are two markers of heavy nicotine addiction?

A

Smoking the 1st cig within 30 min of waking

Smokes 20 or more cig per day

22
Q

About how much nicotine does each cigarette deliver?

A

~2 mg/cig

23
Q

What are the two components to assisting the patient in cessation?

A

Pharmacotherapy

Counseling

24
Q

What are four pharmacotherapies to assist in cessation?

A

Nicotine replacement (short acting, long acting)

Bupropion

Varenicline

25
Q

What are the four MOA of nicotine replacement?

A

Stimulate nicotine receptors, reduce symptoms of withdrawal, decrease frequency of urges, reduce reinforcement of tobacco-delivered nicotine

26
Q

What are the nicotine doses possible with patches? How do this therapy alter quit rates? How long for the onset of action?

A

7, 14, 21 mg/24 hrs

Doubles quit rates

Onset: 2-4 hrs

27
Q

What type of absorption is utilized with nicotine gum and lozenges?

A

Buccal absorption

28
Q

What is the appropriate chewing method for nicotine gum?

A

Chew 15 times, note flavor, stop chewing, put gum b/t cheek and gums, chew again when tingling is gone

29
Q

What is the MOA of bupropion SR?

A

WE DON’T REALLY KNOW. WE ASSUME IT HAS SOMETHING TO DO WITH THE NORADRENERGIC/DOPAMINERGIC PATHWAY

30
Q

What is the contraindication for buproprion SR?

A

increased risk of seizure

31
Q

What is the MOA of varencline?

A

Binds to the same receptor as nicotine in the ventral tegmental area (VTA) leading to an agonist-antagonistic effect

32
Q

How does varencline affect the quit rate?

A

Triples the quit rate

33
Q

Which therapy can increase the quit rate by a factor of 3.6 (2.5-5.2)?

A

Combination of patch with gum or spray

34
Q

What type of relationship does counseling have with quit rates?

A

Dose-response relationship

35
Q

What are some counseling resources available for smokers?

A

1-800-QUITNOW

smokefree.gov

36
Q

How would you treat Mary?

Withhold treatment until she has had counseling and is ready for treatment

4 mg nicotine gum

21 mg nicotine patch

21 mg nicotine patch plus 2 mg nicotine gum

Varenicline

A

21 mg nicotine patch plus 2 mg nicotine gum

or

Varenicline

37
Q

If someone isn’t successful quitting, what should be done next?

A

Try, try, try again

More counseling, alternative pharmacotherapy, if she is willing to try YOU are willing to help

38
Q

How does snus compare to smoking?

A

For an individual, it is a safer alternative.

However, promoting snus as a public health policy would be counterproductive, as many people who may have never used snus would begin to dabble in a world full of evil and empty pleasures.

39
Q

What are some of the effective public policies that have reduced smoking?

A

Tobacco taxation, restrictions on smoking (ie no indoor smoking/increased age), bans on advertising and promotion, smoking cessation interviews

40
Q

What are some of the mortalities related to second hand smoke

A

Heart dz, lung cancer, SIDS

41
Q

Children exposed to second hand smoke are at greater risk for what?

A

SIDS, bronchitis, asthma exacerbations, middle ear infections, cough, phlegm, wheezing

42
Q

What is an undesired consequence of smoking?

A

Impotence

Pulmonary - Matt (47 decks)

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