3.1.1 Smoking Cessation Flashcards by Matt Zabel

What is something that the whole family can enjoy?

Smoking

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What type of problem is smoking?

Global

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What are the smoking rates amongst males? females

Males: 50% Females: 10%

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

1 billion (w/ a b)

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

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

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

Prevention effect Prevention and treatment effect

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

Nicotine dependence

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What is the half-life of nicotine?

2 hours

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

Mesolimbic system

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What are some of the perceived benefits of nicotine?

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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What are some of the symptoms of nicotine withdrawal?

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

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Why is nicotine from cigarettes absorbed so well?

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

Alkalinized to enhance absorption

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What are the 5 A’s of smoking cessation?

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

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

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

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

Advise all smokers to stop!

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

Willingness to quit
Nicotine dependence

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What are the four stages of change?

Precontemplation
Contemplation
Preparation
Action

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

Pharmacotherapy
Counseling

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

Motivational interviewing

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

What is the STAR approach to counseling?

Set a quit date

Tell family and friends

Anticipate challenges and plan for them

Remove tobacco products

What are two markers of heavy nicotine addiction?

Smoking the 1st cig within 30 min of waking

Smokes 20 or more cig per day

About how much nicotine does each cigarette deliver?

~2 mg/cig

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

Pharmacotherapy

Counseling

What are four pharmacotherapies to assist in cessation?

Nicotine replacement (short acting, long acting)

Bupropion

Varenicline

What are the four MOA of nicotine replacement?

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

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

7, 14, 21 mg/24 hrs Doubles quit rates Onset: 2-4 hrs

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

Buccal absorption

What is the appropriate chewing method for nicotine gum?

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

What is the MOA of bupropion SR?

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

What is the contraindication for buproprion SR?

increased risk of seizure

What is the MOA of varencline?

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

How does varencline affect the quit rate?

Triples the quit rate

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

Combination of patch with gum or spray

What type of relationship does counseling have with quit rates?

Dose-response relationship

What are some counseling resources available for smokers?

1-800-QUITNOW smokefree.gov

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

21 mg nicotine patch plus 2 mg nicotine gum or Varenicline

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

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

How does snus compare to smoking?

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.**

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

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

What are some of the mortalities related to second hand smoke

Heart dz, lung cancer, SIDS

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

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

What is an undesired consequence of smoking?

Impotence