3.1.1 Smoking Cessation Flashcards
What is something that the whole family can enjoy?
Smoking
What type of problem is smoking?
Global
What are the smoking rates amongst males? females
Males: 50% Females: 10%
What is the estimated smoking-related mortality between 2001-2100?
1 billion (w/ a b)
What are some of the smoking related morbidities that contribute to the mortality rate?
Lung cancer, Ischemic heart dz, COPD, stroke, other cancers
What are some of the efforts to alter the current course of the projected mortality pattern?
Prevention effect Prevention and treatment effect
Smoking is a chronic disease. What dependence is associated with smoking?
Nicotine dependence
What is the half-life of nicotine?
2 hours
What system is responsible for releasing dopamine after stimulation by nicotine?
Mesolimbic system
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
What are some of the symptoms of nicotine withdrawal?
Headache, lightheadedness, hunger cramps, sleep disturbance, stress, anxiety, cravings, irritability, poor concentration, depression
Why is nicotine from cigarettes absorbed so well?
Lung alveolar epithelium - provides large area for nicotine absorption (tennis court)
Alkalinized to enhance absorption
What are the 5 A’s of smoking cessation?
Ask, Advice, Assess, Assist, Arrange follow-up
What is suggested to increase how often physicians ask about smoking?
Treat smoking as a vital sign (current, former, never)
If a patient responds that they’re a smoker, what would be the next step in promoting smoking cessation
Advise all smokers to stop!
What are the two factors to elucidate when assessing a smoker?
- Willingness to quit
- Nicotine dependence
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
