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BHS I > 4. Tobacco Cessation Counseling > Flashcards

4. Tobacco Cessation Counseling Flashcards

1
Q

Additional Health Consequences

 Reduced \_\_\_\_ response
• Premature \_\_\_\_ and wrinkling
• Increased risk of \_\_\_\_ and macular degeneration
• Increase in \_\_\_\_, decrease in \_\_\_\_
 Increase \_\_\_\_ secretion in stomach
• Impotence and \_\_\_\_
• Disruption of menstruation and menopause
• Increase in risk in \_\_\_\_
A 
immune
aging
cataracts
LDL
HDL
acid
infertility
SIDS
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2
Q 
Smoking and Periodontal Disease
• Smoking promotes periodontal disease
– Depresses immune function, especially
\_\_\_\_ 
– Accelerates rate of \_\_\_\_ loss

• Smoking affects treatment of periodontal disease:
– Delaying ____
– Suppressing immune response
– Correlated with implant failure

A

PMN’s
alveolar bone
wound healing

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3
Q

Oral Effects of
Second Hand Smoke
• Children exposed to smoking in home have about ____ the rate of caries in primary teeth than children in non-smoking homes
• ____ also promotes the growth of microbial biofilm and bacteria and in smokers
• Caries is a ____ disease: smoking parents who kiss children pass on cariogenic bacteria
• Non-____ effects aswell

A

double
nicotine
communicable
oral

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4
Q 
Other Oral Effects of Smoking
• Bad \_\_\_\_
• \_\_\_\_ Teeth
• Altered sense of \_\_\_\_ and \_\_\_\_
• “Smoker’smouth”
– As a dentist, you will recognize smokers immediately...even if they deny it
A

breath
discolored
taste
smell

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5
Q

Oral Health Effects of Smokeless Tobacco

  • Oral cancer, ____ cancer & Leukoplakia • Caries
  • Gingival recession & Periodontitis
  • Damage to oral bone structure
A

pharyngeal

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6
Q 
Other Effects of Smokeless Tobacco
• Addiction
• Higher amounts of \_\_\_\_ than cigarettes
• Increase in \_\_\_\_/ heart rate
• Tooth \_\_\_\_
• Impaired \_\_\_\_
A

nicotine
BP
abrasion
taste

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7
Q

Tobacco Prevalence Rates (CDC,2015)

Healthy People 2020 Target: 12% adults 16% teens
• Current Rates for Cigarette Smoking
16.7% men, 13.6% women, 8.2% teens, 8.4% seniors

• Current Rates for Spit Tobacco (Target 0.3%)
3.4% all adults; 6.7% men, 0.3% women
Highest in ____, WVA, ____ and Mississippi
Lowest in ____, Hawaii, ____ & California

• Current Prevalence Rates for Cigars (Target 0.2%) 8.2% men, 2% women, 7.5% Black adults; 14% teens

A

wyoming
montana
DE
massachusetts

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8
Q 
US Smoking Prevalence
• \_\_\_\_ (21.9%)
• Non-Hispanic whites (16.6%) and non-Hispanic
blacks (16.7%)
• Hispanics (10.1%) and Asians (7%)
• Those below poverty level (\_\_\_\_%)
• Less than HS education (\_\_\_\_%)
• Live in the Midwest (18.7%)

____ High Smoking Rate at 19.9%

A

American Indians/Alaska Native
26.1
24.2
Philadelphia

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9
Q

Advocate Community Interventions
• No-____ zones, ie Penn campus wide ban, restaurants
• High ____, Phila now 3rd highest in nation for cigarettes, still low for ____ tobacco
• Increased enforcement of age ____ sales
• Ban on tobacco company ____ and support of sport events

A 
smoking
taxes
spit
21
promotions
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10
Q

2016 Philadelphia Cigarette Tax raised cost to $4.60 per pack, ____ highest in nation

A

third

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11
Q

Types of Tobacco
• ____
• Smoking
• ____

A

smokeless

e-cig

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12
Q 
Types of Tobacco
• Smokeless
– \_\_\_\_ tobacco
 – Chewing tobacco 
– \_\_\_\_ tobacco
A

dipping

snuff

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13
Q

Popularity of Chewing Tobacco
• Traditional Sports Affiliation
• Increasing Use with ____ Girls & Women
• Recommendation as Harm Reduction
• Novel Use as Cigarette Replacement in ____ or ____
• SNUS

A

teen
workplace
airplanes

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14
Q

E-Cigarettes
• Personal vaporizer (PV)
• PEG, PG, Nicotine
• Harm reduction strategy
• Little ____ on safety
• 2016 FDA strict ____ apply to all tobacco products including tobacco bans, ads, & age limits
• Early adoption 2006-2012, ____ consumption in 2015 due to safety concerns & cost

A

research
regulations
decreased

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15
Q

Smokeless Tobacco:
A Unique Opportunity
• Use is often missed by other ____
• Dental visit is ideal venue to address this problem:
– Routinely ask about use & perform screening
– Discuss ____
– Encourage substitution & cessation

A

health professions

negatives

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16
Q

Your Role (Cont.)
• Dental professionals are not expected to be ____
• Do what you are comfortable with
• Discussing cessation elevates importance
– Reinforcing a common message

  • motivate, ____ and ____
A

psychologists
educate
refer

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17
Q

Rationale for Tobacco Cessation
• Current Behavior Change Issues
– Average of ____ attempts to quit for good
– ____ at least one attempt ever; 44% in 2010

• ____ behavior more difficult
• Physical as well as ____ addiction
• ____
– People like being told “good job!”
– A little enthusiasm and support can go a long way
– You may be the only person in their life that genuinely cares if they quit smoking

A 
5
70%
subtracting
psychosocial
encouragement
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18
Q

The Five A’s

  • ____
  • ____
  • ____
  • ____
  • ____
A 
ask
advise
assess
assist
arrange
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19
Q

Assess

  • Yes: refer to ____ programs
  • No: discuss ____
A

cessation

barriers

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20
Q

The Stages of Change

Behavior change usually occurs in ____ stages

  1. Not considering ____
  2. Thinking about ____
  3. Quitting
  4. ____
  5. Relapse
A

discreet
change
quitting
maintenance

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21
Q

• Not Thinking about Quitting
– Educate, but don’t ____
• Thinking About Quitting
– Motivate, Educate____

• Quitting Now
– Encourage & \_\_\_\_
• Maintenance
– Support \_\_\_\_,
Emphasize Benefits
• Relapse
– Motivate, Educate, Refer
A

push
refer
refer
absitnence

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22
Q

EDUCATE
• ____ oral cancer screening
• ____ effects of smoking/tobacco use on oral
health and general health
• ____ smoking cessation products
• ____ behavioral treatment
• Again: You ARE NOT a psychologist or cessation expert. You are a (valuable) resource for information and education.

A

conduct
review
discuss/recommend
discuss/recommend

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23
Q

Conducting an Oral Cancer Screening
• Standardized ____ & ____ Oral Examination – Tell them what you are doing and why you are
doing it
• Educating Patients Regarding Examination
• Community Oral Cancer Screening Programs – Philadelphia Oral Cancer Walk & 5K
– Free oral cancer screenings! – Great way to get involved

A

extra

intra

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24
Q 
Treating Each Aspect
• Physical Addiction 
– \_\_\_\_ Products
• Habit/Behavioral 
– \_\_\_\_
• Psychological Dependence 
– Distinguish \_\_\_\_ vs. Reality
A

cessation
coping
myth

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25
Q 
Physical Addiction
• Addictive substance: \_\_\_\_ 
• Reinforcer
– Releases \_\_\_\_ in brain 
– Produces pleasure
– Gets to brain in one to two minutes

• Withdrawal Syndrome
– Levels begin to drop ____
– Negative feelings occur

A

nicotine

immediately

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26
Q 
Typical Smoking Pattern
• Usually in withdrawal upon \_\_\_\_
• First cigarette leads to \_\_\_\_ peak
• Serum levels begin to drop immediately upon completion of cigarette
• Withdrawal occurs
• Next cigarette is smoked to relieve
withdrawal
• Pattern is repeated throughout the a day
A

waking

quick

27
Q

Nicotine Absorption

Readly absorbed from:

  • respiratory tract: ____
  • nasally: ____
  • orally: ____
  • skin: ____

Minimal stomach absorption due to ____

A

1-2 min
5-10 min
10-16 min
6-9 hours

acidity

28
Q

Nicotine Absorption
• Nicotine replacement therapy works well in eliminating the pleasurable effect because ____ the products take much longer to produce peak concentrations.
• The “hit” or buzz one gets from smoking cannot be achieved from using these products.
• Therefore, it is generally quite difficult to become ____ addicted to any smoking cessation medication.
• This is why e-cigarettes or vaping will not ____ nicotine dependence. Their rapid absorption provides the same “hit” as cigarettes, creating the same withdrawal-usage pattern throughout the day.

A

all
physically
reduce

29
Q 
Other Effects of Nicotine
• Effects depend of dose
• Stimulant/tranquillizer
• Increases \_\_\_\_
• Increases \_\_\_\_ and motor activity
• Some evidence to suggest it facilitates \_\_\_\_ and decreases aggression
• Slight shift in \_\_\_\_
A

respirations
GI tone
memory
metabolism

30
Q

Nicotine Delivery from Smokeless Tobacco

  • Does not deliver the ____ of nicotine as smoking does
  • Generally speaking, smokeless tobacco contains much ____ levels of nicotine
  • Therefore, smokeless tobaccos are just as ____ as cigarettes
A

“hit”higher

addicting

31
Q

Withdrawal

  • ____
  • anxiousness
  • ____
  • restlessness
  • ____
  • cravings
  • ____ disturbances
  • increased appetite
A

irritability
impatience
depression
sleep

32
Q

Pharmacotherapy: Nicotine Replacement Therapy (NRT)

Benefits
– Prevent ____ withdrawal symptoms to allow cessation of behavioral habit
– Eliminates the ____ effect of nicotine when administered through smoking
– Gives the quitter the time to comfortably break the habit and psychological dependency
– Delay or Decrease ____

A

physical
reinforcing
weight gain

33
Q

Pharmacotherapy: Nicotine Replacement Therapy (NRT)
• Nicotine Toxicity
– ____
– Dizziness
– ____/vomiting/diarrhea
– Very ____ even with concomitant use of NRT and smoking

A

perspiration
nausea
rare

34
Q

FDA Approved “First Line” Medication Recommendations

____
Nicotine Patch
Nicotine Gum Nicotine Lozenge

____
Nicotine Inhaler
Nicotine Nasal Spray Bupropion SR 150mg Varenicline 1mg

A

over-the-counter

prescription

35
Q

Pharmacotherapy: Limitations

Not “magic pills”, and not a “cure”
• Work best when combined with \_\_\_\_
counseling:
– In office if you are inclined or 
– Refer to
• Local programs
• Medication sponsored program
• PA Free Quit Line: 1-877-724-1090
A

behavioral

36
Q

Recommending vs. prescribing
• Patch, Gum and Lozenge are over-the- counter
• FDA has certified these products as safe
– Side effects are ____
• Clinical Practice Guidelines show that:
– These products are efficacious
– They double or triple ____
• ____ products is good health care

A

minimal
success
recommending

37
Q

Patch: Heavy Smokers

• ____ 24/16 Hours
– 10/day or more
– 21mg x 6wks, 14mg x 2wks, 7mg x 2wks

• ____ 24/16 Hours
– 20/day or more
– 21mg x 3/4wks, 14mg x 3/4wks, 7mg x 3/4wks

A

nicoderm CQ

habitrol

38
Q

Patch: Heavy Smokers
• ____ 16 Hours
– 10/day or more
– 15mg x 6wks, 10mg x 2wks, 5mg x 2wks

• ____
– 15 day or more
– 22mg x 6wks

A

Nicotrol

Private Label

39
Q

Moderate Smokers
• ____ (Less than 10/day)
– 14mg x 6wks, 7mg x 2wks

• ____ (Less than 20/day)
– 14mg x 3/4wks, 7mg x 3/4wks

• ____ (Less than 15 day)
– 11mg x 6wks

• ____ not recommended for light smokers (no studies done)

A

Nicoderm
Habitrol
Private Label
Nicotrol

40
Q 
Light Smokers
• \_\_\_\_ cigarettes a day or less
– \_\_\_\_ is generally not recommended
– If quitter insists use only the lowest patch strength for a few weeks
– Suggest \_\_\_\_, lozenge or \_\_\_\_
A

5
NRT
gum
inhaler

41
Q

Patch Patient Counseling
• Apply ____
• Apply a new patch every day to a different,
dry, clean, hairless place
• Rotate sites over a ____ day period
• Do not leave on for more than ____ hours
• Do not use if using ____ (____ hour bolus left in skin when removed)

A 
promptly
seven
24
tobacco
4
42
Q

Patch Side Effects
• ____ Dreams
• Localized Skin Reactions (rash, pruritis, burning)
– Up to 50% of patients have mild form
– Incidence higher with ____ hour products
– Less than ____ discontinue therapy

A

vivid
24
5%

43
Q 
Nicotine Gum
  • \_\_\_\_ (Original, Mint, Orange) 
• Generic
• Both come in
– 2mg (< 25 cigarettes a day)
– 4mg ( >25 cigarettes a day) 
• Option of choice for
 heavy \_\_\_\_ tobacco users
A

nicorette

smokeless

44
Q 
Dosing Gum
• Schedule the same for 2mg and 4mg 
• Weeks 1-6
– 1 piece every one to \_\_\_\_ hours 
• Weeks 7-9
– 1 piece every \_\_\_\_ hours • Weeks 10-12
– 1 piece every \_\_\_\_ hours
A

two
2-4
4-8

45
Q

Gum: Patient Counseling
• Must use on a ____, consistent basis throughout the day (at least 9 pieces)
• Use for a full ____ months with a fixed tapering schedule
• Do not use more than ____ pieces in one day
• Avoid ____ or drinking with gum in mouth
• Additional pieces can be used ____ to deal with specific urges

A 
regular
three
24
eating
PRN
46
Q 
Proper Gum Technique
• Do Not \_\_\_\_!!
• Proper technique
– Activate slowly until “\_\_\_\_” emerges
– Then park between cheek and gum
– When taste disappears, move to another
spot and repeat
– One piece is usually good for \_\_\_\_ minutes
A

chew
peppery taste
30

47
Q

Gum Precautions

Incorrect use may lead to:

  • mouth ____
  • ____, hiccups, etc.
  • ____ ache
A

soreness
dyspepsia
jaw

48
Q

Lozenge
• “Commit”
• ____ administration
• ____ Acting
• Mint Flavor
• 2mg—first cigarette > 30 min. from waking
• 4mg—first cigarette < 30 min. from waking

• Weeks 1-6:
– One piece every one to two hours
• Weeks 7-9:
– One piece every two to four hours
• Weeks 10-12:
– One piece every four to eight hours
A

sublingual

quick

49
Q

Oral Inhaler
• ____
• Two part mouth piece enclosing nicotine
cartridge
• Cartridge = ____mg nicotine
• Mimics the ____ aspect of smoking
• Use 6-16 cartridges/day puffing as needed for up to ____ months

A

prescription
10
oral
six

50
Q

Nasal Spray
• ____
• One metered spray contains ____mg nicotine
• One to two sprays in each nostril per ____, initially—increase as needed
• No more than 5 doses/hr. or 40 does/day
• Use for eight weeks then taper for 4-6 wks.

A

prescription
0.5
hour

51
Q 
Precautions for NRT Use
• \_\_\_\_ within two weeks 
• Unstable \_\_\_\_
• Dysrhythmia
• \_\_\_\_
NRT Contraindicated in \_\_\_\_
A

MI
angina
hypertension
pregnancy

52
Q

Efficacy of NRT
• Using NRT produces doubles or triples the long term quit rates over placebo
• Caution: Not a magic bullet
– Not a ____ for smoking
– Part of a comprehensive treatment program
– Most effective when combined with a ____ modification program

A

cure

behavior

53
Q

Oral Effects of NRT
• Gum
– Not recommended for individuals with extensive dental work, dentures, or ____ disorders
• Lozenge
– May cause minor mouth ____ if left in one spot too long
• Oral Inhaler
– Nicotine vapor mist may irritate ____
• Patch/Bupropion/Varenicline – No ____ effects
– May be ideal for patients with oral concerns

A

TMJ
sores
mouth
oral

54
Q

Safety Concerns
• These are nicotine ____ products
• Using the patch, gum or lozenge does not
introduce anything ____ to the smoker
• Smokers simply get nicotine in a way that
allows them to comfortably reduce usage
• AMA, American College of Cardiology and many other medical societies strongly encourage use

A

replacement

new

55
Q 
Buproprion SR 150mg (Zyban)
• Repackaging of \_\_\_\_
• May increase \_\_\_\_
• Begin 1-2 weeks prior to \_\_\_\_
• Start 150 mg daily, target dose 150mg twice daily 
• 7-10 weeks of therapy: no tapering
A

wellbutrin
dopamine
quitting

56
Q

Buproprion SR 150mg
• Drug interactions:
– Tricyclic antidepressants (lowers ____
threshold)
– MAOI (____ crisis)
• Absolute contraindication: ____ disorder or ____ trauma, ____
• Relative contraindications: Anxiety Disorder, PTSD, Bulimia and Anorexia

A 
seizure
hypertensive
seizure
head
pregnancy
57
Q

Buproprion SR 150mg
• Side effects: ____, insomnia, agitation
– If occurs with initial use of SR Q/day then try
75mg ____ release
– Can be minimized by:
• Reducing SR dosage to ____ daily
• Give entire dose in ____
• Move second dose to as ____ in day as possible
– SR Q/day vs. BID give almost identical ____ mth quits

A 
dry mouth
immediate
once
morning
early
6
58
Q

Varenicline 0.5 - 1mg
• Begin with .5mg taken 1 week before cessation, increase to 1mg on quit date
• Monitor for changes in ____, evaluate for depression and suicide ideation (2008 Warning)
• Side effects: ____, Nausea, ____, Abnormal, vivid strange dreams
• Contraindication: ____ or Psychiatric illness
• Caution with Kidney Disease & Dialysis Patients

____ for Combination Therapy with NRT

A 
mood
dry mouth
insomnia
pregnancy
not approved
59
Q

Combination Therapies
• Clinical trials show that using ____ and ____ increases quit rates over using either alone
– Probably best for ____ smokers: > 2packs/day
• Can use patch or Buproprion as ____ therapy
• Gum, lozenge or inhalers can then be used PRN for specific trigger situations
• CANNOT Use ____ in combination with NRT

A 
patch
buproprion
heavy
"base"
varenicline
60
Q 
Any Exceptions?
 Medical Contraindication
\_\_\_\_ Women
Adolescents
\_\_\_\_ Users
Light Smokers(
A

pregnant
smokeless tobacco
10

61
Q 
Other Products
• No clinical evidence of efficacy: 
– Other \_\_\_\_
– Nicotine Lollypops
– Nicotine \_\_\_\_
– Nicotine Water
– \_\_\_\_ Remedies
Other Treatment Modalities
• \_\_\_\_
• Acupuncture
• Ear Clips
• “Fake” cigarettes
• \_\_\_\_
• Nicotine Fading
• \_\_\_\_ Techniques
A

antidepressants
lip balm
herbal

hypnosis
tapering
aversive

62
Q

REFER
• Local MD specializing in cessation
• Hospital/Community based groups
• Pharmacists specializing in smoking cessation
• American Lung Association/American Cancer Society
• Private therapists

Other Referral Sources
• Product support programs
• PA Free Quit Line 1-877-724-1090
• Five proactive phone calls
• 24-hour support
• Online Support Programs
A

YA

63
Q

Elements of a comprehensive cessation program

• ____ has been specifically trained as a smoking cessation specialist
• Program is multi-session with follow up
• Smoking cessation medication use is
encouraged and monitored
• Emphasizes coping skills and problem solving
• Provides intra- and extra- treatment social
support
• 6-month and one year quit rates are over ____%

A

counselor

35

64
Q

Special Consideration
• Maintenance Phase: staying quit • Support and Encourage
– “Keep up the good work!” – “I am proud of you!”
– Rewards
• Encourage compliance – Medication regime – Behavioral changes
• Strategize about potential barriers

A

YA

BHS I (12 decks)

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