9-Fundamentals of Tobacco Cessation and Managing Risky Alcohol Use

Question 1

Which behavior is the single largest preventable cause of morbidity and mortality in the US?

A) Alcohol use

B) Unprotected sexual intercourse

C) Tobacco use

D) IV drug use

Answer 1

C.
Tobacco use is the leading cause of preventable death in the United States. Physical inactivity is the fourth leading risk factor for global mortality.

Question 2

Smoking leads to or worsens which of the following?

A) Erectile dysfunction

B) Diabetes mellitus

C) Infertility

D) All of the above

Answer 2

D. All of the above.

Smoking worsens or leads to erectile dysfunction, diabetes mellitus and infertility.

Question 3

Which is NOT true about smoking cessation?

A) It leads to a 50% reduction in the risk of heart disease after a year of smoking cessation

B) Quitting at age 30 leads to the same gain in life expectancy as quitting at age 60

C) It leads to a reduction in risk of premature death

D) More than two-thirds of current smokers want to quit completely

Answer 3

B.
Quitting at age 30 adds 10 years of life expectancy versus quitting at age 60, which adds three years of life expectancy.

Question 4

Which treatment for smoking cessation is most effective?

A) Counseling

B) Medication

C) Hypnosis

D) A and B

Answer 4

D. A and B.
The combination of counseling and medication is more effective than either alone, and hypnosis is less effective than either counseling or medication.

Question 5

Each of the following is a first-line medication for smoking cessation approved by the FDA, EXCEPT:

A) Varenicline (Chantix)

B) Bupropion SR (Zyban)

C) Nicotine patches

D) Clonidine

E) Nicotine replacement nasal spray

Answer 5

D.
Clonidine is currently a second-line medication for tobacco cessation as an off-label use. It should be prescribed on a case-by-case basis when the first-line medications are contraindicated or have not been effective.

Question 6

Which statement is true about smoking cessation for the following special populations?

A) First-line for bipolar patients is bupropion.

B) Counseling is the best option for smoking cessation in pregnant smokers

C) Nicotine replacement therapy is not an option for adolescents.

D) Patients with cardiovascular disease are at higher risk of acute coronary syndrome if using nicotine replacement therapy (NRT)

Answer 6

B.
Counseling is the best option for pregnant smokers, as there could be a potential risk of birth defects with NRT. Bipolar patients should not use bupropion but can use the patch. NRT is safe for adolescents. There is no association between nicotine patch use and acute coronary syndrome.

Question 7

Which of the following is NOT a component of the 5 A’s model for smoking cessation?

A) Assist

B) Assess

C) Arrange

D) Accept

Answer 7

D. Accept
The 5 A’s model for tobacco cessation helps to facilitate behavior change. It is comprised of: Ask, Advise, Assess, Assist, Arrange.

The 5 A’s of behavior change counseling are Assess, Advise, Agree, Assist, Arrange.

Question 8

“At-risk drinking” is defined as:

A) Drinking to avoid alcohol withdrawal symptoms

B) Drinking that increases the risk of future problems, but with no current symptoms

C) Getting a DUI

D) Alcohol dependence

Answer 8

B.
At-risk drinking is drinking that increases the risk for future problems, but with no current symptoms; binge drinking ≥ 1 time a month; or exceeding the low risk drinking guidelines at any time.
Getting a DUI would be considered a sign of alcohol use disorder as it is continued use despite internal consequences.
Drinking to avoid withdrawal symptoms is not part of the definition of at-risk drinking or of alcohol use disorder.
“Alcohol abuse and dependence” was the DSM4 terminology for alcohol use disorder.

Question 9

The following patient would be characterized as having moderate alcohol use disorder:

A) A woman who has 1-2 drinks, 5 nights per week over a 12 month period.

B) A male who has no more than 4 drinks on any single day and no more than 14 drinks per week over a 12 month period.

C) A male who does not like to go to a party if there is not going to be alcohol there, has developed tolerance to alcohol use, wakes up craving vodka, and has experienced alcohol withdrawal over a 12 month period.

D) A woman who has lost custody of her children because of her drinking, does not like to go to a party if there is not going to be alcohol there, has developed tolerance to alcohol use, wakes up craving vodka, has experienced alcohol withdrawal, drives drunk and has tried to quit 5 times without success, all over a 12-month period.

Answer 9

C.
A male who does not like to go to a party if there is not going to be alcohol there, has developed tolerance to alcohol use, wakes up craving vodka, and has experienced alcohol withdrawal over a 12 month period.

Alcohol abuse disorder is diagnosed by the presence of at least two out of 11 possible signs or symptoms of the DSM5 alcohol use disorder criteria during a 12-month period.

Moderate alcohol use disorder is categorized by the presence of four to five signs or symptoms that occur over a 12-month period.

Question 10

The following are anti-relapse medications for alcohol use disorder except:

A) Naltrexone

B) Acamprosate

C) Gabapentin

D) Nortriptyline

Answer 10

D.
Nortriptyline is not an anti-relapse medication.
Anti-relapse medications include naltrexone, acamprosate, disulfiram, gabapentin and topiramate.