91. Smoking Cessation (15%)

Question 1

Name benefits of quitting smoking (1)

Answer 1

• Leading cause of preventable death (6.5-9y premature death)
• Financial gains (1ppy = $3650 per year)
• Reduce risks of erectile dysfunction
• 8h - Carbon monoxide eliminated
• 24h - Risk of heart attack begins to drop
• 2w - Improved in lung function, walking easier
• 1mo - Decreased coughing, nasal congestion, shortness of breath
• 1y - Risk of coronary heart disease halved
• 5y - Risk of stroke same level as non-smokers
• 10y - Risk of mouth, throat and esophageal cancer halved, death rate from lung cancer also halved
• 15y - Risk of heart attacks similar to that of non-smokers

Question 2

Describe possible action plan / advice to quit (10)

Answer 2

• Quit day
• Tell family, friends, coworkers about quitting for support
• Remove tobacco products from environment
• Exercise program
• Alternative oral behaviours (gum, lozenges)
• Obstacles (withdrawal, weight gain, triggers)
• Support groups (eg. 1-800-QUIT-NOW)
• Combining counselling and smoking cessation medication is more effective than either alone
• Regular follow-up to assess response, provide support and modify treatment as necessary
• Refer patients/clients to relevant resources where appropriate

Question 3

Peak tobaco withdrawal when?

Answer 3

at 2-3d

Question 4

Highest relapse of tobacco when ?

Answer 4

at 2-3w

Question 5

Describe pharmacotx

Answer 5

Varenicline (Chantix) + Nicotine patch > Varenicline Chantix alone > Thérapie de remplacement de la nicotine (TRN) or Buproprion

Question 6

Describe : Varenicline (Chantix)

Answer 6

• Begin 1w before quit date , slowly increase dose, >12 weeks (evidence up to 12 months)
• AE: Insomnia, headache, abnormal dreams, GI upset
• Note: No evidence that varenicline increases neuropsychaitric adverse events compared to placebo

Question 7

Nommez types Thérapie de remplacement de la nicotine (TRN) (3)

Answer 7

• Gum
• Inhaler
• Lozenge

Question 8

When to begin bupropion ?

Answer 8

begin 1w before quit date

Question 9

Name side effects bupropion (6)

Answer 9

• Insomnia
• Headache
• Dizziness
• Tachycardia
• Xerostomia
• Weight loss

Question 10

When to avoid bupropion ? (3)

Answer 10

Avoid in seizure disorder, eating disorder, alcohol withdrawal

Question 11

Describe use of Nortriptyline in smoking cessation

Answer 11

• AE: Sedation, dry mouth
• Second-line due to side effects

Question 12

Describe combination tx in smoking cessation (3)

Answer 12

• Combination NRT (i.e., pairing a nicotine patch with nicotine gum, lozenges, inhalers or oral sprays) is more effective than placebo or nicotine replacement monotherapy
• NRT in conjunction with bupropion has a modest but significant effect
• Varenicline in conjunction with a nicotine replacement patch is more efficacious than varenicline alone