91. Smoking Cessation (15%) Flashcards
Chez tous les patients, évaluez régulièrement et documentez la situation tabagique, en n’oubliant pas que les gens peuvent cesser et recommencer en tout temps.
Chez les fumeurs, discutez de quoi ?
- Discutez des avantages qu’apporte la cessation ou la diminution du tabac.
- Évaluez régulièrement l’intérêt à cesser ou à diminuer le tabac.
Chez les fumeurs motivés à cesser, recommandez l’adoption d’une approche comportant de ___ stratégies pour cesser de fumer.
multiples stratégies
Nommez techniques non-médicamenteux pour arrêt tabagique
- Arrêt complet
- Pendant la grossesse
- TCC
- Counselling
- Cours en ligne
- Acupuncture
- Hypnose
Nommez rx pour arrêt tabagique (6)
- Patch
- Gomme
- Pilules
- Spray
- Pastille
- Inhalateurs
Nommez RX pour cessation tabagique (3)
- Bupropion
- Champix (No more affective than counselling in adolescents)
- Cytisine (natural health product, more effective than placebo)
Name C-I for bupropion (5)
- Troubles épileptiques
- Troubles alimentaires
- Sevrage alcoolique
- Utilisation d’IMAO
- Allergie
Describe vaping for smoking cessation
- Brièvement recommandé jusqu’à la découverte du syndrome pulmonaire lié au vapotage.
- Conseils récents: bénéfice incertain, risques respiratoires et neurologiques, absence de données de sécurité à long terme.
- Interrogez tous les adolescents sur l’utilisation du vapotage.
Name benefits of quitting smoking
- Leading cause of preventable death
- Financial gains
- 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
Describe possible action plan / advice to quit (10)
- 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
Peak tobaco withdrawal when?
at 2-3d
Highest relapse of tobacco when ?
at 2-3w
Describe : Varenicline (Chantix)
- 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
Nommez types Thérapie de remplacement de la nicotine (TRN) (3)
- Gum
- Inhaler
- Lozenge
When to begin bupropion ?
begin 1w before quit date
Name side effects bupropion (6)
- Insomnia
- Headache
- Dizziness
- Tachycardia
- Xerostomia
- Weight loss
Describe use of Nortriptyline in smoking cessation
- AE: Sedation, dry mouth
- Second-line due to side effects
Describe combination tx in smoking cessation (3)
- 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
