Chapter 43: Tobacco Cessation

Question 1

What are the “5 A’s” for treating tobacco use and dependence

Answer 1

• Ask about tobacco use
• Advise to quit
• Assess willingness to make a quit attempt
• Assist in quit attempt
• Arrange follow up

Question 2

The combination of ____ and ___ is more effective than either one alone for smoking cessation

Answer 2

Counseling and medication

Question 3

The non-nicotine chemicals in tobacco smoke induce which CYP enzyme

Answer 3

1A2

Question 4

Smokers who quit can experience side effects from supratherapeutic levels which drugs

Answer 4

Caffeine, theophylline, warfarin

Question 5

Women age >/= ___ years who smoke should not take ____ due to an increased risk of CV events

Answer 5

35 years

estrogen-containing OCs

Question 6

Treatment guidelines promote the use of behavioral counseling over drugs for which populations?

Answer 6

Pregnant women, adolescents, “light smokers” using < 10 cig/day

Question 7

Which vaccines should smokers receive and which age group should receive them

Answer 7

Pneumovax 23 (age 19-64 years)
influenza vaccine

Question 8

Dosing schedule for Nicotine patch if patient smokes > 10 cig/day

Answer 8

21 mg patch (weeks 1-6)
14 mg patch (weeks 7-8)
7 mg patch (weeks 9-10)

Question 9

Initial dose of Nicotine patch if patient smokes < / = 10 cig/day

Answer 9

14 mg patch

Question 10

Initial dose for gum/lozenge if first cigarette is > 30 min upon waking

Answer 10

2 mg

Question 11

Initial dose for gum/lozenge if first cigarette is < / = 30 min upon waking

Answer 11

4 mg

Question 12

Minimum pieces of gum/lozenge per day during the first 6 weeks

Answer 12

9

Question 13

NRT warnings

Answer 13

Avoid in immediate post-MI period, arrhythmias, angina and pregnancy
Inhaler/nasal spray: avoid in asthma, COPD

Question 14

Side effect from Nicotine patch

Answer 14

vivid dreams

Question 15

Side effect from Nicotine inhaler

Answer 15

mouth and throat irritation

Question 16

Side effect from Nicotine nasal spray

Answer 16

nasal irritation

Question 17

T/F: nicotine patch does not need to be removed before an MRI

Answer 17

false

Question 18

Which formulation and strength of NRT can reduce or delay weight gain

Answer 18

4 mg gum or lozenge

Question 19

Patients should not do this before or during use of gum/lozenge

Answer 19

do not eat or drink 15 min before or during use

Question 20

Bupropion MOA

Answer 20

blocks reuptake of DA and/or NE resulting in reduced cravings and other withdrawal symptoms

Question 21

Varenicline MOA

Answer 21

partial alpha-4 beta-2 nicotinic receptor agonist

Question 22

When are Bupropion & Varenicline started

Answer 22

1 week before the quit date (since they reduce cravings)

Question 23

T/F: Bupropion & Varenicline need to be tapered when they are d/c

Answer 23

False

Question 24

Bupropion SR brand name for smoking cessation

Answer 24

Zyban

Question 25

Varenicline brand name

Answer 25

Chantix

Question 26

Bupropion SR dosing & max dose

Answer 26

150 mg QAM for 3 days, then 150 mg BID | Max dose: 300 mg/day

Question 27

Bupropion BW

Answer 27

Increased risk of suicide thinking and behavior in children, adolescents and young adults taking antidepressants

Question 28

Bupropion CI

Answer 28

Seizure disorder, hx of anorexia/bulemia; with MAOi, linezolid or IV methylene blue

Question 29

Bupropion & varenicline warnings

Answer 29

Serious neuropsychiatric events

Question 30

Bupropion SE

Answer 30

Dry mouth, insomnia, tremors, weight loss

Question 31

To decrease risk of insomnia with Bupropion, take the first dose upon waking up and take the 2nd dose __ hours after the first dose

Answer 31

8

Question 32

Varenicline SE

Answer 32

nausea, insomnia, abnormal dreams, HA

Question 33

To decrease risk of nausea with varenicline, how can it be taken

Answer 33

Take after eating with a full glass of water

Question 34

If a patient is concerned about weight gain, which treatments can be used for smoking cessation

Answer 34

Gum, lozenge and bupropion SR

Question 35

If a patient is concerned about depression, which treatments can be used for smoking cessation

Answer 35

Bupropion SR

Question 36

If a patient has a history of seizures, which treatments for smoking cessation should be avoided

Answer 36

Bupropion SR and Varenicline

Question 37

When applying a nicotine patch, how long should you press down on the patch to the skin

Answer 37

~10 sec

Question 38

How long should a nicotine patch be worn

Answer 38

24 hrs

Question 39

If a patient is having vivid dreams from the nicotine patch, what can the patient be counseled to do

Answer 39

remove the patch prior to bedtime (after about 16 hrs) and apply a new one in the morning

Question 40

Do not use the same site to apply a nicotine patch for at least ___

Answer 40

1 week

Question 41

T/F: The nicotine patch can be cut

Answer 41

false

Question 42

How to chew nicotine gum

Answer 42

- chew slowly until there is a tingle or peppery flavor in the mouth - Park it in between the cheek and gum - When the tingle or flavor goes away, begin chewing slowly again until it returns, then park the gum again - Repeat until most of the flavor or tingle is gone (~30 min) - Do not eat or drink 15 min before or during chewing