Chapter 43: Tobacco Cessation Flashcards
What are the “5 A’s” for treating tobacco use and dependence
- Ask about tobacco use
- Advise to quit
- Assess willingness to make a quit attempt
- Assist in quit attempt
- Arrange follow up
The combination of ____ and ___ is more effective than either one alone for smoking cessation
Counseling and medication
The non-nicotine chemicals in tobacco smoke induce which CYP enzyme
1A2
Smokers who quit can experience side effects from supratherapeutic levels which drugs
Caffeine
theophylline
warfarin
Women age >/= ___ years who smoke should not take ____ due to an increased risk of CV events
35 years
estrogen-containing OCs
Treatment guidelines promote the use of behavioral counseling over drugs for which populations?
Pregnant women
adolescents
“light smokers” using < 10 cig/day
Which vaccines should smokers receive and which age group should receive them
Pneumovax 23 (age 19-64 years) influenza vaccine
Dosing schedule for Nicotine patch if patient smokes > 10 cig/day
21 mg patch (weeks 1-6)
14 mg patch (weeks 7-8)
7 mg patch (weeks 9-10)
Initial dose of Nicotine patch if patient smokes < / = 10 cig/day
14 mg patch
Initial dose for gum/lozenge if first cigarette is > 30 min upon waking
2 mg
Initial dose for gum/lozenge if first cigarette is < / = 30 min upon waking
4 mg
Minimum pieces of gum/lozenge per day during the first 6 weeks
9
NRT warnings
MI: myocardial infarction, otherwise known as a heart attack.
Avoid in immediate post-MI period
arrhythmias
angina and pregnancy
Inhaler/nasal spray: avoid in asthma, COPD
Side effect from Nicotine patch
vivid dreams
are dreams that are so clear and realistic that they feel like real life
Side effect from Nicotine inhaler
mouth and throat irritation
Side effect from Nicotine nasal spray
nasal irritation
T/F: nicotine patch does not need to be removed before an MRI
false
Which formulation and strength of NRT can reduce or delay weight gain
4 mg gum or lozenge
Patients should not do this before or during use of gum/lozenge
do not eat or drink 15 min before or during use
Bupropion MOA
blocks reuptake of DA and/or NE
resulting in reduced cravings
and other withdrawal symptoms
Varenicline MOA
partial alpha-4 beta-2 nicotinic receptor agonist
When are bupropion & varenicline started
1 week before the quit date (since they reduce cravings)
T/F: Bupropion & Varenicline need to be tapered when they are d/c
False
bupropion SR brand name for smoking cessation
Zyban
varenicline brand name
Chantix
bupropion SR dosing & max dose
150 mg QAM for 3 days, then 150 mg BID
Max dose: 300 mg/day
bupropion BBW
Increased risk of suicide thinking and behavior in
- children
- adolescents
- young adults taking antidepressants
Bupropion CI
Seizure disorder
hx of anorexia/bulemia
with MAOi
linezolid or IV methylene blue
Bupropion & varenicline warnings
Serious neuropsychiatric events
Bupropion SE
dry mouth
insomnia
tremors
weight loss
To decrease risk of insomnia with bupropion, take the first dose upon waking up and take the 2nd dose __ hours after the first dose
8
Varenicline SE
nausea
insomnia
abnormal dreams
HA
To decrease risk of nausea with varenicline, how can it be taken
Take after eating with a full glass of water
If a patient is concerned about weight gain, which treatments can be used for smoking cessation
Gum
lozenge
bupropion SR
If a patient is concerned about depression, which treatments can be used for smoking cessation
bupropion SR (Zyban)
If a patient has a history of seizures, which treatments for smoking cessation should be avoided
Bupropion SR
Varenicline
When applying a nicotine patch, how long should you press down on the patch to the skin
~10 sec
How long should a nicotine patch be worn
24 hrs
If a patient is having vivid dreams from the nicotine patch, what can the patient be counseled to do
remove the patch prior to bedtime
(after about 16 hrs)
and apply a new one in the morning
Do not use the same site to apply a nicotine patch for at least ___
1 week
T/F: The nicotine patch can be cut
false
How to chew nicotine gum
- 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
