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Preventative Med. & Nutrition > Exam #2: Treating Nicotine Dependence > Flashcards

Exam #2: Treating Nicotine Dependence Flashcards

1
Q

What are the big three tobacco products?

A

1) Cigarettes
2) Smokeless
3) Cigars/ pipes

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2
Q

What are the physiologic effects of nicotine?

A

Epinephrine is released leading to:

1) Increased HR, BP, RR
2) Suppressed insulin output
3) Sudden glucose release

DA dump leads to feelings of pleasure

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3
Q

What pathologies do the physiologic effects of nicotine lead to?

A
  • Heart disease
  • Lung disease
  • DM
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4
Q

Why does tobacco meet the definition of addiction?

A

Tobacco induces:

1) Tolerance
2) Withdrawal
3) Continued use in spite of harm

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5
Q

What is the definition of a cigarette? What is the nicotine dose of a cigarette?

A

Any roll of tobacco wrapped in paper or substance not containing tobacco
- 21mg of inhaled nicotine per pack

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6
Q

Why is menthol put in cigarettes?

A

Mild anesthesia

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7
Q

What is snus?

A
  • Parked in upper lip and gum
  • Marked to women
  • No spitting
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8
Q

What is snuff?

A

Snorted

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9
Q

How many packs of cigarettes is tin of Kodiak equal to?

A

4 packs

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10
Q

What causes cancer in smokeless tobacco?

A

TSNA (Tobacco Specific Nitrosamines)

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11
Q

How is smokeless tobacco manipulated to increased absorption?

A

Free basing decreases acid levels and increases salivation

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12
Q

What is the definition of a cigar? What is the nicotine dose of a cigar?

A

Any roll of tobacco wrapped in TOBACCO
- 100-444mg of nicotine

Doesn’t have to be smoked to be absorbed

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13
Q

What are the 5 A’s?

A
  • Ask= Id users
  • Advise= urge to quit
  • Assess= determine willingness to quit
  • Assist= aid the patient
  • Arrange= schedule follow-up
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14
Q

What are the 5 R’s?

A
  • Relevance= why is it personal
  • Risks= id. consequences
  • Rewards= id. benefits
  • Roadblocks= what are barriers
  • Repetition= re-eval w/ each visit
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15
Q

What is NRT?

A

Nicotine Replacement Products

*No TSNAs

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16
Q

What is the “patch” as an NRT? Why do these need to be bridged with an alternative source of nicotine?

A

Long-acting nicotine

- 21mg dose but ONLY 17mg absorbed, which is LESS than a normal pack of cigs

17
Q

How long do people need to be on the patch?

A

6 months

18
Q

Should patients wear the patch at night?

A

Yes, but they can take it off with “bad dreams”

19
Q

What are gum and lozenges used for?

A

Breakthrough cravings i.e. bridge the patch

20
Q

When do patients get have a peak absorption from gum or lozenge? What is the implication?

A

15-20 min.

Need to take BEFORE they would have normally smoked

21
Q

What is bupropion? What is the mechanism of action?

A
  • Wellbutrin, an antidepressant that increases DA reward, mimicking nicotine
  • Nicotine receptor blocker
22
Q

What patients should NOT use wellbutrin?

A 
Seizure hx 
Brain tumor 
CVA 
Brain surgery 
Alcoholics 
Anorexia/ Bulimia 
Hx of abuse 
LOC >30 min 
Skull Fx 
Inter-cranial bleed
23
Q

What is Varenicline? What is the mechanism of action?

A

Chantix

  • Binds nicotine receptor and activates it; also blocks nicotine
24
Q

What should Chantix be taken with?

A

Water and a banana

25
Q

What patients is Chantix contraindicated with?

A
  • Pilots
  • Heavy equipment user
  • Seizure hx.
26
Q

What is the best treatment for spit tobacco users?

A

Chantix

27
Q

What other NRTs can spit tobacco users besides Chantix?

A

Gum, Patch, Lozenge

NOT nasal spray or oral inhaler*

28
Q

How do you determine the dose effectiveness of NRTs?

A

Too much= nausea

Too little= cravings

29
Q

Why not use nasal spray or oral inhaler?

A

Very expensive

300-500 dollars a months

30
Q

What does nicotine do the caffeine?

A

Increases clearance b/c of CYP1A2 induction

31
Q

What is the relationship between opiates and smoking?

A

Need more pain medication than non-smokers

32
Q

What do you need to be weary of in spit tobacco users? Why?

A

Spit tobacco= high level Vitamin K

Dose of coumadin can be v. high–>MUST CHECK PT/INR to ensure no risk of bleeding when quitting

33
Q

How many cigs is 45 minutes of hookah use equivalent to?

A

60

34
Q

During 45 minutes of hookah use, what is the carcinogen dose?

A

50x higher

Charcoal used to burn tobacco increased the carcinogen dose.

35
Q

What are the drawbacks to e-cigs?

A
  • No regulation
  • Cannot control nicotine/ titrate
  • Contains propylene glycol–>carcinogen
  • Vegetable glycerin–>pneumonia (suppository)
  • Contain NSTAs
36
Q

What is the danger of e-juice or smoke juice used in e-cigs?

A
  • Contain v. concentrated nicotine doses that exceed lethal nicotine dose for children
  • Approach adult nicotine dose
37
Q

What is the effect of SHS exposure in utero?

A

Increases the risk of SIDS

38
Q

What are teen smokers at higher risk for?

A
  • Depression

- Suicide

39
Q

What is third hand smoke?

A
  • Nicotine deposits and gets re-aerosolized

- Contains TSNAs

Preventative Med. & Nutrition (30 decks)

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