Health Promotion Flashcards
What are the 5As of SNAP?
- Ask
- Assess
- Advise
- Assist
- Arrange
What is the role of the 5As?
Detection, assessment and management of SNAP RFx
Percentage overweight / obese clinic attendees?
Overweight: 62.7%
Obese: 27%
Which risk factor is responsible for the greatest burden of disease?
Smoking (9.7%)
What is involved in the assess component of the 5As?
Assess:
- level of RFx and relevance to individual and their health
- readiness to change
- health literacy
What should be done to assist individuals in RFx modification?
- develop RFx Mx plan: may inc lifestyle education tailored to the pt, pharmacotherapy
- support for self monitoring
what should be arranged in 5As?
- Referral to allied health services or community programs
- phone info / counselling
- follow, prevention and mx of relapse
How can nicotine dependence be assessed?
- number of minutes between waking to first cigarette
- number of cigarettes per day
- the type of cravings or withdrawal symptoms experienced when unable to smoke / in previous quit attempts.
What are the markers of nicotine dependence?
- Smoking within 30mins of waking
- Smoking >10cigs / day
- Hx of withdrawal Sx
What information should be provided to smokers who are interested but unsure about quitting?
- patient information re smoking
- support available (quitline, pharmacotherapy)
- suggest follow up visit
How should smokers who are ready to quit be assisted?
- agreeing on a quit date
- identifying smoking triggers and discussing quitting strategies
- providing self-help materials
- prescribing pharmacotherapy based on clinical suitability and patient preference
- arranging follow-up visits at 1–2 weeks to prevent relapse
- considering referral to a quit program.
Effectiveness of nicotine replacement therapy in quitting?
Increases quit rates by 60%
When should nicotine patch be started?
Pre cessation treatment with patch started 2 weeks prior to quit day demonstrates improved success rates
Contraindications to nicotine replacement therapy?
- Recent onset life threatening arrhythmias
- Pregnancy or lactation
- Caution: MI, severe angina, recent CVA and arrhythmia
What is the most effective mono therapy?
Varenicline; doubles sustained abstinence rates at 6 months
AEx varenicline?
- Nausea. Minimise by gradually up-titrating dose, having tablets with food
- Less common: HA, difficulty sleeping, nightmares.
- Rare: vomiting, abdo pain, flatulence, constipation.
Bupropion contraindications?
-Allergy
-Seizures
-Anorexia or bulimia
-CNS tumours
-MAOi within 14d
Caution: EtOH abuse, recent head trauma, renal impairment, drugs lowering seizure threshold.
Varenicline trade name?
Champix
What is varenicline?
Nicotinic receptor partial agonist used to treat nicotine addiction (3x more effective than placebo)
How does varenicline differ from bupropion / NRT?
Partial agonist at nicotinic receptors therefore both reduces cravings for and decreases pleasurable effects of cigarettes
Varenicline mechanism of action?
- Partial agonist of nicotinic receptors (cf nicotine’s full agonism) therefore causing less effect of dopamine release.
- Competitive binding reduces ability of nicotine to bind and stimulate mesolimbic dopamine system
How is varenicline excreted?
Renally excreted (93%). Small proportion glucuronidated, oxidated or conjugated to hexose.
What are the quit programs addicted smokers should be referred to?
- Quitline
- Tobacco treatment specialist or
- local Quit programs
Goals of weight loss for adults?
Achieve sustainable weight reduction (e.g. 1-4kg / month in short term, 5 - 10% initial body weight in long term)
When may bariatric surgery be considered?
BMI >40 or >35 with comorbidities improved by weight loss
What are the common medications associated with weight gain?
- Atypical antipsychotics
- Beta Blockers (propranol, pizotifen)
- Insulin modifiying (sulphonylureas, TZDs)
- Sodium valproate
- Anabolic steroids
What are the atypical anti-psychotics associated with weight gain?
- Clozapine
- Olanzapine
- Lithium
- TCAs (inc amitriptyline)
What are the components of SNAP?
- Smoking
- Overweight / obesity
- Nutrtion
- Alcohol
- Physical activity
