Health Promotion

Question 1

What are the 5As of SNAP?

Answer 1

• Ask
• Assess
• Advise
• Assist
• Arrange

Question 2

What is the role of the 5As?

Answer 2

Detection, assessment and management of SNAP RFx

Question 3

Percentage overweight / obese clinic attendees?

Answer 3

Overweight: 62.7%
Obese: 27%

Question 4

Which risk factor is responsible for the greatest burden of disease?

Answer 4

Smoking (9.7%)

Question 5

What is involved in the assess component of the 5As?

Answer 5

Assess:

• level of RFx and relevance to individual and their health
• readiness to change
• health literacy

Question 6

What should be done to assist individuals in RFx modification?

Answer 6

• develop RFx Mx plan: may inc lifestyle education tailored to the pt, pharmacotherapy
• support for self monitoring

Question 7

what should be arranged in 5As?

Answer 7

• Referral to allied health services or community programs
• phone info / counselling
• follow, prevention and mx of relapse

Question 8

How can nicotine dependence be assessed?

Answer 8

• 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.

Question 9

What are the markers of nicotine dependence?

Answer 9

• Smoking within 30mins of waking
• Smoking >10cigs / day
• Hx of withdrawal Sx

Question 10

What information should be provided to smokers who are interested but unsure about quitting?

Answer 10

• patient information re smoking
• support available (quitline, pharmacotherapy)
• suggest follow up visit

Question 11

How should smokers who are ready to quit be assisted?

Answer 11

• 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.

Question 12

Effectiveness of nicotine replacement therapy in quitting?

Answer 12

Increases quit rates by 60%

Question 13

When should nicotine patch be started?

Answer 13

Pre cessation treatment with patch started 2 weeks prior to quit day demonstrates improved success rates

Question 14

Contraindications to nicotine replacement therapy?

Answer 14

• Recent onset life threatening arrhythmias
• Pregnancy or lactation
• Caution: MI, severe angina, recent CVA and arrhythmia

Question 15

What is the most effective mono therapy?

Answer 15

Varenicline; doubles sustained abstinence rates at 6 months

Question 16

AEx varenicline?

Answer 16

• Nausea. Minimise by gradually up-titrating dose, having tablets with food
• Less common: HA, difficulty sleeping, nightmares.
• Rare: vomiting, abdo pain, flatulence, constipation.

Question 17

Bupropion contraindications?

Answer 17

-Allergy
-Seizures
-Anorexia or bulimia
-CNS tumours
-MAOi within 14d
Caution: EtOH abuse, recent head trauma, renal impairment, drugs lowering seizure threshold.

Question 18

Varenicline trade name?

Answer 18

Champix

Question 19

What is varenicline?

Answer 19

Nicotinic receptor partial agonist used to treat nicotine addiction (3x more effective than placebo)

Question 20

How does varenicline differ from bupropion / NRT?

Answer 20

Partial agonist at nicotinic receptors therefore both reduces cravings for and decreases pleasurable effects of cigarettes

Question 21

Varenicline mechanism of action?

Answer 21

• 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

Question 22

How is varenicline excreted?

Answer 22

Renally excreted (93%).
Small proportion glucuronidated, oxidated or conjugated to hexose.

Question 23

What are the quit programs addicted smokers should be referred to?

Answer 23

• Quitline
• Tobacco treatment specialist or
• local Quit programs

Question 24

Goals of weight loss for adults?

Answer 24

Achieve sustainable weight reduction (e.g. 1-4kg / month in short term, 5 - 10% initial body weight in long term)

Question 25

When may bariatric surgery be considered?

Answer 25

BMI >40 or >35 with comorbidities improved by weight loss

Question 26

What are the common medications associated with weight gain?

Answer 26

• Atypical antipsychotics
• Beta Blockers (propranol, pizotifen)
• Insulin modifiying (sulphonylureas, TZDs)
• Sodium valproate
• Anabolic steroids

Question 27

What are the atypical anti-psychotics associated with weight gain?

Answer 27

• Clozapine
• Olanzapine
• Lithium
• TCAs (inc amitriptyline)

Question 28

What are the components of SNAP?

Answer 28

• Smoking
• Overweight / obesity
• Nutrtion
• Alcohol
• Physical activity