Lecture 19

Question 1

Pathophysiology of smoking

Answer 1

When a person inhales cig smoke, they get a rapid rise of nicotine levels. Causes a conformational change when it activates on these nicotinic acetylcholine receptors, causes a dopamine increase. Highest concentration is in this mesolimbic area which is referred to as the reward center of the brain. Makes you feel good and this is the effect that ends up getting people addicted to smoking.

Question 2

Fagerstrom Test values

Answer 2

1-2 = low dependence
3-4 = low to mod dependence
5-7 = mod
9+ = high

Question 2

5As?

Answer 2

Ask, Advise, Assess, Assist, Arrange

Question 3

stage of change - precontemplation

Answer 3

no intention of quitting within the next 6 months

Question 4

contemplation

Answer 4

patient is considering quitting within the next 6 months

Question 5

preparation

Answer 5

patient ready to quit (with next 30 days)

Question 6

action

Answer 6

patient has put their plan into action (1 day to 6 months)

Question 7

maintenance

Answer 7

pt has successfully made behaviour change (abstained from smoking) lasting > 6 months

Question 8

when do you fork into your 5Rs

Answer 8

at the assess stage when pt is unwilling to quit

Question 9

When assessing what are the 3 questions to ask

Answer 9

readiness, importance, self efficacy

Question 10

Assist STAR approach

Answer 10

set a change date
tell family, friends and coworkers about quitting
anticipate challenges
remove barriers
- make your home smoke free
- avoid social situations where you usually smoke etc

Question 11

what is in arrange

Answer 11

arrange a follow up

Question 12

what are the 5Rs

Answer 12

relevance, risk-rewards, roadblocks, repetition

Question 13

what is the strength for patients who smoke more than 10 cigs per day

Answer 13

Nicoderm and Habitrol step 1
21mg/24h

Question 14

What is the path strength for patients who have completed step 2

Answer 14

Nico/Hab step 3, 7mg/24h

Question 14

what is the strength of patches for patients who smoke less than or equal to 10 cigs per day

Answer 14

Nicoderm and Hab step 2
14mg/24h

Question 14

Common side effects of patches

Answer 14

skin irritaiton, sleep problems, vivid dreams

Question 14

Nicorette strengths depending on pack per day

Answer 14

4mg, if greater than 25 cigs per day
2mg if less than or 25 cigs per day

Question 14

thrive dosing

Answer 14

4mg if greater than 20 cigs or more per day
2mg if less than 20 cigs

Question 15

when do you disgard gum

Answer 15

after 30 minutes

Question 15

nicotine nicorette lozenges smoking strenghts

Answer 15

4mg for pt who smoke within 30 mins of waking
2mg who smoke more than 30 mins after waking

Question 15

reduce to quit

Answer 15

step 1 = 0-6 weeks, decrease cigs by at least 50%. use gum for cravigns
step 2 - 6w-6 mo 0 cut down cigs using gum, try to stop smoking cigs by 6 mo
step 3 - within 9 mo - no cigs, gum for cravings
step 4 - within 12 mo, stop using gum within 3 months of stopping smoking

Question 15

nicotine thrive lozenge dosing

Answer 15

2mg if more than or 20 cigsper day
1mg if less than 20 cigs per day

Question 15

CI lozenges

Answer 15

phenylketonuria

Question 15

nicorette inhaler dosing

Answer 15

4mg delivered per replacable nicotine cartridge

Question 15

how many mg does 1 spray have

Answer 15

1mg, max 2 sprays per dose, 4 sprays per hour, 64 sprays per day

Question 16

MOA of bupropion

Answer 16

weak inhibitor of the neuronal uptake of NE and dopamine

Question 17

Bupropion dosing

Answer 17

150mg SR daily x 3 days, then 150mg SR BID x 7-12 weeks.

Question 18

when to start bupropion

Answer 18

1 week before quit date

Question 19

Varenicline MOA

Answer 19

partial agonist of nicotinic receptor. inhibits nicotine binding and causes partial stimulation

Question 20

What can bupropion be used in for combo therapy

Answer 20

path or gum