Lecture 19 Flashcards
Pathophysiology of smoking
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.
Fagerstrom Test values
1-2 = low dependence
3-4 = low to mod dependence
5-7 = mod
9+ = high
5As?
Ask, Advise, Assess, Assist, Arrange
stage of change - precontemplation
no intention of quitting within the next 6 months
contemplation
patient is considering quitting within the next 6 months
preparation
patient ready to quit (with next 30 days)
action
patient has put their plan into action (1 day to 6 months)
maintenance
pt has successfully made behaviour change (abstained from smoking) lasting > 6 months
when do you fork into your 5Rs
at the assess stage when pt is unwilling to quit
When assessing what are the 3 questions to ask
readiness, importance, self efficacy
Assist STAR approach
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
what is in arrange
arrange a follow up
what are the 5Rs
relevance, risk-rewards, roadblocks, repetition
what is the strength for patients who smoke more than 10 cigs per day
Nicoderm and Habitrol step 1
21mg/24h
What is the path strength for patients who have completed step 2
Nico/Hab step 3, 7mg/24h
what is the strength of patches for patients who smoke less than or equal to 10 cigs per day
Nicoderm and Hab step 2
14mg/24h
Common side effects of patches
skin irritaiton, sleep problems, vivid dreams
Nicorette strengths depending on pack per day
4mg, if greater than 25 cigs per day
2mg if less than or 25 cigs per day
thrive dosing
4mg if greater than 20 cigs or more per day
2mg if less than 20 cigs
when do you disgard gum
after 30 minutes
nicotine nicorette lozenges smoking strenghts
4mg for pt who smoke within 30 mins of waking
2mg who smoke more than 30 mins after waking
reduce to quit
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
nicotine thrive lozenge dosing
2mg if more than or 20 cigsper day
1mg if less than 20 cigs per day
CI lozenges
phenylketonuria
nicorette inhaler dosing
4mg delivered per replacable nicotine cartridge
how many mg does 1 spray have
1mg, max 2 sprays per dose, 4 sprays per hour, 64 sprays per day
MOA of bupropion
weak inhibitor of the neuronal uptake of NE and dopamine
Bupropion dosing
150mg SR daily x 3 days, then 150mg SR BID x 7-12 weeks.
when to start bupropion
1 week before quit date
Varenicline MOA
partial agonist of nicotinic receptor. inhibits nicotine binding and causes partial stimulation
What can bupropion be used in for combo therapy
path or gum
