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PHRM 504 > Lecture 8: Smoking Censation > Flashcards

Lecture 8: Smoking Censation Flashcards

1
Q

Nicotine Delivery

A
  • does not use tobacco
  • Bidis
  • Cigarettes
  • Cigars/ Cigarillos
  • Dissovable tobacco
  • smokeless tobacco: dip, chew, spit, snuff
  • E-cigarette ( juuling, vaping)
  • Hookah
  • Kreteks
  • Pipes
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2
Q

Cigarette smoking epidemiology

A
  • 14% of amercians smoke every day
  • 19.3% of americans use some kind of tobacco product daily
  • influenced by gender, race/ ethnicity, age, education level and socioeconomic status
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3
Q

Cigarette smoking can cause

A

Cancers: Larynx, esophagus, trachea, bronchus and lung, stomach, liver, pancreas, kidney and ureter, cervix, bladder

Chronic Diseases: Stroke, blindness, diabetes, infertility, hip fractures, ectopic pregnancy, erectile dysfunction

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4
Q

Consequences of Cigarette smoking

A
  • Lung Cancer: 25x increased risk : 90% lung cancer deaths due to smoking
  • COPD: 12x increased risk of death: 80% of COPD deaths due to smoking
    Coronary heart disease: 2-4 increased risk
  • Type 2 diabetes: 30-40% increased risk
  • Stroke: 2-4 increased risk
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5
Q

Dopamine

A

pleasure, appetite supression

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6
Q

Norepinephrine

A
  • Arousal, appetite supression
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7
Q

Acetylcholine

A

Arousal, cognitive enhancement

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8
Q

Glutamate

A

Learning, memory enhancement

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9
Q

Serotonin

A

Mood modulation, appetie suppression

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10
Q

B- endorphin and GABA

A
  • anxiety and tension decreases
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11
Q

Quitting smoking short term benefits

A
  • 20 mins blood pressure decreases
  • 8 hours blood carbon monoxide to normal
  • 24 hours chance of heart attack decreases
  • 2 weeks- 3 mths lung function increases up to 30%
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12
Q

Quitting smoking long term benefits

A
  • 1 year- 50% lower risk of coronary heart disease
  • 5 years- decreased risk of stroke to that of nonsmoker
  • 10 years 50 % lower risk of lung cancer, death and cancer in mouth, throat, esophagus, bladder, kidney, pancreas than smokers
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13
Q

5A’s Approach to cessation

A
  1. Ask about tobacco use
  2. Advise to quit
  3. Assess willingness to make a quit attempt
  4. Assist in quit attempt
  5. Arrange and follow up ( follow up within 1st week after quit date
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14
Q

If unwilling to quit, 5R’s Approach

A
  1. Relevance
  2. Risks (what worries you)
  3. Rewards ( how stopping would help you)
  4. Roadblocks ( why is it difficult to quit)
  5. Repetition ( If ready, go back to 5A’s. If not ready, repeat how stopping would benefit them and reassure them that theyre not doing it alone)
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15
Q

Exclusion to self care (smoking cessation)

A
  • severe heart disease
  • pregnant/ breastfeeding
  • less than 18
  • active peptic ulcer disease
  • uncontrolled hypertension on medication
  • previously failed OTC products and would like to try Rx
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16
Q

Medicaid coverage in NYS

A
  • only 17 states offer comprehensive coverage which includes: counseling- individual, group, telephonic
  • Medications- nicotine patch, gum, inhaler inhaler, lozenge, buproprion, varenicline
  • might still mean barriers exist
17
Q

Non- pharmacologic options

A
  • Behavioral counseling

- Hypnosis and acupuncture- not proven effective

18
Q

Nicotine Patch

A
  • NicoDerm CT ( OTC) and generic products
19
Q

Patch Administration

A
  • apply new patch each morning to dry skin and wear for 24 hours ( upper arm, upper chest, shoulder, back, inner arm)
  • wash hands after applying and removing patch
  • rotate application site at least once/ week
  • do not cut patch or wear more than 1 at a time
20
Q

Patch Dosing

A
  • For more than 10 cigarettes a day: 21 mg weeks (1-6), 14 mg weeks (7-8) and 7mg (weeks 9-10)
    For less than 10 cigarettes a day: 14 mg weeks ( 1-6), 7 mg weeks (7-8) and none for weeks 9-10)
21
Q

Patch counseling

A
  • start on or before quit date
  • continue using if slip occurs
  • discard by folding and placing in trash
  • remove before MRI
  • remove patch at bedtime if vivid dreams
  • store in a cool dry place away from children
22
Q

Nicotine Gum

A

Nicorette (OTC) and generic gums

23
Q

Patch side effetcs

A

insomnia, vivid dreams, skin irritation

24
Q

Gum Dosing

A

2 mg: 1st cigarette after 30 mins after waking up
4mg: 1st cigarette before 30 mins after waking up
Minimum 9 per day for the first 6 weeks
Maximum 24 per day

(Week 1-6) 1 piece every 1-2 hrs
(Week 7-9) 1 piece every 2-4 hrs
(Week 10-12) 1 piece every 4-8 hrs

25
Q

Gum Dosing Side effects

A

Mouth irritation, jaw soreness; if swallowed, heartburn, nausea and hiccups

26
Q

Gum counseling

A
  • rapid chewing -> excess nicotine release
  • Wait 15 mins after eating or drinking before use (especially if acidic)
  • Store in a cool dry place away from children
27
Q

Nicotine Lozenge

A

Nicorette (OTC), Nicorette Mini (OTC), generic lozenge

28
Q

Lozenge Dosing

A

2 mg: 1st cigarette 30 mins after waking up
4mg: 1st cigarette before or 30 mins after waking up
Minimum 9 per day for the first 6 weeks
Maximum 20 per day

(Week 1-6) 1 piece every 1-2 hrs
(Week 7-9) 1 piece every 2-4 hrs
(Week 10-12) 1 piece every 4-8 hrs

29
Q

Lozenge Administration

A
  • Place between gum and cheek –> melt slowly –> move to other side until completely dissolved ( takes 20-30 min)
30
Q

Lozenge side effects

A

Mouth irritation, hiccups, heartburn, nausea

31
Q

Lozenge Counseling

A
  • Wait 15 mins after eating or drinking before use (especially if acidic)
  • Use 1 lozenge at a time
  • store in cool, dry place away from children
32
Q

Nicotine Mouth Spray

A
  • Nicorette Quickmoist (OTC)
33
Q

Mouth Spray Dosing

A
  • 1mg/spray, spray when urge to smoke
  • (Weeks 1-6), 1-2 sprays per hour
    Max 4 sprays/hr or 64 sprays per day
  • (Weeks 7-9)- Reduce sprays by half
    -(Weeks 10-12)- Reduce more
    Max 4 sprays/day by week 12
34
Q

Mouth Spray Administration

A
  • Open dispenser and prime
  • Repeat priming if spray has not been used for 2 days
  • Spray in mouth by pressing firmly and avoid inhaling while spraying
  • Do not swallow for few seconds after spraying
  • Close dispenser
35
Q

Mouth Spray Side Effetcs

A

Hiccups, headache, nausea, throat infection

36
Q

Mouth Spray Counseling

A
  • Avoid eating or drinking
  • discard at pharmacy
  • store in a cool dry place away from children

PHRM 504 (22 decks)

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