Lecture 8: Smoking Censation Flashcards
Nicotine Delivery
- does not use tobacco
- Bidis
- Cigarettes
- Cigars/ Cigarillos
- Dissovable tobacco
- smokeless tobacco: dip, chew, spit, snuff
- E-cigarette ( juuling, vaping)
- Hookah
- Kreteks
- Pipes
Cigarette smoking epidemiology
- 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
Cigarette smoking can cause
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
Consequences of Cigarette smoking
- 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
Dopamine
pleasure, appetite supression
Norepinephrine
- Arousal, appetite supression
Acetylcholine
Arousal, cognitive enhancement
Glutamate
Learning, memory enhancement
Serotonin
Mood modulation, appetie suppression
B- endorphin and GABA
- anxiety and tension decreases
Quitting smoking short term benefits
- 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%
Quitting smoking long term benefits
- 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
5A’s Approach to cessation
- Ask about tobacco use
- Advise to quit
- Assess willingness to make a quit attempt
- Assist in quit attempt
- Arrange and follow up ( follow up within 1st week after quit date
If unwilling to quit, 5R’s Approach
- Relevance
- Risks (what worries you)
- Rewards ( how stopping would help you)
- Roadblocks ( why is it difficult to quit)
- 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)
Exclusion to self care (smoking cessation)
- 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
Medicaid coverage in NYS
- 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
Non- pharmacologic options
- Behavioral counseling
- Hypnosis and acupuncture- not proven effective
Nicotine Patch
- NicoDerm CT ( OTC) and generic products
Patch Administration
- 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
Patch Dosing
- 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)
Patch counseling
- 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
Nicotine Gum
Nicorette (OTC) and generic gums
Patch side effetcs
insomnia, vivid dreams, skin irritation
Gum Dosing
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
Gum Dosing Side effects
Mouth irritation, jaw soreness; if swallowed, heartburn, nausea and hiccups
Gum counseling
- 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
Nicotine Lozenge
Nicorette (OTC), Nicorette Mini (OTC), generic lozenge
Lozenge Dosing
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
Lozenge Administration
- Place between gum and cheek –> melt slowly –> move to other side until completely dissolved ( takes 20-30 min)
Lozenge side effects
Mouth irritation, hiccups, heartburn, nausea
Lozenge Counseling
- 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
Nicotine Mouth Spray
- Nicorette Quickmoist (OTC)
Mouth Spray Dosing
- 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
Mouth Spray Administration
- 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
Mouth Spray Side Effetcs
Hiccups, headache, nausea, throat infection
Mouth Spray Counseling
- Avoid eating or drinking
- discard at pharmacy
- store in a cool dry place away from children
