Module 4 - Smoking Cessation

Question 1

Goals to Smoking Cessation

Answer 1

1. educate about risks associated with tobacco use
2. use strategies for interacting with patients
3. keep up to date on the most current recommendations (OTC and Rx)
4. keep up to date on alternative therapies
5. provide educational materials
6. recommend other valuable resources such as telephone quit lines, etc.
7. understanding billing
8. recognize need of patients who continue to smoke
9. educate patients who use smokeless
10. educate patients who use e-cigarettes

Question 2

• Reinforce the Serious Risks

Answer 2

• lung cancer (increases 25x)
• CVD (increases 4x)
• COPD (increases 13x)
• Risk of stroke returns to baseline after 2-5 years
• Risk of CVD significantly decreases after cessation

Question 3

• Models

Answer 3

5 A Model
- Ask
- Advise
- Assess
- Assist
- Arrange

Ask-Advise-Refer Model

Question 4

• Prochaska & DiClemente Stages of Change

Answer 4

Precontemplation
- Description: patient is not consider change
- Strategy: raise doubts, increase perception of risks

Contemplation
- shows awareness of problem
- evoke reasons to change, list risk of not changing

Determination/Preparation
- “ive got to do something”
- help patient make steps to change

Action
- patient stops smoking
- help with steps towards change

Maintenance
- sustains change
- help identify strategies to prevent relapse

Relapse
- slips
- avoid demoralization and discouragement ( sends back to contemplation)

Question 5

• Drug Therapy
  Nicotine gum

Answer 5

• flexible dosing to manage withdrawal sx
• relief of oral cravings
• delayed weight gain
• otc

Question 6

• Drug Therapy
  Nicotine lozenge

Answer 6

• flexible dosing to manage withdrawal sx
• relief of oral cravings
• delayed weight gain-
• more discrete than gum
• otc

Question 7

• Drug Therapy
  Nicotine patch

Answer 7

• once a day dosing
• convenient east to use
• less conspicuous
• otc

Question 8

• Drug Therapy
  Nicotine inhaler

Answer 8

• flexible dosing to manage withdrawal symptoms
• head to mouth motion that mimics smoking

Question 9

• Drug Therapy
  Nicotine nasal spray

Answer 9

• flexible dosing to manage withdrawal symptoms
• fast delivery of nicotine and rapid relief of withdrawal symptoms

Question 10

• Drug Therapy
  Bupropion SR

Answer 10

• concomitant treatment of depression
• delayed weight gain
• non nicotine option
• oral tablet

Question 11

• Drug Therapy
  Varenicline

Answer 11

• non nicotine option
• oral tablet