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OTC II > Non-Rx Smoking Cessaion > Flashcards

Non-Rx Smoking Cessaion Flashcards

1
Q

Consequences of Smoking

A

-Cancer (not just lung cancer)…
-Cardiovascular Disease
-Pulmonary Disease (asthma, COPD)
-Reproductive Effects
-Ophthalmic

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2
Q

Benefits of quit Smoking

A

-Health
-Appearance: Smell, wrinkles, teeth
-Money
-Family/loved ones

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3
Q

Quitting benefits in a time frame

A

minutes: decreases BP
hours: CO goes down
months: improved circulation, lung function, better mucus clearing, decreased respiratory symptoms (walk longer w/o shortness of breath)
1 year: heart disease goes down
5 years: stroke risk goes down
10y: lung cancer and other cancer risk goes down
15y: risk of heart disease normalizes

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4
Q

Pathophysiology of Nicotine Dependence

A

-Tobacco is the vehicle to deliver nicotine
-Nicotine acts on nicotine acetylcholinergic receptors (nAChRs) ->AP cause Dopamine release

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5
Q

What causes Withdrawal symptoms?

A

-nicotine receptors are upregulated but no nicotine to bind (stopped smoking)

-Anxious, irritable, insomnia
-cravings, impatience, restlessness
-frustration, hostility, inability to concentrate

starts within 24 hours, can last days, weeks, or longer

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6
Q

When is the phase with the most severe symptoms?

A

Day 1-3
-set day of quitting
-prepare the patient for symptoms (person of support)

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7
Q

Relapse vs. Slip up

A

-Relapse: back to smoking habits

-Slip up: attempting to quit, but having 1 cigarette

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8
Q

How does smoking affect caffeine consumption?

A

-smoking upregulates enzymes that make people tolerate more caffeine
-> So when people stop smoking, the enzymes go down and people are more sensitive to caffeine

-> Withdrawal symptoms after drinking coffee + in top of the symptoms from quitting smoking

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9
Q

Assessments of Smoking Abstinence

A

-MO levels -> fall within hours after the last cigarette (done in clinical trials)
-How confident is the patient? (rate from 0-10)
-Fagerstorm test
-Why I smoke: 18 questions -> allows behavioral intervention
-

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10
Q

What is the Fagerstorm test?

A

-Assess physical dependence on nicotine

-How soon do you smoke? How many cigarettes?

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11
Q

Why I smoke

A

-18 questions -> allows behavioral intervention
-Stimulation
-Handling
-Pleasure
-Relaxation/ Tension Reduction
-Craving
-Habit

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12
Q

Ultimate Assessment

A

Ready to quit?
Stage 1: Not ready within the next month
Stage 2: Ready within the next month
Stage 3: Recent quit with last 6 months
Stage 4: Former smoker, quit > 6 months ago

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13
Q

What are the 5As?

A

-Ask about tobacco use ´: recent quitter? former smoker?
-Advise to quit: Normalize, permission to share, encourage

-Assess readiness: Not thinking? -> Start thinking
5Rs: (Relevance, Risks, Rewards, Roadblocks, Repetition)

-Assist
-Arrange

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14
Q

When should patients start using nicotine replacement products?

A

The day they quit

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15
Q

Nonpharmacologic
How to create a plan

A

-QUIT DATE: 2 days to 2 weeks
-Top reasons for quitting
-Top triggers à Top coping strategies
-Smoke-free-vision
-Support system

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16
Q

Nonpharmacologic
Coping Triggers

A

-Stimulating: walks, healthy food, jogging
-Handling: pencil, stress ball
-Pleasure: build them a reward system (healthy snacks, movies)
-Relaxation: stress relief
-Cravings: let them know it is there, medication
-Habits: avoid situations, inform others to change

17
Q

Nonpharmacologic

A

-Counseling
-QUITline
-Motivational Interviewing
-> READS
Rolling with resistance
Express empathy
Avoid arguing
Develop discrepancy
Support self-efficacy

18
Q

5 Rs

A

Relevance: Why quit?
Risks: NEGATIVE Consequence
Reward: Benefits of cessation
Roadblocks: Blockers
Repetition: continue to address

19
Q

Treatment Principles

A

-Medication
-Counseling
-Medication + Counseling
-Combination of Medication: short-term (Gum, Lozenges) + Long-term (Patch)

20
Q

First line of medication

A

1st line:
-Nicotine-Replacement Therapy
-Bupropion
-Varenicline (Chantix)

2nd line:
-Nortriptyline
-Clonidine

21
Q

Exclusion of Self-Treatment
EXAM!

A

-Heart disease (recent heart attack, last 2 weeks, uncontrolled! BP)
-for Gum and Lozenges (GI ulcers)
-Pregnancy
-under 18
-> not absolute contraindication (pt might be in hospital and use NRT, so supervised?)

22
Q

Nicotine Gum

A

> 30 minutes – 2 mg
< 30 minutes after waking - 4 mg
if patients wear dentures -> Lozenges might be preferable

-Short-acting
-Max: 24 pieces a day
-Side: jaw muscle soreness (too much or fast chewing)

23
Q

Nicotine Gum Chewing

A

Chew slowly, PARK between cheek and gum when a tingling sensation (nicotine release) appears -> Resume chewing when tingling sensation fades and park in a
different area of the mouth

24
Q

Nicotine Lozenge

A

> 30 minutes – choose 2 mg
< 30 minutes – choose 4 mg

-short-acting
-Max: 20 per day
-dissolve slowly over 20-30 minutes
-NO chewing, don’t Swallow, rotate in the mouth

25
Q

Gum and Lozenges Similarities

A

-Short-acting
-Onset: 5-10 minutes onset; cigarettes work within 10 sec
-Dosing
-Side effects are similar
-oral substitute and may cause delayed weight gain (nicotine suppresses appetite -> stop cigarette -> more appetite)
-no food or beverage before or during use
-can and should be used combined with a nicotine patch
-use at least 9 pieces a day for the first 6 weeks -> to be ahead of cravings

26
Q

Nicotine Transdermal Patch

A

-Long-acting: (delivered over 24 hours)
-discrete
-Dosing: 7, 14, 21 mg

-Same exclusions to self-treatment as other NRT
-Unique side effect: local skin reactions (not for patients with skin conditions)

27
Q

Nicotine Transdermal Patch

A

-7 mg, 14 mg, 21 mg
more than 10 cigarettes – start at 21 mg
less than 10 min cigarettes – start at 14 mg

28
Q

What are the side effects of Nicotine Patches?

A

-Itching, burning, and redness from the adhesive
-treated with OTC hydrocortisone cream

29
Q

How long to use the patch?

A

-Don’t use the same patch within a week
-rotate application sites
-done leave on for more than 24 hours

30
Q

Patient case Algorithm

A

Step 1: Is he ready? Why quitting? How much, how often do you smoke? Coffee? Quit-date? Cut back method?

Step 2: Excluded from Self-treatment: Heart disease, pregnancy, under 18, skin conditions

Step 3: Find the right product

Step 4: Counsel on dosing, side effects, and how to use

OTC II (17 decks)

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