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Addiction Medicine > Quit Smoking > Flashcards

Quit Smoking Flashcards

1
Q

Smoking cessation:

Most pertinent history must include?

A

1) Standard history
2) Focus on smoking history in detail - onset, volume, timing, patterns of use, previous attempts; success/failures
3) Triggers

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2
Q

Smoking cessation:

What are the quit differences between sexes?

A

1) Women require higher NRT due to a faster metabolism but can also be familial elevated metabolism (these people are at greatest risk of lung carcinoma)
2) Women have lower levels of withdrawal and high success rates if they quit in the first 2 weeks of their menstrual cycle

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3
Q

Smoking cessation:

Is it safe to smoke on NRT?

A

yes

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4
Q

Smoking cessation:

Four techniques with higher rates of success in COPD clients?

A

1) develop a treatment plan
2) self recording of smoking/trigger/patterns
3) advise on weight control methods
4) facilitate social support
* other important strategies include - linking COPD to smoking and personalising cessation based on lung function tests

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5
Q

Smoking cessation:

What is the 5A strategy?

A

Ask, Assess, Advise, Assist, Arrange

RACGP have chose 3A’s - Ask, Advise, Act

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6
Q

Smoking cessation:

Referral options?

A

1) Quitline 13 78 48 (call back services)
2) Australasian Smoking Cessation Professionals - Special Interest Group (ASCP-SIG) through APSAD website
3) Online (www.quitcoach.org.au, www.icanquit.com.au [my preference as a one stop shop])
4) Apps (www.quitnow.gov.au)

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7
Q

Smoking cessation:

Which enzyme does smoking induce?

A

CYP 1A2 The levels will change according to levels of smoking

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8
Q

Smoking cessation:

By how much does NRT increase the chances of quitting?

A

Approximately 20% (from 50% increased to 70%)

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9
Q

Smoking cessation:

How does nicotine work?

A

agonist of the Anti-Cholinergic Receptors (α4β2 nAChR) resulting in release of dopamine

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10
Q

Smoking cessation:

Varenicline MOA and regimen?

A
  • Antagonist of Anti-Cholinergic receptor preventing dopamine release
  • 12 week course
  • start 1 - 2 weeks before quitting
  • up-titrate dose (0.5mg for 3 days, 0.5mg BD for 4 days, 1mg BD until 12 weeks complete)
  • If successful a second 12 week course is available to increase longterm cessation success
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11
Q

Smoking cessation:

Varenicline adverse effects?

A
  • nausea (30%)
  • improves with time, food and slow up-titration
  • insomnia
  • abnormal dreams
  • reports of behaviour/mood changes, suicidal ideation but no causal link found
    • growing evidence of reducing alcohol cravings/levels of consumption
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12
Q

Smoking cessation:

Bupropion dosing?

A
  • 150mg for 3 days

- 150mg BD for 7 - 9 weeks

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13
Q

Smoking cessation:

When is the best time to apply nicotine patches?

A

last thing before going to bed at night as it avoid movement and sweating thus increasing chances of maximum absorption (can be adjusted depending on individual effects and lifestyle)

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14
Q

Smoking cessation:

What technique can be used to avoid local irritation from nicotine patch?

A

-topical hydrocortisone cream-patch rotation

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15
Q

Smoking cessation:

Common smoking cessations issues?

A

1) weight gain (record weight on reviews) - average of 5kg after 1 year; 20% do not gain
2) temporary mental health deterioration (screen with DASS21) especially with depression history

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16
Q

Smoking cessation:

What screening do smokers need?

A

from 35 years of age do spirometry (25% of smokers develop COPD)

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17
Q

Smoking cessation:

Why smoking is perceived as helping with stress?

A

nicotine withdrawals influence levels of stress, smoking relieves the withdrawal so gets interpreted as relaxing (stress paradox)

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18
Q

Smoking cessation:

non-pharmacological strategies?

A

1) Counselling (for clients with depression/anxiety increased quit rates by 45% compared to no counselling)
2) exercise
- a 10min walk reduces cravings for up to 45min
- found to reduce relapse by 46% over 3 years
3) meditation/mindfullness/CBT

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19
Q

Smoking cessation:

How to approach weight gain?

A

interventions can undermine cessation so accept weight gain as cessation is healthier.
Simply try to eat sensibly and exercise regularly.

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20
Q

Smoking cessation:

Important drug interactions with nicotine?

A

1) Warfarin - smokers have a 13% higher dose

2) Clozapine - can be deadly toxic if not monitored in conjunction with changes in smoking levels

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21
Q

Smoking cessation:

Bupropion MOA?

A

Selective re-uptake inhibitor of Noradrenaline and Dopamine and also antagonises nicotine receptors

  • is a prodrug so genetic variability in metabolism can impact efficacy
  • Avoid combination or in wash out period of MAOi’s
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22
Q

Smoking cessation:

Bupropion side effects?

A
  • Insomnia
  • dry mouth
  • headache
  • 1 in 1000 risk of seizures
  • hypertension
23
Q

Smoking cessation:

Bupropion adjuncts?

A

quick acting NRT can be used for triggers

24
Q

Smoking cessation:

What quick acting NRT agents are there?

A
  • Gum-lozenge-spray

- starts to work in 1 - 10 min ( 1 - 4 sprays every hour PRN) inhaler-film

25
Q

Smoking cessation:

What to use in pregnancy?

A

NRT as varenicline and bupropion are contraindicated

26
Q

Smoking cessation:

how to estimate rollie usage?

A

average of 0.5g of tobacco per cigarette

27
Q

Smoking cessation:

How to tailors compare to rollies in terms of health risk?

A

On par

28
Q

Smoking cessation:

How to approach dual substance dependence abstinence attempts eg. Alcohol and smoking?

A

Concurrent treatment results in 25% increased likelihood of drug abstinence at 12 months even if longterm smoking cessation is not achieved

29
Q

Smoking cessation:

What other emotional influences aside from mental health disorders should be considered?

A

Loss of relationship with smoking/cigarettes - often a traumatic separation. The feelings associated with this should be explored, discussed and acknowledged to allow for the best chance of cessation

30
Q

Smoking cessation:

What good does nicotine do in combination with alcohol?

A
  • delays gastric emptying reducing peak blood alcohol level
  • accelerates alcohol metabolism
  • reduces sedation, cognitive impairment and alcohol withdrawal severity
31
Q

Smoking cessation:

Negative impacts of alcohol on smoking?

A
  • accelerates nicotine metabolism leading increased use for the same effect
  • activates pro-carcinogen conversion to carcinogens in tobacco faster than if alcohol was not available
32
Q

Smoking cessation:

If an anti-platelet is required in a smoker what would be best?

A

Clopidogrel - smoking induces CYP450 1A2 increasing active metabolites (25% reduction in cardiovascular events compared to 8% in non smokers)
*Other anti-platelets may be more effective in non smokers

33
Q

Smoking cessation:

Caffeine metabolism and smoking?

A

Caffeine is metabolised quicker so smokersrequire more to get the same effects.
Caffeine toxicity can occur after smoking cessation to levels increasing by up to 36% in 1 week.
Ideally reduce caffeine intake by half when quitting.

34
Q

Smoking cessation:

What withdrawal can often be confused with nicotine withdrawal?

A

Caffeine - hence caffeine abstinence is not recommended during smoking cessation attempts

35
Q

Smoking cessation:

How many times has an average 40 yo smoker attempted to quit?

A

20 times

36
Q

Smoking cessation:

How to assist cravings when on varenicline?

A

Quick acting NRT - noevidence as yet but used in clinical practice

37
Q

Smoking cessation:

Can NRT be used in combination with smoking?

A

Yes - when using NRT inhalation on cigarettes is not as deep and often they smoke less

38
Q

Smoking cessation:

What is a helpful technique to deal with triggers?

A

break up any paired behaviours eg. reading the paper and smoking etc.

39
Q

Smoking cessation:

What other agents may be considered for smoking cessation?

A 
Nortriptyline - must not be first line~75mg daily for 12 weeks (not on PBS for smoking cessation)
Adverse effects (dry mouth, constipation, nausea, sedation, headaches, arrhythmias, OD risk)
40
Q

Smoking cessation:

What are some key milestones post quitting?

A
  • 1 to 9 months coughing and lung function increase
  • 1 year CAD risk is half that of a smoker
  • 5 years CVA risk returns to non-smoker level
  • 10 years lung cancer risk is half of a smoker
  • 15 years CAD risk returns to non-smoker level
41
Q

Smoking cessation:

Pregnancy risks with smoking?

A
  • poorer perinatal outcomes (low birth weight, SGA, preterm, perinatal death, SIDs, cleft palate/lip)
  • placental abruption
  • longterm effects (childhood cancers, neurodevelopmental or behavioural problems, obesity, hypertension, diabetes, asthma)
42
Q

Smoking cessation:

Optimal times to promote cessation?

A
  • presentation with a smoking related problem
  • pre surgery
  • family planning
  • during or after hospitalisation
43
Q

Smoking cessation:

Most reliable predictor of nicotine dependence?

A

smoking within 30 minutes of waking.

44
Q

Smoking cessation:

Rate of unsupported successful cessation?

A

3 - 5%

45
Q

Smoking cessation:Nicotine withdrawal symptoms?

A

-frustration/irritability-anxiety-poor concentration-increased appetite-restless-low mood-insomnia

46
Q

Smoking cessation:

At what age can NRT be used?

A

12 years and over

47
Q

Smoking cessation:

quick acting NRT release profiles?

A

film and spray 1 - 10 mininhaler, gum, lozenge 10 - 20min

48
Q

Smoking cessation:

Appropriate duration of NRT?

A

3 months is advised however can be extended to no longer than 12 months.
Evidence does not extend past 24 weeks, however it may be helpful for harm reduction and increase confidence on NRT cessation if continued for up to 12 months.

49
Q

Smoking cessation:

Best time to start NRT?

A

Can be started on quitting however there is evidence that pre-cessation long acting NRT initiation increases successful smoking cessation by 34%

50
Q

Smoking cessation:

When to reduce typical NRT doses?

A

If a person is less than 45kg do not use above a 14mg patch

51
Q

Smoking cessation:

Common NRT side effects?

A

patches - vivid dreams (improve with time and can be minmised with timing of patch application)
Quick acting NRT - gums (dyspepsia, nausea), mouth spray/inhaler (mouth and throat irritation)

52
Q

Smoking cessation:

Does nicotine get into breast milk?

A

Yes but is less harmful than continued smoking.

Reduce exposure by using NRT after breastfeeds.

53
Q

Smoking cessation:

Practical tips by category-stress/anger-peer pressure/social cues-risk of lapse-maintaining motivation

A
  • muscle relaxation/breathing techniqes
  • reverse saying no/avoid smoking friends early during quit phase
  • not a puff rule
  • reward system using money saved as motivation
54
Q

Smoking cessation:

Paediatric impacts of secondhand smoke?

A

higher rates of

  • respiratory infections
  • middle ear infections
  • meningococcal infections
  • asthma

Addiction Medicine (11 decks)

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