Smoking Cessation Flashcards
Which of the following is NOT currently recommended as a smoking cessation aid?
a. Behavioral counseling
b. E-cigarettes
c. Nicotine inhaler
d. Nicotine nasal spray
e. Bupropion
b
Which of the following drug levels would increase in a pt who stops smoking?
a. Gemfibrozil
b. Theophylline
c. Clonazepam
d. Ziprasidone
e. Aripiprazole
b
Smoking induces the metabolism of caffeine, theophylline, warfarin, olanzapine, clozapine, and others. If a pt suddenly stopped smoking but continued to take these meds at the same dose, the concentration would increase as the induction effect wears off.
Which of the following meds reduces nicotine cravings and other withdrawal symptoms by blocking dopamine and norepinephrine reuptake?
a. Bupropion
b. Nicotine inhaler
c. Varenicline
d. Nicotine patch
e. Nicotine lozenge
a
What is the advantage of using the nicotine patch and nicotine gum together?
a. Combo therapy has a higher chance of success.
b. A lower patch dose can be used, decreasing the risk of tachycardia.
c. Pts may experience less insomnia at bedtime.
d. There’s a greater reduction in the risk of CV disease.
e. There’s no advantage to using them together.
a
Combo therapy with a long-acting product (patch) and a short-acting product (gum, lozenge, inhaler, or spray) used PRN for cravings will work better than just 1 form of nicotine replacement alone.
Which of the following statements concerning bupropion dosing for smoking cessation are correct?
a. Start it at least 1 week before the desired quit date.
b. Titrate to a TDD of 400 mg.
c. Doses should be taken at least 8 hours apart.
d. Take the 2nd dose at bedtime to reduce GI side effects.
e. When discontinuing, taper the dose down over 2 weeks.
a, c
-Both bupropion SR and Chantix don’t need to be tapered off when discontinued.
-Take the 1st dose of bupropion in the morning and the 2nd dose 8 hours after to reduce the risk of insomnia.
-The max TDD is 300 mg.
A pt is picking up a nicotine inhaler for the 1st time. Which of the following side effects should she be counseled on?
a. Bradycardia
b. Altered sense of smell
c. Throat irritation
d. Peppery taste
e. Abnormal dreams
c
Which of the following are contraindications to using bupropion SR?
a. Use with IV methylene blue
b. Use with linezolid
c. Use with escitalopram
d. Hx of bulimia
e. Use with an MAO inhibitor
f. Bradycardia
a, b, d, e
Hx of seizures is also a contraindication.
Which of the following should a pt be counseled on when starting varenicline?
a. Take the 2nd dose at bedtime to decrease the risk of nausea.
b. If a dose is missed, take 2 tabs when the next dose is due.
c. Take after eating and with a full glass of water.
d. D/c it once smoking has stopped for 2 weeks.
e. If the craving to smoke is severe, chew the tabs for faster relief.
c
What is the MOA of varenicline?
a. Dopamine and norepinephrine reuptake inhibitor
b. Selective serotonin reuptake inhibitor
c. Selective norepinephrine and serotonin reuptake inhibitor
d. Partial nicotinic receptor agonist
e. Serotonin 5HT2C antagonist
d
HPI: BH is a 56 y/o female who presents to the clinic in October for an evaluation, so she can quit smoking. The pharmacist reviews her profile before starting the visit.
Allergies: Wellbutrin (seizures)
PMH: Depression
Smoking Hx: Smoked 1.5 PPD for the last 19 years. First cigarette usually smoked 10 min after waking up when she has her morning coffee.
Height: 5’5”
Weight: 186 lbs
Home Meds: Lexapro 20 mg PO daily
Additional Notes: BH is concerned that she’ll gain more weight when she stops smoking. She’s already overweight and struggles because of her depression.
Which tobacco cessation is most appropriate for BH?
a. Chantix
b. Bupropion SR
c. Nicotine patch + bupropion SR
d. Nicotine inhaler + nicotine gum
e. Nicotine patch + nicotine lozenge
e
Bupropion and Chantix shouldn’t be used because of BH’s seizure hx.
HPI: BH is a 56 y/o female who presents to the clinic in October for an evaluation, so she can quit smoking. The pharmacist reviews her profile before starting the visit.
Allergies: Wellbutrin (seizures)
PMH: Depression
Smoking Hx: Smoked 1.5 PPD for the last 19 years. First cigarette usually smoked 10 min after waking up when she has her morning coffee.
Height: 5’5”
Weight: 186 lbs
Home Meds: Lexapro 20 mg PO daily
Additional Notes: BH is concerned that she’ll gain more weight when she stops smoking. She’s already overweight and struggles because of her depression.
The pharmacist recommends the nicotine patch for BH. Which starting dose is most appropriate?
a. 28 mg/24 hour
b. 21 mg/24 hour
c. 14 mg/24 hour
d. 10 mg/24 hour
e. 7 mg/24 hour
b
1 pack = 20 cigarettes
> 10 cigarettes per day –> 21 mg/24 hour
</= 10 cigarettes per day –> 14 mg/24 hour
HPI: BH is a 56 y/o female who presents to the clinic in October for an evaluation, so she can quit smoking. The pharmacist reviews her profile before starting the visit.
Allergies: Wellbutrin (seizures)
PMH: Depression
Smoking Hx: Smoked 1.5 PPD for the last 19 years. First cigarette usually smoked 10 min after waking up when she has her morning coffee.
Height: 5’5”
Weight: 186 lbs
Home Meds: Lexapro 20 mg PO daily
Additional Notes: BH is concerned that she’ll gain more weight when she stops smoking. She’s already overweight and struggles because of her depression.
BH is concerned about gaining more weight when she stops smoking. Which med may be beneficial to prevent initial weight gain?
a. Nicotine 2 mg lozenge
b. Nicotine 21 mg/24 hour patch
c. Nicotine 4 mg gum
d. Varenicline
e. Nicotine nasal spray
c
The 4 mg dose of the nicotine gum and lozenge has been shown to delay weight gain.
HPI: BH is a 56 y/o female who presents to the clinic in October for an evaluation, so she can quit smoking. The pharmacist reviews her profile before starting the visit.
Allergies: Wellbutrin (seizures)
PMH: Depression
Smoking Hx: Smoked 1.5 PPD for the last 19 years. First cigarette usually smoked 10 min after waking up when she has her morning coffee.
Height: 5’5”
Weight: 186 lbs
Home Meds: Lexapro 20 mg PO daily
Additional Notes: BH is concerned that she’ll gain more weight when she stops smoking. She’s already overweight and struggles because of her depression.
Which of the following immunizations can be recommended for BH today?
a. Influenza vaccine only
b. Prevnar 13 only
c. Prevnar 20 only
d. Influenza vaccine and Prevnar 20
e. Influenza vaccine and Prevnar 13
d
Smoking is a criterion for Prevnar 20 vaccination in patients aged 19-64 years.
HPI: BH is a 56 y/o female who presents to the clinic in October for an evaluation, so she can quit smoking. The pharmacist reviews her profile before starting the visit.
Allergies: Wellbutrin (seizures)
PMH: Depression
Smoking Hx: Smoked 1.5 PPD for the last 19 years. First cigarette usually smoked 10 min after waking up when she has her morning coffee.
Height: 5’5”
Weight: 186 lbs
Home Meds: Lexapro 20 mg PO daily
Additional Notes: BH is concerned that she’ll gain more weight when she stops smoking. She’s already overweight and struggles because of her depression.
What is BH’s pack-year smoking hx?
28.5
Pack-year smoking hx = (cigarette packs/day) x (# of years smoked)
Pts taking Chantix should be warned of the risk for:
a. Drug interactions with MAO inhibitors
b. Serotonin syndrome
c. Acute renal failure
d. Serious neuropsychiatric events
e. Liver failure
d
