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PHAR253 > Smoking Cessation > Flashcards

Smoking Cessation Flashcards

1
Q

True or false: if you set the stage for a smoker to quit and they dont quit immediately, then it was a failure

A

false
if you dont get them to quit right now, but you set the stage to eventually quit, that is still a huge success

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2
Q

What is the best method to quit smoking?

A

there is no best method
simply trying something is likely close enough

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3
Q

What are patches often combined with?

A

a second form of NRT
-often a good move

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4
Q

True or false: with NRT cessation products we can be flexible with dosing

A

true

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5
Q

Where do the real issues lie with smoking?

A

behavioural aspects of smoking

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6
Q

What is the average number of cigarettes smoked per day among daily smokers in Saskatchewan?

A

13

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7
Q

What is the approximate age when people start smoking cigarettes in the USA and Europe?

A

15

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8
Q

List three points about the average smoker.

A

24 years old
smoke 14 cigs per day
lights up a cig within 30min of waking

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9
Q

How much are your chances of quitting smoking reduced if you light up after waking?

A

40%

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10
Q

What is a tendency that occurs with smokers trying to cut back on the number of cigs?

A

tend to take longer drags and hold the smoker longer

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11
Q

True or false: health warnings on the boxes of cigarettes have not been overly effective

A

true

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12
Q

Describe the physical aspects of addiction.

A

mood-altering effects
instant reinforcement
nicotine causes dopamine release

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13
Q

Describe the social aspects of addiction.

A

ritual of smoking
morning coffee
after meals
cigarette breaks
bar/friends

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13
Q

How many days into quitting tend to be the toughest?

A

2 days in
-irritability
-depressed
-anxiety
-difficulty concentrating

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13
Q

What is the average amount of weight gained during smoking cessation?

A

~5kg most within first 3 months)

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14
Q

What is the impact of nicotine on metabolism?

A

increases catecholamines
aromatic hydrocarbons impact metabolism
-enzyme induction: 1A1, 1A2, 2E1
-blood levels of certain drugs drop

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15
Q

What is the clinical implication of smoking on drug metabolism?

A

in general, minimal impact on drug therapy
-psychotropic agents
-methadone
-some oncology agents
can fax the MD regarding a change

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16
Q

What is the most common strategy that is done for quitting smoking?

A

cold turkey

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17
Q

What is the counseling service provided by Canadian Cancer Society to aid in quitting smoking?

A

Smokers Helpline

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18
Q

True or false: as pharmacists, we are well equipped to provide counseling on the behavioural aspects of smoking addiction

A

false

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19
Q

Are gimmicks an okay method of quitting smoking?

A

if they act as a crutch, great!

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20
Q

Are vapes a good method for quitting smoking?

A

not really
vapes provided fast release of nicotine which is not ideal a

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21
Q

Describe the two historical methods of quitting smoking.

A

lobelia plant:
-nicotine like substance
-was added to gums, lozenges, etc
silver acetate
-when you smoke it leads to bitter taste
-added to mouth wash and lozenges

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22
Q

True or false: if you dont have time to talk to a patient, you should tell them to keep and read the package inserts of nicotine products

A

true

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23
What are the brands of nicotine gum?
Nicorette Thrive
24
What are nicotine gums designed to do?
give enough nicotine to take the edge off slow release process
25
How is nicotine gum absorbed?
buccal route (lag time) -lag time makes it unideal for prn use
26
How is the release rate of nicotine gum controlled?
chewing -chew a few moments until peppery taste -then a cycle of bite, bite, park for up to 30min
27
What is the effect of coffee and acidic drinks on nicotine gum?
less nicotine absorbed -not a huge worry, just adjust -have gum before coffee break
28
What is the indication on the nicotine gum packages for the 2mg and 4mg strengths?
2mg: < than 25 cigs/day 4mg: > than 25 cigs/day
29
Is it a huge worry if you guess the wrong dose of a nicotine gum?
no, the smoker can adjust
30
What are the two approaches to the use of nicotine gum?
PRN use -use whenever urge hits -always playing catch up scheduled -defuses the next urge
31
What are the side effects of nicotine gum?
throat irritation burping/hiccups jaw fatigue nausea (esp with faster chewing)
32
Can you smoke while using a nicotine gum?
you can but we would rather not
33
How much nicotine is delivered with a patch?
21mg over 24hrs
34
Do patches provide burst levels of nicotine or baseline levels of nicotine?
baseline levels
35
Describe proper application of nicotine patches.
apply to: upper body/outer upper arm/hip clean, dry, non-hairy, healthy skin can shower with it on (dont apply after shower) change daily at the same time dont re-use a site within 7 days
36
What are the side effects of nicotine patches?
local reaction headache, insomnia, nausea -the patch or withdrawal symptoms? dreams/nightmares -take it off before bed, but might have a morning craving so use gum/lozenge/mist
37
What is the step down order for nicotine patches?
21mg: weeks 1-6 14mg: weeks 7-8 7mg: weeks 9-10 *different timelines are okay, its better than smoking*
38
Why do we need a weaning process for nicotine patches?
it takes time to: -eliminate dependency -allow for behaviour changes -become aware of cessation benefits -get over stress from trying to quit
39
Do the packages say that you can combine NRTs?
no
40
Differentiate between active forms of NRTs and passive forms of NRTs.
active forms: -gum -lozenge -mist -inhaler passive form: -patch
41
Describe the inhaler as a method of quitting smoking.
puffing sensation stays intact (cig-like) buccal absorption (not pulmonary)
42
Explain how to use the inhaler.
the foil ends of the cartridge get poked by the device inhale deeply each cartridge lasts ~20min of frequent puffing
43
How many cartridges of the inhaler can be used during the first phase of quitting smoking?
min: 6 per day max: 12 per day
44
True or false: like gum, coffee and acidic drinks can lower the amount of nicotine absorbed from the inhaler
true
45
True or false: the original Nicorette lozenges are still sold
true replaced by mini lozenges
46
What strength do the Nicorette and Thrive lozenges come in?
Nicorette: 2mg or 4mg Thrive: 1mg or 2mg *pack a day or less: 2mg (Nicorette) or 1mg* *pack a day or more: 2mg (Thrive) or 4mg*
47
How should nicotine lozenges be used?
suck until the nicotine flavour is strong rest the lozenge in your cheek until the taste fades repeat the process for 30 min
48
How long does a nicotine lozenge last?
30 min
49
How much nicotine is in one cigarette?
1mg
50
Describe the mini-lozenges.
dissolve 3x faster lasts about 10 min move from side-to-side prn
51
Describe the quick-mist method for quitting smoking.
sprayed into mouth (not towards back of throat) effect within 60 seconds (fastest method) hold spray in mouth for a few seconds and dont inhale dont eat or drink for about 15 min
52
How many sprays of the quick mist can be used at once? How many can be used per day?
2 sprays at a time 64 sprays per day
53
Which antidepressant can be used for smoking cessation? What is its mechanism?
bupropion (Zyban SR) increases noradrenaline and dopamine via uptake blockage *still need willpower*
54
What would be a scenario where bupropion would likely be the drug of choice for smoking cessation?
depression -quitting is difficult until depression is dealt with -works in the non-depressed
55
What is the typical regimen of bupropion for smoking?
150mg OD for first 3 days then 150mg BID (8hr separation and not near bedtime) keep smoking days 1-7, then quit smoking (can add NRT from this point on)
56
What are the side effects of bupropion?
dry mouth insomnia less weight gain when quitting smoking derm seizure disorders (dont see it at smoking dose)
57
Aside from bupropion, are there other antidepressants that can be used for smoking cessation?
nortriptyline SSRIs (not that helpful)
58
What is the mechanism of varenicline?
partial nicotine agonist and also blocks nicotine (smoking is less enjoyable)
59
What is the dosing of varenicline?
days 1-3: 0.5mg OD days 4-7: 0.5mg BID day 8 and on: 1mg BID *titration to help decrease nausea* *stop smoking around day 7-14&
60
What are the side effects of varenicline?
nausea abnormal dreams constipation drowsiness
61
Which formulation of bupropion is used for smoking cessation?
SR
62
True or false: the adverse effects of varenicline outweigh the benefits
false
63
Describe cytisine as a method of smoking cessation.
plant-derived (almost varenicline like) oral capsule OTC status considered useful
64
What are the main steps in selecting an agent for a patient?
ask about their smoking habit -# of cigs/day, how early, after meals, etc number of quit attempts -tried what to date? what helped? pick a method give them quitting tips
65
Asking about the number of cigs per day is an important aspect in selecting an agent, why?
reflects on how tough it might be to quit needed for NRT dosing
66
Why is it important to ask about how early in the day a smoker lights up?
earlier smokers will have a tougher time quitting
67
Why is it important you ask a smoker what they have tried so far in terms of quitting?
helps decide what is next what to avoid can help explain what went "wrong"
68
What are the factors that can be used when selecting an agent?
health status -derm, TMJ, heartburn, cardio, depressed quit history dependency -early morning cravings, hand-mouth ritual product use history patient preference -picking easiest way? control over nic intake? weight gain an issue? cost
69
How many calories are burned from one cigarette?
10 calories
70
Which smokers have a greater chance of quitting cold turkey?
light smokers
71
True or false: lots of smokers eventually succeed cold turkey
true *using a crutch is a good idea*
72
Which form of NRT is the best?
none, simply pick one its patient preference find the sweet spot between withdrawal symptoms and nicotine side effects
73
True or false: NRT cannot be used alongside bupropion
false they can be used together
74
Are varenicline and NRT used together?
pharmacologically, it does not make any sense
75
Can patients with cardiovascular disease use an NRT?
it is not suggested however it is more dangerous to continue smoking than use NRT -would be wise to be monitored by an MD
76
Can pregnant women use an NRT?
there is no safe dose of nicotine in pregnancy, although NRT is safer than smoking IR>patch (only bursts compared to 24/7)
77
Can NRTs be used beyond 3 months?
continue with NRT as long as need be -treatment should be flexible -smoker should vary their approach according to their needs
78
What is the maximum amount of nicotine that a person should be receiving from a patch per day?
84mg
79
What proportion of smokers succeed in quitting on their first try?
1/10
80
What are the stages of change?
precontemplation contemplation preparation action maintenance
81
What is the biggest aspect of quitting smoking?
motivation
82
What is often the first choice of therapy for smoking?
varenicline or a combination of 2 NRT methods (patch+gum/lozenge/etc)
83
True or false: bupropion appears to be less effective than combo NRT or varenicline
true
84
How long is therapy generally slated for?
3 months but varenicline and bupropion can be extended up to a year -an extra 12wks of varenicline may prevent relapse NRT can be used indefinitely
85
What is the Rule of 3?
a nicotine craving lasts 3 minutes a nicotine addiction lasts 3 days the psychological addiction lasts 3 weeks+
86
Are quit dates helpful?
yes, gives the smoker time to think -try develop new habits two weeks before (things that take the fun out of smoking)
87
Describe smokers cough.
often worse in morning minimal sputum at first, becomes productive ~40% of smokers have one can get worse when quitting starts to decline after ~3 months
88
True or false: there is a product for smokers cough
false

PHAR253 (16 decks)

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