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PHARM 253 Exam 1 > Smoking Cessation > Flashcards

Smoking Cessation Flashcards

1
Q

What we hope to do as pharmacists?

A

If you help a person quit smoking, way to go, you just added years to their life
If you don’t get them to quit right now, but you set the stage to eventually quit, that is still a huge success
Don’t get bogged down trying to get the ‘best’ method; simply trying something is likely close enough

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2
Q

What is a good move? What is hard about quitting?

A

You will see that combining a patch with a second form of NRT is often agood move
Pharmacists are sticklers for following the rules. But in the case of NRT cessation products, we can be flexible with dosing
Starting them on a product is just a small part of the equation. The behavioral aspects of smoking (and quitting) is where the real issues lie

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3
Q

Does smoking impact other meds?

A

Starting to smoke, or quitting, generally has little impact other medicines the person may be using (a few exceptions)

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4
Q

Is cultural tobacco connecected with addiction?

A

NO, tobacco use today, including inhaling has no connection with First Nations.

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5
Q

Aveerage SMoker Stats

A
  • 24 years old, 14 cigs per day, lights up within 30 mins of waking
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6
Q

Why is lighting up 30 mins before wakening bad?

A
  • Reduce the chances of quitting by 40%
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7
Q

Can one smoke on the patch?

A

People can smoke on the patch, if drop them down from 15 cigs to 7 cigs

SUCCESS (would rather have them not smoke on the patch)

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8
Q

Smokers trying to cut back tend to…..

A

Smokers trying to cut back on the number of cigs tend to take longer drags and hold the smoke longer

Squeeze the filter, more smoke gets in

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9
Q

Are smoking warnings effective?

A

No - Only one that had traction “look 30 at 16”

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10
Q

What are the aspects of an addiction?

A

Physical:
Mood altering
Instant reinforcement
Nicotine –> Dopamine

Behvaioural/Social:
Ritual of smoking
Morning coffeee
After meals
Cigarette breaks
Bar/friends

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11
Q

What days are the toughest to quit smoking?

A
  • First. 2 days

Irritability, anxiety, depressed, diffuclty concentrating

  • Weight gain - Approx. 5 kg (most within first 3 months)
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12
Q

What is the rule of 3”s?

A

3 minutes ‘nic fit’
3 days nic addiction
3 weeks psych addiction

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13
Q

Nicotines impact on Drug Metabolism

A
  • Increase catecholamines –> Increase metabolic rate
  • Aromatic hydrocrabones –> Increase metabolism through enzyme induction
  • One of the effects may be a drop in blood level, however, re-establishes new blood level
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14
Q

If someone starts smoking, blood levels may

A

Drop

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15
Q

If someone stops smoking, blood levels may…

A
  • levels rise as enzyme induction now normal (slower metabolism)
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16
Q

If a smoker continues to smoke while on a medication blood levels

A

No effect

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17
Q

Is there a big worry about drug levels? Which agents? What to do if worried?

A
  • In general, minimal impact of drug tx
  • Psychotropic agents, methadone, some oncology agents
  • FAX MD re the chnage
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18
Q

What is a word we should avoid?

A

“FAILURE”

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19
Q

What is th emain method of cessation?

A

Cold turkey -nNeed willpower here

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20
Q

In regards to counselling, an important distinction is……

A

Addictions counselling vs Pharmacist counselling
Big difference!

Psychiatry –> Different
Pharmacist –> More of an advisor; cannot provide behvaioural changes

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21
Q

Should we be worried about scams?

A

Scams vs. legitimate

  • If they act as. a crutch, great
  • Device to fiddle with
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22
Q

Should e-cigs be used to quit?

A

No - Fast hit of nicotine, want slow delievery

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23
Q

Lobeila Plant

A

nicotine-like substance
- Historical –> pre-champix

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24
Q

Silver Acetate

A

Silver acetate + smoke –> Bitter taste

  • Historical

Deterrent –> Tastes terrible

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25
Q

To quit one must have ________. If we are busy, we need to inform the pt of what?

A

Still need motivation
Product + “program”

IF you have NO time for the patient ….

READ THE FINE PACKAGE INSERT

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26
Q

Nicotine Gum Brands

A

Nicorette and Thrive

  • 2 or 4 mg in gum resin
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27
Q

Nicotine Gum release. How long does it take to work?

A
  • Just enough to take the edge off
  • DO not chew fast, slow release prep 9controlled by chewing)
  • BUCCAL DELIEVERY: want nicotine to hit mouth, absorbed (little lag), to the brain
  • Gum takes 5-8 mins to work –> Morning smokers that lag time is important
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28
Q

Nicotine Gum Technique

A

BITE BITE –> PARK –> repeat for up to 30 min

  • if smoker needs more, can go faster
  • If smoker needs less, can go slower
  • Chew until pepper taste
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29
Q

Nicotine GUm Interactions

A

-Coffee and acidic drinks slow abdorption
- SMoke with coffee, have gum before coffee
- Chew a bit more

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30
Q

Is 2 or 4 mg a big mistake if switched?

A

NO –> Chew what you need

  • Under-dosing is a major issue
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31
Q

NRT Heart Attack

A

If have heart attack, 2 weeks after then NRT –> Second heart attack is common anyways
- What if they smoke in those 2 weeks –> Easy call for JT to use Nicorette

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32
Q

Two approaches to Gum:
One should have what for how long?

A

PRN - Use whenever urge hits but always playing ctach up

Scheduled: Defuses the next urge

Emergency supply likely needed for months

Wean Off: Follow package insert; hyowever, can be on for a long time

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33
Q

Nicotine Gum Side Effects

A

Throat Irritation
Burping/hiccups
Jaw fatigue
Nauseau

34
Q

Can one become addicted to the gum?

A

Very hard, slow release prep

  • Preferably do not want the smoking during gum use but if smoke less cigaretets than ok
35
Q

Transdermal Nicotine Patch Design

A
  • 114 mg of Nicotine, 21 mg over 24 hours to the
  • 7 mg, 14 mg, 21 mg
36
Q

Nicotine levels via smoking vs patch

A

Smoking fluctuates
Patch is constant

37
Q

Patch SIte Application, switching sites?

A

upper body / outer upper arm / hip
clean / dry / non-hairy / healthy skin
showering is fine with it on

Don’t re-use a site within 7 days

38
Q

Patch S/e

A

Local rxn –> redness, move it around

“How are you with band aids?”

Headache, insomnia, nauseai (or just withdrawal sx)

Nightmares/dreams
–> Take 24 hour patch off at night vs 16 hour patch (hard to find) –> less impact on those who smoke upon wakening

39
Q

Step Down Tx

A
  • Not worried –> Follow pt
  • If not ready, maybe behavioural change shave not occured
  • FLexible algorithm
40
Q

A person is ready to drop wean off the patch when:

A

eliminate dependency
allow for behavior changes
become aware of cessation benefits
get over stress from trying to quit

41
Q

What is the suces srate of all NRT’s?

A
  • 1/10 will succeed (10%), NRT increases it to 20%
42
Q

What are the active forms of nRT? They are also refrred to as….

A

“Rescue methods” –> PRN use with patch to cover emergencies

Gum, lozenge, inhaler, mist

43
Q

Passive form (baseline level) NRT

A

PATCH

44
Q

Inahler Effectiveness and Absorption

A

puffing sensation stays intact (cig-like)
buccal absorption again (not pulmonary)

45
Q

Inhaler Directions

A

6 min, max 12 carts/day

  • Low level directions, get in ball park
46
Q

Lozenges Choosing a Strength:

A

Nicorette: 2, 4 mg
Thrive: 1,2 mg

  • Does not matter, suck on it more or less
47
Q

Lozenge technique

A

Suck –> Until nicotine flavour is strong
Rest –> Cheek until taste fades
Repeat –> 30 mins

48
Q

Mini-Lozenges Difference from lozenges. Strength?

A

Dissolves 3x faster
Lasts about 10 min
Move from side-to-side prn

2 / 4 mg

49
Q

Quick Mist Directions

A

sprayed into mouth (but not towards back of throat)some effect within 60 seconds
‘hold’ spray in mouth few seconds + don’t inhale
don’t eat or drink for about 15 min

50
Q

Fastest delivery system

A

Quick-mist

51
Q

Bupropion:

A
  • Two strengths: SR and XL
52
Q

Does bupropion only work for depressed people:

A

Depression more common in smokers
Quitting is difficult until depression is dealt with
It works in the non-depressed too

53
Q

How does bupropion work?

A

Antidepressants seem to reduce cravings
↑ NA and ↑ DA via uptake blockage (noradrenaline, doapmuine)

STILL NEED WILLPOWER

54
Q

Bupropion Does and Schedule

A
  • 150 mg bid SR (max) (switch to bid on day 4)
  • Keep on smoking for first week, day 7 go cold turkey, can add on nRT at any point
55
Q

Bupropion s/e, di

A

S/e:

Dry mouth, insomnia, decraesed weight, derm

DI: MAOI’s, seizure disorders

56
Q

DOsing interval Bupropion

A

Sr: Want > 8 hour seperation, and last dose not near bedtime

57
Q

Bupropion Effectiveness:

A

Bupropion: 20%
With NRT: 30%

58
Q

Other anti-depressants

A

Notriptylline
SSRI’s

59
Q

Varencilline (CHampix) MOA:

A
  • Partial nicotine agonist
  • Some hit of nicotine, get enough dopamine to wave off withdrawal
  • Also blocks nicoitne from smoke from binding
60
Q

Dosing of CHampix

A

0.5 mg OD (1-3), 0.5 mg BID(4-7), 1 mg BID (8)

  • Titration helps decrease nausaeu
  • STop smoking for day 7 to 14
61
Q

Does champix with NRT make sense?

A

NO

62
Q

Champix S/e

A

Nauseau, abnormal dreams, constipation, drowsiness

  • Increase sucicide risk?????
63
Q

Cytistine

A
  • OTC cap
  • Plant-derived
    Considered useful
  • Varencilline-like
64
Q

Slecting an agent: Ask about:

A

Ask about their smoking habit
(# cigs overall, how early in day, after meals, etc)

Number of quit attempts
tried what to date?
what seemed to help (however small)?

65
Q

In regards to slecting an agent one should consider:

A

Pt’s expectations and bring them to reality

66
Q

Weight gain Smoking Cessation

A

1 cigarette burns about 10 calories

If a quitter does not change any eating habits, they will likely gain - about 3-4 kg

67
Q

Can one use NRT while on zyban (bupropion)? Champix?

A

YES

Champix No –> Does not makes ense

68
Q

Champix and Zyban Combo?

A

Makes people a bit more nervous
- A possibility –> More s/e
- Shown some value for sure and sometimes no value - evidence lacking

69
Q

Preganncy and NRT

A

There is NO safe dose of nicotine during pregnancy.NRT, although potentially harmful to the fetus, is safer than smoking

GO WITH QUICK RELEASE OVER PATCH

70
Q

Treatment with NRT DUration:

A

Withdrawal symptoms vary minute by minute, hour byhour, day by day.

Treatment should be flexible enough to put more control in the hands of the smoker. Smokers should vary their approach according to their needs.

Continue with NRT as long as need be

71
Q

What is the patch maximum per day?

A
  • 84 mg
72
Q

What is the main thing needed for peopl to quit?

A

BEHAVIOUR CHANGES –> MOTIVATION

Make behaviour harder to do –> Make new behaviour easier to do

73
Q

Steps of Behaviour CHange:

A

Pre-contemplation (I love to smoke, see not benefits of quitting)

Contemplation

Preparartion (turning point)

Action

Maintenance (now se ebenefits, what was i thinking?”

74
Q

Smoking is how many addictions:

A

3

Behavioural, Physical, Social

75
Q

need time to:

A

eliminate your dependency on nicotine

replace smoking with other activities

become aware of the benefits

76
Q

Pharmacists need to know:

A

WHY PEOPLE SMOKE

  • Plan for cravings
77
Q

Cravings last how long? what to do?

A

Last 3 mins

The 4 D’s

  • DO something else
  • Delay
    Deep breathing
    Drink water
78
Q

Tips for cravings

A
  • Tell family about attempt
    remove ashtrays
    Reward yourself
79
Q

Quit Day Technique

A

brush your teeth, then smoke right away (GROSS)
change brands
use your other hand
change seating in the house
try cutting down; smoke only half the cig postpone lighting for a few minutes
emptying ashtrays (or put butts in a jar)
put cigs in a different spot (house, car, etc)

  • 2 WEEKS
80
Q

Smokers Cough

A

often worse in morning
minimal sputum at first, becomes productive
~40% of smokers have one

arts to decline after ~3 months

PHARM 253 Exam 1 (8 decks)

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