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Pharm 229 Professional practice 4 FINAL > Smoking Cessation > Flashcards

Smoking Cessation Flashcards

1
Q

How many consultations of per year
how many billings
Consists of what

A

8 billings with money + 1 mandatory billing (not paid, to ensure continuity)

40$ initial assessment
3x primary follow up (15 each)
4x secondary follow up (10 each)

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2
Q

How long do you have to wait if patient withdraws from billing

A

1 year

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3
Q

How often do you need to update smoking cessation certificate

A

every 5 years

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4
Q

What are the 5As that training program must have

A

Ask
Advise
Assess
Assist
Arrange

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5
Q

What is the minimum requirement for smoking cessation (2)

A

Need to be willing to quit in the next month
Need to set a quit date

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6
Q

What does it mean if patient is smoking within 30 minutes upon waking?

A

Use stronger dose

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7
Q

Should you focus on the “how” or “why” to quit in the first consultation meeting

A

How

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8
Q

What are important points to note in the first quit consultation meeting? (4)

A

of cigarettes
Time to first cigarette
Previous quit attempt methods
Medical conditions

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9
Q

T/F the first consultation quit meeting has to be in person

A

False

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10
Q

Differentiate between primary and secondary follow ups

A

Primary:
- focus on proper use
- dosage
- side effects of smoking cessation

Secondary:
- Just for motivation

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11
Q

What to do if patient does not answer in 3 call attempts?
Regular client
Not a regular

A

Regular client
- hold & document attempt

Not a regular
- close off program with unknown status

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12
Q

How long does primary & secondary follow-up have to be billed?

A

Primary
- within 21 days

Secondary
- within 30 days

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13
Q

T/F Primary and secondary follow-up forms are the same?

A

True

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14
Q

What is the purpose of the final evaluation form?
Paid/unpaid?

A

to document quit status
- successful or unsuccessful or unknown
- unpaid
- for data

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15
Q

What is the definition of a successful quit?

A

Ministry does not define

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16
Q

T/F tobacco use disorder is the #3 cause of preventable death and disease in canada

A

False
- #1

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17
Q

How much shorter is life expectancy for smokers?

A

At least 10 years

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18
Q

What medical conditions can arise from smoking consequences? (10)

A
  • Stroke, CHD
  • PAD
  • ED
  • Diabetes
  • Osteoporosis/hip fractures
  • Cataracts
  • Macular degeneration
  • Rheumatoid arthritis
  • COPD
  • Dementia
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19
Q

What are pregnancy effects of smoking?

A
  • Decreased fertility
  • preterm deliver
  • stillbirth (death of baby before birth)
  • Low birth weight
  • Sudden infant death
  • Ectopic pregnancy
  • Orofacial clefts
  • ADHD in children
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20
Q

How does smoking affect sperm

A

Affect number of sperm with abnormal morphology
- inc risk of birth defects
- miscarriage
- childhood cancer

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21
Q

Which receptor does nicotine stimulate? Release what?

A

Stimulate A4 B2 ACh receptor in the brain to release dopamine

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22
Q

How many mg of nicotine does each cig have?
How many is absorbed?
Lethal dose?

A

8-20mg
- 1-2 mg is absorbed

500-1500mg is lethal dose

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23
Q

What are negative effects of nicotine
BP inc #
HR inc #

A
  • highly addictive with fast delivery
  • teratogenic in fetal development
  • inc BP by 5-10 mmHg
  • inc HR by 10-20 bpm
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23
Q

What are positive benefits of nicotine? (3)

A
  • Stimulates memory and alertness
  • Improves depression, anxiety, pain, tourette’s, ADHD, weight loss, schizophrenia
  • lower incidence of alzheimer’s, parkinson’s, colitis
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24
T/F is nicotine as addicting as crack cocaine?
True
25
How much does quitting smoking before the age of 40 reduce risk of dying from smoking-related disease?
90%
26
Benefits of quitting in: 20 min 8 hours 24 hours 2 weeks - 3 months 1-9 months 1 year 5 years 10 years 15 years
20 min - BP returns to baseline 8 hours - CO blood levels drop to normal 24 hours - risk of heart attack starts to drop 2 weeks - 3 months - airways in your lungs relax and you can more air into your lungs and breathe easier 1-9 months - cough less, lungs work better 1 year **IMPORTANT - added risk of CHD is HALF of a smokers 5 years - Same chance of having a stroke as a non-smoker 10 years - chance of getting cancer is much lower 15 years - risk of CHD is similar to non-smoker
27
What are benefits of stopping smoking before surgery? (3)
- Fewer complications & reduces recovery time - Anesthesia is safer - Improved healing & reduces the wound infections
28
What is the average quit attempts before someone is smoke-free for life
6-7 attempts
29
Which 5As is this statement part of: "most important thing you can do to prevent another heart attack is quit smoking and I can help you"
Advise
30
What is the acronym for quit plan? What does it stand for?
S Set a quit date/reduce day T Tell a family, friend A Anticipate challenges R Remove tobacco products
31
What are the 4Ds to manage cravings and triggers
Delay
32
Why do patients who quit smoking gain weight?
Patients are used to the hand to mouth -> eat more -> weight gain
33
T/F there is more depression in patients who smoke MOA?
True - tobacco smoke has monoamine oxidase inhibitor
34
T/F NRT is arterial delivery
False - venous
35
Are you able to go into the water with an NRT patch? Exercise?
Water? Yes, for short periods of times Exercise - remove patch 2 hours before engaging in prolonged exercise (increases absorption)
36
NRT patch dosing 14mg 21mg 21mg + 7
14mg - <10 cpd 21mg - 10-29 cpd 21mg + 7 - over 29 cpd
37
What to do if patient has skin reactions from the patch (4)
- try different brand - HC cream - Daily non-drowsy antihistamine (cetirizine/reactine) - Topical corticosteroid inhaler spray (fluticasone)
38
Which dosage form is useful in reduce to quit strategy and address oral craving
Nicotine gum
39
What can impair buccal absorption of nicotine?
Recent food and fluids (especially acidic)
40
What are the steps for taking nicotine gum (4)
1. Chew once or twice 2. Park the gum between your gums and cheek 3. Hold gum in position for 1 minute until taste fades 4. repeat for 30 minutes then discard
41
Where is the nicotine inhaler absorbed? What problem does it address?
oral mucosa - not lungs Addresses hand to mouth ritual
42
T/F nicotine inhaler can be used with patch
True
43
Directions in using a nicotine lozenge?
Suck until strong flavour, then park until it fades - repeat process for 30 minutes
44
How do you use the nicotine quick mist spray
1. Prime the spray pump (1st use of sitting over 2 days) 2. Point spray nozzle as close as possible to open mouth on the cheek - avoid spraying down throat 2. Use 1-2 sprays every 30-60 PRN
45
Buproprion Drug class MOA
Drug class - norepinephrine dopamine reuptake inhibitor MOA - increase in dopamine
46
Bupropion dosing When to begin? Duration? Titration
- Begin 1-2 weeks prior to quit date - 150mg daily for 3 days - Inc to 150mg BID Duration: 7-12 weeks Use 150mg daily for longterm
47
Buproprion Most common Side effects (2)
- Dry mouth - insomnia (easily avoidable, can take in the AM)
48
Bupropion Contraindications? (5) Drug interactions?
Contraindications - MAO inhibitors - SEIZURE - bulimia or anorexia - undergoing abrupt withdrawal from alcohol or benzos - use with caution in <30ml/min eGFR Drug interactions - drugs that lower seizure threshold (theophylline, antipsychotics, antidepressants, systemic corticosteroids)
49
Varenicline drug class & MOA
Partial agonist for a4B2 nicotinic ACh receptor - low-mod level dopamine stimulation Reduces pleasure from smoking (withdrawals): by blocking nicotine from the cigarette from binding
50
How long is varenicline used for? Dose
up to 24 weeks Dose - 0.5mg daily then BID
51
varenicline Side effects (2)
- Nausea, insomnia - Psychiatric effects (mood, agitation, behavioural changes)
52
Which drug is the most effective in helping smokers achieve abstinence?
Varenicline
53
T/F there are no increase in CV events with NRT or vareniciline
True
54
Which combination is effective 1st line choice?
Bupropion & NRT
55
Varenicline drug interactions
- Alcohol - h2 antagonists - quinolone antibiotics
56
What is the first approach to smoking cessation in pregnancy & breastfeeding?
Counselling is first line - if ineffective, intermittent NRT dosing (lozenges, gum) used over patch
57
What are most drug interactions with smoking associated with? Which enzyme? inc/dec med dose if patient is quitting smoke?
Most interactions are due to tobacco smoke - CYP 1A2 enzyme INDUCER - need to reduce dose as smoking will no longer clear the medication as quick
58
What should patients do if they are planning on quitting smoking and drink 5+ cups of coffee/day
Caffeine metabolized by CYP1A2 - need to cut intake by half
59
Which NHP is similar efficacy to varenicline? What is it made of? MOA?
Cystine - plant-based alkaloid found in members of leguminoase - partial agonist of a4B2 receptor
60
What are the stages patients are in for quitting smoking (5)
1. Pre-contemplation - Cons> pros 2. Contemplation - Pros = cons 3. Preparation - Pros > cons 4. Action 5. Maintenance - 6+ months
61
In the conviction confidence model, define (high/low), give examples: Skepticism Frustration Lack of knowledge cynicism Empowered
Skepticism - High confidence, low conviction: - "I can quit whenever, ut I don't need to" Frustration - High conviction, low confidence - "I know I should quit, but I don't think I can" Lack of knowledge cynicism - Low knowledge, low conviction - "I don't need to quit" Empowered - high confidence + high conviction - I SHOULD quit and I CAN quit
62
What are general principles of motivation interviewing? (4)
1. Express empathy 2. Develop discrepancy 3. Roll with resistance 4. Support self-efficacy
63
What are the 5 R's to enhance motivation to quit tobacco
1. Relevance - the "why test" 2. Risks - consequences 3. Rewards - long-term benefits 4. Roadblocks - identify barrers 5. Repetition - repeat at each encounter - reassure those who have failed
64
T/F 1/2 of smokers will die from smoking 1 in 4 deaths is caused by smokers
1/2 of smokers will die from smoking - true 1 in 4 deaths is caused by smokers - false, 1 in 5

Pharm 229 Professional practice 4 FINAL (5 decks)

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