Smoking Cessation Flashcards
How many consultations of per year
how many billings
Consists of what
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)
How long do you have to wait if patient withdraws from billing
1 year
How often do you need to update smoking cessation certificate
every 5 years
What are the 5As that training program must have
Ask
Advise
Assess
Assist
Arrange
What is the minimum requirement for smoking cessation (2)
Need to be willing to quit in the next month
Need to set a quit date
What does it mean if patient is smoking within 30 minutes upon waking?
Use stronger dose
Should you focus on the “how” or “why” to quit in the first consultation meeting
How
What are important points to note in the first quit consultation meeting? (4)
of cigarettes
Time to first cigarette
Previous quit attempt methods
Medical conditions
T/F the first consultation quit meeting has to be in person
False
Differentiate between primary and secondary follow ups
Primary:
- focus on proper use
- dosage
- side effects of smoking cessation
Secondary:
- Just for motivation
What to do if patient does not answer in 3 call attempts?
Regular client
Not a regular
Regular client
- hold & document attempt
Not a regular
- close off program with unknown status
How long does primary & secondary follow-up have to be billed?
Primary
- within 21 days
Secondary
- within 30 days
T/F Primary and secondary follow-up forms are the same?
True
What is the purpose of the final evaluation form?
Paid/unpaid?
to document quit status
- successful or unsuccessful or unknown
- unpaid
- for data
What is the definition of a successful quit?
Ministry does not define
T/F tobacco use disorder is the #3 cause of preventable death and disease in canada
False
- #1
How much shorter is life expectancy for smokers?
At least 10 years
What medical conditions can arise from smoking consequences? (10)
- Stroke, CHD
- PAD
- ED
- Diabetes
- Osteoporosis/hip fractures
- Cataracts
- Macular degeneration
- Rheumatoid arthritis
- COPD
- Dementia
What are pregnancy effects of smoking?
- Decreased fertility
- preterm deliver
- stillbirth (death of baby before birth)
- Low birth weight
- Sudden infant death
- Ectopic pregnancy
- Orofacial clefts
- ADHD in children
How does smoking affect sperm
Affect number of sperm with abnormal morphology
- inc risk of birth defects
- miscarriage
- childhood cancer
Which receptor does nicotine stimulate? Release what?
Stimulate A4 B2 ACh receptor in the brain to release dopamine
How many mg of nicotine does each cig have?
How many is absorbed?
Lethal dose?
8-20mg
- 1-2 mg is absorbed
500-1500mg is lethal dose
What are negative effects of nicotine
BP inc #
HR inc #
- highly addictive with fast delivery
- teratogenic in fetal development
- inc BP by 5-10 mmHg
- inc HR by 10-20 bpm
What are positive benefits of nicotine? (3)
- Stimulates memory and alertness
- Improves depression, anxiety, pain, tourette’s, ADHD, weight loss, schizophrenia
- lower incidence of alzheimer’s, parkinson’s, colitis
T/F is nicotine as addicting as crack cocaine?
True
How much does quitting smoking before the age of 40 reduce risk of dying from smoking-related disease?
90%
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
What are benefits of stopping smoking before surgery? (3)
- Fewer complications & reduces recovery time
- Anesthesia is safer
- Improved healing & reduces the wound infections
What is the average quit attempts before someone is smoke-free for life
6-7 attempts
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
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
What are the 4Ds to manage cravings and triggers
Delay
Why do patients who quit smoking gain weight?
Patients are used to the hand to mouth -> eat more -> weight gain
T/F there is more depression in patients who smoke
MOA?
True
- tobacco smoke has monoamine oxidase inhibitor
T/F NRT is arterial delivery
False
- venous
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)
NRT patch dosing
14mg
21mg
21mg + 7
14mg
- <10 cpd
21mg
- 10-29 cpd
21mg + 7
- over 29 cpd
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)
Which dosage form is useful in reduce to quit strategy and address oral craving
Nicotine gum
What can impair buccal absorption of nicotine?
Recent food and fluids (especially acidic)
What are the steps for taking nicotine gum (4)
- Chew once or twice
- Park the gum between your gums and cheek
- Hold gum in position for 1 minute until taste fades
- repeat for 30 minutes then discard
Where is the nicotine inhaler absorbed? What problem does it address?
oral mucosa
- not lungs
Addresses hand to mouth ritual
T/F nicotine inhaler can be used with patch
True
Directions in using a nicotine lozenge?
Suck until strong flavour, then park until it fades
- repeat process for 30 minutes
How do you use the nicotine quick mist spray
- Prime the spray pump (1st use of sitting over 2 days)
- Point spray nozzle as close as possible to open mouth on the cheek
- avoid spraying down throat - Use 1-2 sprays every 30-60 PRN
Buproprion
Drug class
MOA
Drug class
- norepinephrine dopamine reuptake inhibitor
MOA
- increase in dopamine
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
Buproprion
Most common Side effects (2)
- Dry mouth
- insomnia (easily avoidable, can take in the AM)
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)
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
How long is varenicline used for? Dose
up to 24 weeks
Dose
- 0.5mg daily then BID
varenicline
Side effects (2)
- Nausea, insomnia
- Psychiatric effects (mood, agitation, behavioural changes)
Which drug is the most effective in helping smokers achieve abstinence?
Varenicline
T/F there are no increase in CV events with NRT or vareniciline
True
Which combination is effective 1st line choice?
Bupropion & NRT
Varenicline drug interactions
- Alcohol
- h2 antagonists
- quinolone antibiotics
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
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
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
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
What are the stages patients are in for quitting smoking (5)
- Pre-contemplation
- Cons> pros - Contemplation
- Pros = cons - Preparation
- Pros > cons - Action
- Maintenance
- 6+ months
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
What are general principles of motivation interviewing? (4)
- Express empathy
- Develop discrepancy
- Roll with resistance
- Support self-efficacy
What are the 5 R’s to enhance motivation to quit tobacco
- Relevance
- the “why test” - Risks
- consequences - Rewards
- long-term benefits - Roadblocks
- identify barrers - Repetition
- repeat at each encounter
- reassure those who have failed
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
