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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
Q

T/F is nicotine as addicting as crack cocaine?

A

True

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25
Q

How much does quitting smoking before the age of 40 reduce risk of dying from smoking-related disease?

A

90%

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26
Q

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

A

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
Q

What are benefits of stopping smoking before surgery? (3)

A
  • Fewer complications & reduces recovery time
  • Anesthesia is safer
  • Improved healing & reduces the wound infections
28
Q

What is the average quit attempts before someone is smoke-free for life

A

6-7 attempts

29
Q

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”

A

Advise

30
Q

What is the acronym for quit plan?
What does it stand for?

A

S Set a quit date/reduce day
T Tell a family, friend
A Anticipate challenges
R Remove tobacco products

31
Q

What are the 4Ds to manage cravings and triggers

A

Delay

32
Q

Why do patients who quit smoking gain weight?

A

Patients are used to the hand to mouth -> eat more -> weight gain

33
Q

T/F there is more depression in patients who smoke
MOA?

A

True
- tobacco smoke has monoamine oxidase inhibitor

34
Q

T/F NRT is arterial delivery

A

False
- venous

35
Q

Are you able to go into the water with an NRT patch?
Exercise?

A

Water?
Yes, for short periods of times

Exercise
- remove patch 2 hours before engaging in prolonged exercise (increases absorption)

36
Q

NRT patch dosing
14mg
21mg
21mg + 7

A

14mg
- <10 cpd

21mg
- 10-29 cpd

21mg + 7
- over 29 cpd

37
Q

What to do if patient has skin reactions from the patch (4)

A
  • try different brand
  • HC cream
  • Daily non-drowsy antihistamine (cetirizine/reactine)
  • Topical corticosteroid inhaler spray (fluticasone)
38
Q

Which dosage form is useful in reduce to quit strategy and address oral craving

A

Nicotine gum

39
Q

What can impair buccal absorption of nicotine?

A

Recent food and fluids (especially acidic)

40
Q

What are the steps for taking nicotine gum (4)

A
  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
Q

Where is the nicotine inhaler absorbed? What problem does it address?

A

oral mucosa
- not lungs

Addresses hand to mouth ritual

42
Q

T/F nicotine inhaler can be used with patch

A

True

43
Q

Directions in using a nicotine lozenge?

A

Suck until strong flavour, then park until it fades
- repeat process for 30 minutes

44
Q

How do you use the nicotine quick mist spray

A
  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
  3. Use 1-2 sprays every 30-60 PRN
45
Q

Buproprion
Drug class
MOA

A

Drug class
- norepinephrine dopamine reuptake inhibitor

MOA
- increase in dopamine

46
Q

Bupropion dosing
When to begin?
Duration?
Titration

A
  • 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
Q

Buproprion
Most common Side effects (2)

A
  • Dry mouth
  • insomnia (easily avoidable, can take in the AM)
48
Q

Bupropion
Contraindications? (5)
Drug interactions?

A

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
Q

Varenicline
drug class & MOA

A

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
Q

How long is varenicline used for? Dose

A

up to 24 weeks

Dose
- 0.5mg daily then BID

51
Q

varenicline
Side effects (2)

A
  • Nausea, insomnia
  • Psychiatric effects (mood, agitation, behavioural changes)
52
Q

Which drug is the most effective in helping smokers achieve abstinence?

A

Varenicline

53
Q

T/F there are no increase in CV events with NRT or vareniciline

A

True

54
Q

Which combination is effective 1st line choice?

A

Bupropion & NRT

55
Q

Varenicline drug interactions

A
  • Alcohol
  • h2 antagonists
  • quinolone antibiotics
56
Q

What is the first approach to smoking cessation in pregnancy & breastfeeding?

A

Counselling is first line
- if ineffective, intermittent NRT dosing (lozenges, gum) used over patch

57
Q

What are most drug interactions with smoking associated with?
Which enzyme?
inc/dec med dose if patient is quitting smoke?

A

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
Q

What should patients do if they are planning on quitting smoking and drink 5+ cups of coffee/day

A

Caffeine metabolized by CYP1A2
- need to cut intake by half

59
Q

Which NHP is similar efficacy to varenicline? What is it made of?
MOA?

A

Cystine
- plant-based alkaloid found in members of leguminoase
- partial agonist of a4B2 receptor

60
Q

What are the stages patients are in for quitting smoking (5)

A
  1. Pre-contemplation
    - Cons> pros
  2. Contemplation
    - Pros = cons
  3. Preparation
    - Pros > cons
  4. Action
  5. Maintenance
    - 6+ months
61
Q

In the conviction confidence model, define (high/low), give examples:
Skepticism
Frustration
Lack of knowledge cynicism
Empowered

A

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
Q

What are general principles of motivation interviewing? (4)

A
  1. Express empathy
  2. Develop discrepancy
  3. Roll with resistance
  4. Support self-efficacy
63
Q

What are the 5 R’s to enhance motivation to quit tobacco

A
  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
Q

T/F
1/2 of smokers will die from smoking
1 in 4 deaths is caused by smokers

A

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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