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Naplex 2025 > Smoking Cessation > Flashcards

Smoking Cessation Flashcards

1
Q

What are some of the notable risk factors associated with Smoking?

A
  • Heart Disease
  • Stroke
  • Pregnanct Complications
  • COPD
  • Cancers
  • Etc…
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2
Q

What is that we find the Pack-Year Smoking History?

A
  • Cigarettes packs / Days x # of years
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3
Q

What are some of the chemicals that cigarettes activiate and how does that affect the body?

A
  • Nicotinic and Dopamine Receptor
  • increase dopamine release and activation of reward center
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4
Q

What is an essential part of smoking cessations and what are the two components of it?

A
  • COUNSELING
  • Behavioral and Soical
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5
Q

What are the 5 A’s of smoking cessation?

A
  • Ask about use
  • Advise to quit
  • Assess wanting to quit
  • Assist in quiting
  • Arrange follow up
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6
Q

What should be encourage for all smokers and what are some of the things they can help with?

“withdrawal symptoms”

A
  • Medications [OTC or RX]
  • Help with: anxiety, irritability, depression, insomnia, poor concentration, restlessness, increased appetite…
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7
Q

What are the first line options for Smoking Cessation?

A
  • 5 OTC: Patch, Gum, Lozenge, Nasal Spray, Inhaler
  • 2 Rx: Bupropion & Varenicline
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8
Q

How should you use the Medicaitons in a first line way?

A
  • Combination of two drugs [i.e., patch + rx or patch + gum]
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9
Q

What are some exceptions to drug treatment in smoking cessation?

A
  • ALWAYS do beheavioral over drugs for those that have limited safety [Pregnancy, adolsecent, smokeless tobacco, “light” smokers]

Light = < 10 cigarettes a day

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10
Q

What is important to know about electronic cigarettes when it comes to smoking cessation?

A
  • NOT RECOMMENDED
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11
Q

What are some of the drug interactions with smoking?

A
  • Tobacco induces 1A2
  • Those that quit have increased levels of caffeine, theophylline, fluvoxmine, olanzapine, cloazpine, R-warfarin
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12
Q

What are some of the vaccines that smokers should get?

A
  • 19-64 yo should get pneumoccocal and flu
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13
Q

What are the Nicotine Replacement Therapies [NRT] that are used?

A
  • Patch [NicoDerm CQ]
  • Gum [Nicorette]
  • Lozenge [Nicorette Mini]
  • Inhaler
  • Nasal Spray

Patch, Gum,, Lozenge = OTC
Inhaler, Nasal Spray = RX

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14
Q

How is the Patch dosed for smoking cessation?

A
  • Number of cigarettes per day
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15
Q

How is the Gum and Lozenge dosed in smoking cessation?

A
  • Timing to first cigarette upon waking
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16
Q

What are some of the warnings for NRTs in smoking cessation?

A
  • AVOID post MI, with arrhythmias, angina, pregnancy
  • NO inhalers or nasal sprays in COPD/Asthma
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17
Q

What are some of the Side Effects of NRT in smoking cessation?

A
  • Insomnia, headache, dizziness, nervousness, dyspepsia
  • Patch = Vivid Dreams
  • Inhalers = mouth/throat infections
  • Nasal Spray = nasal irriation
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18
Q

What is the dosing strategy for the patch if the patient has smoked MORE than 10 cigarettes per day?

A
  • Start: 21mg/d x 6w
  • Then: 14mg/d x 2w
  • Last: 7mg/d x 2w
19
Q

What is the dosing strategy for the patch if the patient has smoked LESS than 10 cigarettes per day?

A
  • Start: 14mg/d x 6w
  • Last: 7mg/d x 2w
20
Q

What is the dosing strategy for the gum and lozenge if the patient has their first cigarette LESS THAN 30 minutes upon waking?

A
  • Start: 4mg Q1-2H x 6w
  • Then: 4mg Q2-4H x3w
  • Last: 4mg Q4-8H x 3w
21
Q

What is the dosing strategy for the gum and lozenge if the patient has their first cigarette MORE THAN 30 minutes upon waking?

A
  • Start: 2mg Q1-2H x6w
  • Then: 2mg Q2-4h x 3w
  • Last: 2mg Q4-8H x 3w
22
Q

What is the MOA of Burpropion?

A
  • Blocks reuptake of dopamine and/or norepinephrine
23
Q

When should Bupropion be started?

A
  • BEFORE the quit day [1-2w
  • NO need to taper
24
Q

What are some of the Formulations for Bupropion and some of the Dosing?

A
  • Bupropion SR, Wellbutrin SR & XL [for depression]
  • SR: 150mg QAM x3d, then 150mg BID [MAX: 300mg]
25
Q

What are the boxed warnings for Bupropion?

A
  • Increase suicidal thoughts in childern, adolescents, and young adults on Antidepressants
26
Q

What are the contraindications for Bupropion?

A
  • Those with… seizures, anorexia/bulimia; using MAOi, linezolid, or IV methylene blue
27
Q

What are some of the warnings for Bupropion?

A
  • Neuropsychiatric events [mood, hallucinations, paranoia, anxeity…]
28
Q

What are the side effects of bupropion?

A
  • Dry Mouth
  • Insomnia
  • Tremors
  • Weight Loss
  • Anxiety
  • Headache…
29
Q

What is the MOA for Varenicline?

A
  • Partial agonist for alpha-4 beta-2 nicotinic receptor
  • Stops nicotine from binding and relieves withdrawal symptoms/stops surges of dopamine
30
Q

When should Varenicline be started?

A
  • BEFORE the quit date [1w]
  • NO need to taper
31
Q

What is the dosing for varenicline?

A
  • Day 1-3: 0.5mg QD
  • Day 4-7: 0.5mg BID
  • Day 8+: 1mg BID
32
Q

What are some of the warnings for Varenicline?

A
  • Neuropsychiatric Events [mood, hallucinations, paranoia, anxeity…]
33
Q

What are some of the Side Effects of Varenicline?

A
  • Nausea
  • Insomnia
  • Vivid Dreams
  • Headaches
34
Q

What is important to know when taking Varenicline?

A
  • Take after eating with a full glass of water
35
Q

What are some treatment considerations for Tobacco Cessation?

A
  • ALL should be offered meds unless contraindicated
  • COMBO! of Patch + Gum, Lozenge or Bupropion
  • Varenciline > Bupropion
36
Q

What should you use in Weight Gain, Depression, Dentures, Asthma/COPD, Skin Issues, or Seizures for Smoking cessation?

A
  • Weight Gain: USE gum, lozenge, Bupropion SR
  • Depression: USE Bupropion SR
  • Dentures: AVOID Gum
  • Asthma/COPD: AVOID inhaler, nasal spray
  • Skin: AVOID patch
  • Seizures: AVOID buproion, varenicline
37
Q

What are some key conseling points for patches?

“administration”

A
  • Use in AM [save pouch to use to throw away]
  • Sticky side on clean, dry, hairless area
  • Wear for 24h
  • Rotate sites
  • NEVER cut or wear more than one
38
Q

What are some key conseling points for gum?

“chewing”

A
  • Chew slowly until “tingle” or peppery taste
  • Then park between gum and check
  • No tingle; chew again slowly until its back
  • Repeat until no more tingle
  • DO NOT eat or drink 15 mins before or during chewing
39
Q

What are some key conseling points for Lozenge?

A
  • DO NOT eat or drink 15 mins before or during
  • DO NOT chew
  • May cause tingle
  • NO more than one at a time
40
Q

What are some key conseling points for inhaler?

A
  • Inhale deeply or short puffs
  • Cartridge = 20mins of use
  • Clean Mouthpiece regularly
  • Keep at room temp
41
Q

What are some key conseling points for nasal spray?

A
  • Tilt head back and spray once in each nostril
  • May cause sneeze or coughing
42
Q

What are some key conseling points for bupropion/

A
  • START 1 week before quit
  • Can cause…suicidal thoughts or nausea
  • DO NOT use if… seizure, anorexia/bulimia
43
Q

What are some key conseling points for varenicline?

A
  • START 1 week before quit
  • Can increase alcohol effects

Naplex 2025 (10 decks)

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