Smoking Cessation Flashcards
What are some of the notable risk factors associated with Smoking?
- Heart Disease
- Stroke
- Pregnanct Complications
- COPD
- Cancers
- Etc…
What is that we find the Pack-Year Smoking History?
- Cigarettes packs / Days x # of years
What are some of the chemicals that cigarettes activiate and how does that affect the body?
- Nicotinic and Dopamine Receptor
- increase dopamine release and activation of reward center
What is an essential part of smoking cessations and what are the two components of it?
- COUNSELING
- Behavioral and Soical
What are the 5 A’s of smoking cessation?
- Ask about use
- Advise to quit
- Assess wanting to quit
- Assist in quiting
- Arrange follow up
What should be encourage for all smokers and what are some of the things they can help with?
“withdrawal symptoms”
- Medications [OTC or RX]
- Help with: anxiety, irritability, depression, insomnia, poor concentration, restlessness, increased appetite…
What are the first line options for Smoking Cessation?
- 5 OTC: Patch, Gum, Lozenge, Nasal Spray, Inhaler
- 2 Rx: Bupropion & Varenicline
How should you use the Medicaitons in a first line way?
- Combination of two drugs [i.e., patch + rx or patch + gum]
What are some exceptions to drug treatment in smoking cessation?
- ALWAYS do beheavioral over drugs for those that have limited safety [Pregnancy, adolsecent, smokeless tobacco, “light” smokers]
Light = < 10 cigarettes a day
What is important to know about electronic cigarettes when it comes to smoking cessation?
- NOT RECOMMENDED
What are some of the drug interactions with smoking?
- Tobacco induces 1A2
- Those that quit have increased levels of caffeine, theophylline, fluvoxmine, olanzapine, cloazpine, R-warfarin
What are some of the vaccines that smokers should get?
- 19-64 yo should get pneumoccocal and flu
What are the Nicotine Replacement Therapies [NRT] that are used?
- Patch [NicoDerm CQ]
- Gum [Nicorette]
- Lozenge [Nicorette Mini]
- Inhaler
- Nasal Spray
Patch, Gum,, Lozenge = OTC
Inhaler, Nasal Spray = RX
How is the Patch dosed for smoking cessation?
- Number of cigarettes per day
How is the Gum and Lozenge dosed in smoking cessation?
- Timing to first cigarette upon waking
What are some of the warnings for NRTs in smoking cessation?
- AVOID post MI, with arrhythmias, angina, pregnancy
- NO inhalers or nasal sprays in COPD/Asthma
What are some of the Side Effects of NRT in smoking cessation?
- Insomnia, headache, dizziness, nervousness, dyspepsia
- Patch = Vivid Dreams
- Inhalers = mouth/throat infections
- Nasal Spray = nasal irriation
What is the dosing strategy for the patch if the patient has smoked MORE than 10 cigarettes per day?
- Start: 21mg/d x 6w
- Then: 14mg/d x 2w
- Last: 7mg/d x 2w
What is the dosing strategy for the patch if the patient has smoked LESS than 10 cigarettes per day?
- Start: 14mg/d x 6w
- Last: 7mg/d x 2w
What is the dosing strategy for the gum and lozenge if the patient has their first cigarette LESS THAN 30 minutes upon waking?
- Start: 4mg Q1-2H x 6w
- Then: 4mg Q2-4H x3w
- Last: 4mg Q4-8H x 3w
What is the dosing strategy for the gum and lozenge if the patient has their first cigarette MORE THAN 30 minutes upon waking?
- Start: 2mg Q1-2H x6w
- Then: 2mg Q2-4h x 3w
- Last: 2mg Q4-8H x 3w
What is the MOA of Burpropion?
- Blocks reuptake of dopamine and/or norepinephrine
When should Bupropion be started?
- BEFORE the quit day [1-2w
- NO need to taper
What are some of the Formulations for Bupropion and some of the Dosing?
- Bupropion SR, Wellbutrin SR & XL [for depression]
- SR: 150mg QAM x3d, then 150mg BID [MAX: 300mg]
