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]
What are the boxed warnings for Bupropion?
- Increase suicidal thoughts in childern, adolescents, and young adults on Antidepressants
What are the contraindications for Bupropion?
- Those with… seizures, anorexia/bulimia; using MAOi, linezolid, or IV methylene blue
What are some of the warnings for Bupropion?
- Neuropsychiatric events [mood, hallucinations, paranoia, anxeity…]
What are the side effects of bupropion?
- Dry Mouth
- Insomnia
- Tremors
- Weight Loss
- Anxiety
- Headache…
What is the MOA for Varenicline?
- Partial agonist for alpha-4 beta-2 nicotinic receptor
- Stops nicotine from binding and relieves withdrawal symptoms/stops surges of dopamine
When should Varenicline be started?
- BEFORE the quit date [1w]
- NO need to taper
What is the dosing for varenicline?
- Day 1-3: 0.5mg QD
- Day 4-7: 0.5mg BID
- Day 8+: 1mg BID
What are some of the warnings for Varenicline?
- Neuropsychiatric Events [mood, hallucinations, paranoia, anxeity…]
What are some of the Side Effects of Varenicline?
- Nausea
- Insomnia
- Vivid Dreams
- Headaches
What is important to know when taking Varenicline?
- Take after eating with a full glass of water
What are some treatment considerations for Tobacco Cessation?
- ALL should be offered meds unless contraindicated
- COMBO! of Patch + Gum, Lozenge or Bupropion
- Varenciline > Bupropion
What should you use in Weight Gain, Depression, Dentures, Asthma/COPD, Skin Issues, or Seizures for Smoking cessation?
- 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
What are some key conseling points for patches?
“administration”
- 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
What are some key conseling points for gum?
“chewing”
- 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
What are some key conseling points for Lozenge?
- DO NOT eat or drink 15 mins before or during
- DO NOT chew
- May cause tingle
- NO more than one at a time
What are some key conseling points for inhaler?
- Inhale deeply or short puffs
- Cartridge = 20mins of use
- Clean Mouthpiece regularly
- Keep at room temp
What are some key conseling points for nasal spray?
- Tilt head back and spray once in each nostril
- May cause sneeze or coughing
What are some key conseling points for bupropion/
- START 1 week before quit
- Can cause…suicidal thoughts or nausea
- DO NOT use if… seizure, anorexia/bulimia
What are some key conseling points for varenicline?
- START 1 week before quit
- Can increase alcohol effects
