Smoking Cessation

Question 1

What two neurotransmitters are released in response to nicotine that produce pleasurable response and reinforces the addiction?

Answer 1

dopamine and norepinephrine

Question 2

T/F smoking increases total cholesterol and LDL, and decreases HDL

Answer 2

true

Question 3

What conditions are children exposed to smoking at a greater risk of developing?

Answer 3

Middle ear infections, Lower respiratory tract infections, Asthma, leukemia

Question 4

In the US, how many deaths are caused by fetal tobacco syndrome?

Answer 4

4,000 infant deaths

Question 5

How long does it take for the risk of CAD to be indistinguishable from that of individuals who have never smoked after quitting?

Answer 5

within 2 years. This is true no matter how long or how much one smoked

Question 6

What percentage of smokers receive medical advice or assistance about quitting?

Answer 6

20%

Question 7

What are the 5 stages of change?

Answer 7

Stage 1 – Precontemplation, Stage 2 – Contemplation, Stage 3 – Preparation, Stage 4 – Action, Stage 5 - Maintenance

Question 8

How should you counsel a patient regarding the weight gain they may experience when they quit?

Answer 8

80% of patients gain weight over the first months post cessation, (approx. 2kg – 10kg average) but later lose much or all of this weight

Question 9

What are the first line medications for smoking cessation?

Answer 9

nicotine replacement, bupropion SR, varenicline

Question 10

When do nicotine withdrawal cravings peak?

Answer 10

within 24-72 hours, then decline over the next several weeks

Question 11

What are the common nicotine patches?

Answer 11

Nicoderm CQ, Habitrol, Rite Aid, Novartis

Question 12

What is the recommended patch dosing for someone who smokes more than 10 cigarettes/day?

Answer 12

21mg for 6 weeks, 14mg for 2 weeks, 7 mg for 2 weeks (10 weeks total)

Question 13

What is the recommended patch dosing for someone who smokes ess than 10 cigarettes/day?

Answer 13

14mg for 6 weeks, then 7mg for 2 weeks (8 weeks total)

Question 14

What are contraindications to the patch?

Answer 14

pregnant/breastfeeding, continuing to use tobacco, dyrhythmias, HTN, depression, asthma

Question 15

What is the recommended dosing for nicotine gum?

Answer 15

those smoking more than 25 cigarettes per day start with 4mg, everyone else starts at 2mg. chew one piece of gum every 1-2 hours at first. No more than 24 pieces/day

Question 16

What is the recommended dosing for lozenges?

Answer 16

If patients usually smokes first cigarette within 30 minutes of waking up, use the 4mg lozenge. If patients has first smoke after 30 minutes, use the 2mg lozenge.

Question 17

When should nicotine nasal spray (NICOTROL NS) be used?

Answer 17

reserved for patients who have failed to quit smoking by using gum or patch. High side effect profile and increased dependence

Question 18

Name three advantage of the nicotine patch?

Answer 18

Steady-state nicotine levels, Easy to use and conceal, good compliance

Question 19

T/F. Disadvantages to the patch include inability to titrate dose, allergic rxns, and not available for use in patients w/dermatologic conditions?

Answer 19

True

Question 20

Name three advantage of nicotine gum/

Answer 20

satisfy oral cravings, delay weigh gain, ability to titrate therapy

Question 21

T/F. Disadvantage to the patch include gum chewing is rude, may ruin dental work, need proper chewing technique, and can’t eat or drink 30 minutes before or while using the gum

Answer 21

False, can’t eat or drink 15 minutes before using the gum. everything else is true

Question 22

Which of the following are advantages to nicotine lozenges: satisfy oral cravings, easy to use and conceal, ability to titrate doses

Answer 22

All are advantages of lozenges.

Question 23

What are three disadvantages to nicotine lozenges?

Answer 23

GI side effects, slow dissolution (20-30 minutes), no eating 15 minutes before or during use

Question 24

T/F. Advantages to nicotine nasal spray are its easy titration and its similarities to crack cocaine

Answer 24

False, it shares no similarities with crack cocaine. But it is easy to titrate

Question 25

What are three disadvantages to nicotine nasal spray?

Answer 25

nasal or throat irritation, higher potential for dependence, CI for patients with chronic nasal disorders

Question 26

Name two advantages of the nicotine inhaler

Answer 26

easy titration and mimics the hand-to-mouth ritual of smoking

Question 27

Which of the following are disadvantages to nicotine inhalers: throat/mouth irritation, cartridges need to be stored in thermal reservoirs, used w/caution in patients with underlying bronchospastic conditions?

Answer 27

All are true except cartridges are stored betwee 59-86 degree F (not thermal reservoirs)

Question 28

What are the dosing recommendations for buproprion (Zyban)?

Answer 28

Initial dose: 150mg/day x 3 days. dose can be increased to 150mg BID x 7-12 weeks. Max 300mg/day

Question 29

What are common side effects to buproprion (Zyban)?

Answer 29

dry mouth and insomnia

Question 30

What is the recommended dosing for Varenicline (Chantix)?

Answer 30

0.5mg and 1mg BID for 12 weeks.

Question 31

What should symptoms should be monitored closely for patients using Varenicline (Chantix)?

Answer 31

development of serious neuropsychiatric symptoms or worsening of psychiatric illness

Question 32

What is an absolute contraindication to Bupropion SR (Zyban)?

Answer 32

shouldn’t be prescribed to any patient with a h/o of seizures or any patient taking MAO inhibitors

Question 33

What is a major advantage of Bupropion SR (Zyban) over other medical therapies?

Answer 33

No risk of nicotine toxicity if patient continues to smoke