Smoking Cessation Flashcards
What two neurotransmitters are released in response to nicotine that produce pleasurable response and reinforces the addiction?
dopamine and norepinephrine
T/F smoking increases total cholesterol and LDL, and decreases HDL
true
What conditions are children exposed to smoking at a greater risk of developing?
Middle ear infections, Lower respiratory tract infections, Asthma, leukemia
In the US, how many deaths are caused by fetal tobacco syndrome?
4,000 infant deaths
How long does it take for the risk of CAD to be indistinguishable from that of individuals who have never smoked after quitting?
within 2 years. This is true no matter how long or how much one smoked
What percentage of smokers receive medical advice or assistance about quitting?
20%
What are the 5 stages of change?
Stage 1 – Precontemplation, Stage 2 – Contemplation, Stage 3 – Preparation, Stage 4 – Action, Stage 5 - Maintenance
How should you counsel a patient regarding the weight gain they may experience when they quit?
80% of patients gain weight over the first months post cessation, (approx. 2kg – 10kg average) but later lose much or all of this weight
What are the first line medications for smoking cessation?
nicotine replacement, bupropion SR, varenicline
When do nicotine withdrawal cravings peak?
within 24-72 hours, then decline over the next several weeks
What are the common nicotine patches?
Nicoderm CQ, Habitrol, Rite Aid, Novartis
What is the recommended patch dosing for someone who smokes more than 10 cigarettes/day?
21mg for 6 weeks, 14mg for 2 weeks, 7 mg for 2 weeks (10 weeks total)
What is the recommended patch dosing for someone who smokes ess than 10 cigarettes/day?
14mg for 6 weeks, then 7mg for 2 weeks (8 weeks total)
What are contraindications to the patch?
pregnant/breastfeeding, continuing to use tobacco, dyrhythmias, HTN, depression, asthma
What is the recommended dosing for nicotine gum?
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
What is the recommended dosing for lozenges?
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.
When should nicotine nasal spray (NICOTROL NS) be used?
reserved for patients who have failed to quit smoking by using gum or patch. High side effect profile and increased dependence
Name three advantage of the nicotine patch?
Steady-state nicotine levels, Easy to use and conceal, good compliance
T/F. Disadvantages to the patch include inability to titrate dose, allergic rxns, and not available for use in patients w/dermatologic conditions?
True
Name three advantage of nicotine gum/
satisfy oral cravings, delay weigh gain, ability to titrate therapy
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
False, can’t eat or drink 15 minutes before using the gum. everything else is true
Which of the following are advantages to nicotine lozenges: satisfy oral cravings, easy to use and conceal, ability to titrate doses
All are advantages of lozenges.
What are three disadvantages to nicotine lozenges?
GI side effects, slow dissolution (20-30 minutes), no eating 15 minutes before or during use
T/F. Advantages to nicotine nasal spray are its easy titration and its similarities to crack cocaine
False, it shares no similarities with crack cocaine. But it is easy to titrate
What are three disadvantages to nicotine nasal spray?
nasal or throat irritation, higher potential for dependence, CI for patients with chronic nasal disorders
Name two advantages of the nicotine inhaler
easy titration and mimics the hand-to-mouth ritual of smoking
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?
All are true except cartridges are stored betwee 59-86 degree F (not thermal reservoirs)
What are the dosing recommendations for buproprion (Zyban)?
Initial dose: 150mg/day x 3 days. dose can be increased to 150mg BID x 7-12 weeks. Max 300mg/day
What are common side effects to buproprion (Zyban)?
dry mouth and insomnia
What is the recommended dosing for Varenicline (Chantix)?
0.5mg and 1mg BID for 12 weeks.
What should symptoms should be monitored closely for patients using Varenicline (Chantix)?
development of serious neuropsychiatric symptoms or worsening of psychiatric illness
What is an absolute contraindication to Bupropion SR (Zyban)?
shouldn’t be prescribed to any patient with a h/o of seizures or any patient taking MAO inhibitors
What is a major advantage of Bupropion SR (Zyban) over other medical therapies?
No risk of nicotine toxicity if patient continues to smoke
