Smoking Cessation Flashcards
How many adults in the US smoke?
1 in 5
What percent of smokers want to quit? What % succeed?
70% want to quit
5% succeed
What are the 5 steps in treating tobacco use and dependence?
- Ask (smoking status)
- Advise (to quit)
- Assess (willingness to quit)
- Assist
- Arrange
What are the 5 Rs of motivational intervention with smokers who do not want to quit?
- Relevance
- Risks
- Rewards
- Roadblocks
- Repetition
What test is used to evaluate tobacco use?
Fagerstrom test
What are the treatment options (general) for smoking cessation?
- behavioral therapy
- nicotine replacement therapy (gum, lozenge, patch)
- Bupropion SR (Zyban)
- Varenicline (Chantix)
- 2nd line: clonidine and nortriptyline
What is the quit rate associated with behavior modification programs?
30%
How does nicotine replacement therapy work?
- supplies body w/ low levels of nicotine to help diminish withdrawal sxs
- doubles quit rate when used w/ behavioral counseling
- not recommended for active smokers, active PUD, pregnancy, lactation
How is transdermal NRT used?
- apply to non-hairy, clean, dry site on upper body
- rotate daily
- AE: erythema, burning, pruritis
How is nicotine gum used?
- proper chewing technique to promote slow buccal absorption of nicotine
- 30 minutes
- park gum
Nicotine Nasal Spray
- delivers nicotine more rapidly than gum or patch
- AE: nasal and throat irritation, rhinitis, sneezing, coughing, watering eyes
Nicotine Inhaler
- plastic rod with a nicotine plug that provides a nicotine vapor when puffed
- each cartridge has 4 mg nicotine, similar to gum
Nicotine Lozenge
- full dose released gradually by placing lozenge in mouth and sucking until completely dissolved
- dosing based on time to 1st cigarette (< or > 30 minutes in AM)
- avoid eating or drinking acidic products 15 minutes before/after
CIs of Bupropion
- hx of seizure disorder
- coadministration with MAOI
- current or prior dx of bulimia or anorexia nervosa
- do not use with Wellbutrin
Drug Interactions of Bupropion
- carbamazepine decreases [bupropion]
- cimetidine increase [bupropion]
- MAOIs: increase toxicity of bupropion
AEs of Bupropion
- seizures w/ high doses
- insomnia, irritability
- dry mouth, HA
- weight gain/loss
When is therapy initiated with bupropion?
while patient is still smoking and establish target quit date for 7 days after starting Zyban
Who requires adjusted Zyban dosing and how should it be adjusted?
- pts with renal or hepatic insufficiency
- decrease dose by 50%
MOA of Chantix/Varenicline
- selectively blocks nicotine binding to alpha4 beta2 nicotinic ACh receptors
- partially stimulates the nicotinic receptor to decrease cravings and withdrawal sxs
Precautions for Chantix
- coadministration w/ NR patch resulted in increased risk of nausea, HA, vomiting, dizziness, fatigue
- safety and efficacy of administering w/ other NRTs has not been established
AEs of Chantix
- most common: nausea, sleep disturbance, HA, abnormal dreams, constipation, flatulence, vomiting
- several reports of violent or bizarre behavior, suicidal thoughts, suicide
- may be linked to MI, DM, seizure, confusion
Who requires adjusted dosing of Chantix?
renal dysfuncton (if CrCl < 30 mL/min)
Usage of Chantix is banned in which groups?
-airline pilots and air traffic controllers
