Smoking Cessation

Question 1

How many adults in the US smoke?

Answer 1

1 in 5

Question 2

What percent of smokers want to quit? What % succeed?

Answer 2

70% want to quit

5% succeed

Question 3

What are the 5 steps in treating tobacco use and dependence?

Answer 3

1. Ask (smoking status)
2. Advise (to quit)
3. Assess (willingness to quit)
4. Assist
5. Arrange

Question 4

What are the 5 Rs of motivational intervention with smokers who do not want to quit?

Answer 4

• Relevance
• Risks
• Rewards
• Roadblocks
• Repetition

Question 5

What test is used to evaluate tobacco use?

Answer 5

Fagerstrom test

Question 6

What are the treatment options (general) for smoking cessation?

Answer 6

• behavioral therapy
• nicotine replacement therapy (gum, lozenge, patch)
• Bupropion SR (Zyban)
• Varenicline (Chantix)
• 2nd line: clonidine and nortriptyline

Question 7

What is the quit rate associated with behavior modification programs?

Answer 7

30%

Question 8

How does nicotine replacement therapy work?

Answer 8

• 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

Question 9

How is transdermal NRT used?

Answer 9

• apply to non-hairy, clean, dry site on upper body
• rotate daily
• AE: erythema, burning, pruritis

Question 10

How is nicotine gum used?

Answer 10

• proper chewing technique to promote slow buccal absorption of nicotine
• 30 minutes
• park gum

Question 11

Nicotine Nasal Spray

Answer 11

• delivers nicotine more rapidly than gum or patch

- AE: nasal and throat irritation, rhinitis, sneezing, coughing, watering eyes

Question 12

Nicotine Inhaler

Answer 12

• plastic rod with a nicotine plug that provides a nicotine vapor when puffed
• each cartridge has 4 mg nicotine, similar to gum

Question 13

Nicotine Lozenge

Answer 13

• 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

Question 14

CIs of Bupropion

Answer 14

• hx of seizure disorder
• coadministration with MAOI
• current or prior dx of bulimia or anorexia nervosa
• do not use with Wellbutrin

Question 15

Drug Interactions of Bupropion

Answer 15

• carbamazepine decreases [bupropion]
• cimetidine increase [bupropion]
• MAOIs: increase toxicity of bupropion

Question 16

AEs of Bupropion

Answer 16

• seizures w/ high doses
• insomnia, irritability
• dry mouth, HA
• weight gain/loss

Question 17

When is therapy initiated with bupropion?

Answer 17

while patient is still smoking and establish target quit date for 7 days after starting Zyban

Question 18

Who requires adjusted Zyban dosing and how should it be adjusted?

Answer 18

• pts with renal or hepatic insufficiency

- decrease dose by 50%

Question 19

MOA of Chantix/Varenicline

Answer 19

• selectively blocks nicotine binding to alpha4 beta2 nicotinic ACh receptors
• partially stimulates the nicotinic receptor to decrease cravings and withdrawal sxs

Question 20

Precautions for Chantix

Answer 20

• 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

Question 21

AEs of Chantix

Answer 21

• 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

Question 22

Who requires adjusted dosing of Chantix?

Answer 22

renal dysfuncton (if CrCl < 30 mL/min)

Question 23

Usage of Chantix is banned in which groups?

Answer 23

-airline pilots and air traffic controllers