Smoking Cessation

Question 1

Medical conditions related to tobacco: Cardiovascular disease and Stroke

Answer 1

Raises triglycerides
Lowers HDL
Damage cells that line blood vessels
Causes thickening and narrow of blood vessels
Causes clots to form

Question 2

Medical conditions related to tobacco: Pregnancy

Answer 2

Damage sperm and ED
Premature birth
Birth defects
SIDS

Question 3

Medical conditions related to tobacco: Bone and tissue

Answer 3

Osteoporosis
Delayed bone healing after fracture
Gum disease

Question 4

Smokeless tobacco cancers in your body

Answer 4

Esophagus
Mouth and throat
Pancreas

Question 5

Nicotine replacement therapies timeline

Answer 5

NRT is recommended for 2-3 months after smoking cessation

Question 6

NRT taper dosage

Answer 6

Light smokers 10cigs/day

Start on quit day with 21mg/day for 6 weeks, followed by 14mg/day for 2 weeks, finish with 7mg/day for 2 weeks

Question 7

Nicotine lozenge (OTC)

Answer 7

Placed in the mouth and dissolves over 30 minutes
Can be used in smokers with TMJ, poor dentition, or dentures
Use one lozenge every 1-2 hours for 6 weeks
Maximum dose is 5 lozenges every 6 hours or 20 lozenges per day

Question 8

Nicotine gum (OTC)

Answer 8

Most common short-acting NRT used
Chewing the gum releases nicotine that is absorbed through the oral mucosa
Chew one piece of gum every 1-2 hours for 6 for a total duration of 3 months

Question 9

Varenicline (Chantix) MOA

Answer 9

Agonizes and blocks alpha-4 beta-2 nicotine acetylcholine receptors
Binds to and produces partial stimulation of alpha-4 beta-2 nicotine receptor, thereby reducing nicotine withdrawal
Since the drug binds to alpha-4 beta-2 it blocks nicotine from binding to the receptor reducing the pleasure reward

Question 10

Bupropion (Wellbutrin, Zyban)

Answer 10

Unknown; thought to act by enhancing central nervous system noradrenergic and dopaminergic release
May benefit smokers who are concerned about post-cessation weight gain
Considered first-line therapy for smokers with schizophrenia
Contraindicated for smokers with seizure disorder

Question 11

Varenicline (Chantix) SE

Answer 11

Neuropsychiatric side effects: Risk of suicide (Black Box Warning)
Cardiovascular side effects: MI, Stroke

Nausea
Constipation
Sleep disturbance
Unusual dreams

Question 12

Bupropion (Wellbutrin, Zyban) SE

Answer 12

Insomnia
Dry mouth
Headaches

Question 13

5 stages of change

Answer 13

Stage 1- Pre-contemplation: Not thinking about quitting
Stage 2- Contemplation: Thinking about quitting but not ready to quit
Stage 3- Preparation: Getting ready to quit
Stage 4- Action: Quitting, actively trying
Stage 5- Maintenance: Remaining a non-smoker

Question 14

Cessation techniques 5 A’s

Answer 14

Ask- ask each patient about tobacco use
Advise- strongly urge all tobacco user to quit
Advice- (Clear, Strong, Personalized)
Assess- determine the patient’s willingness to quit in the next 30 days
Assist- provide aid for the patient to quit
Arrange- schedule follow-up, congratulate on success

Question 15

Calculate “pack years”

Answer 15

Number of pack-years=(packs smoke per day) x (years as a smoker) or
Number of pack-years=(number of cigarettes smoked per day/20) x number of years smoked