Smoking Cessation

Question 0

What is nicotine?

Answer 0

occurring substance in tobacco
most addictive agent
NOT carcinogenic

Question 1

Smoking related with?

Answer 1

mental disorder

Question 2

What is in the smoke/smoking condensate?

Answer 2

nicotine and vasoconstriction
CO
toxic and carcinogenic additives and chemical reactions
enters via ARTERIAL route (FASTER than venous)
7000 harmful chemicals enter smokers bloodstream

Question 3

Smoke chemicals?

Answer 3

Lead and polonium
hydrogen cyanide
formaldehye
aresenic
methanol (rocket fuel)

Question 4

Nicotine half life?

Answer 4

1-2hrs

approximately 6 hrs

Question 5

Nicotine doses can be manipulated by?

Answer 5

puff volume
depth of inhalation
extent of dilution with room air
rate and intensity of puffing

Question 6

Addictive nature of nicotine?

Answer 6

nicotinic receptors releases dopamine
nicotine remains int eh nicotinic receptors for approximately two hrs
dopamine shuts off when nicotine fades out of the receptors –> nicotine cravings begin
pts needs to smoke every 2 hrs
makes more nicotinic receptors

Question 7

MAO A in the brain?

Answer 7

inhibiting MAOA blocks the dopamine and serotonin

Question 8

Harman?

Answer 8

condesnation produce of acetaldheye and biogenic amines

Question 9

What does Harman do?

Answer 9

inhibits MAO

passes BBB

Question 10

What happens to the nicotine receptors when they quit?

Answer 10

goes back to the normal number of nicotine receptors

Question 11

Nicotine receptors and Ach?

Answer 11

attaches to Ach and mimics actions of Ach

Question 12

Menthol?

Answer 12

very addicted

Question 13

Smoking: male vs female?

Answer 13

Male:
-true addiction
female:
-habit formation

Question 14

E cig?

Answer 14

liquid nicotine turns into vapor
cannot be used in hospital (potential spark)
NOT vapor - AEROSOL
cannot tell how much nicotine is in the e cig
never intended to help ppl stop smoking - target YA

Question 15

Tx?

Answer 15

first line: nicotine replacement therapy, bupropion, varenicline
second line: nortripyline, clonodine
future: topirimate

Question 16

Vernicline?

Answer 16

start 1 wk before quit date

Question 17

NRT?

Answer 17

patch plus: basal + short acting –> both basal and short acting
basal dose: based on number of cigs per day
takes 24 hrs
bridge w/ prn NRT for the first 24 hrs
too much NRT: increased nausea

Question 18

How many NRT lozenges can you have?

Answer 18

no more than 20/day

Question 19

NRT basal dose?

Answer 19

less than 10 CPD –> 14mg
+5cpd = +7mg
40cpd = 42mg

Question 20

Short acting lozenge/gum?

Answer 20

2mg - small dose (20cpd)

Question 21

Instruction for “gum”?

Answer 21

do not chew/sucked –> all goes to GI –> GI probs

puncture to get the drugs out

Question 22

Motivational interviewing?

Answer 22

collaborative conversation style for strengthening a persons own motivation and commitment to change 
not arguing and needs to change
not offering direct advice to giving a solution w/out the pt's permission
not taking expert stance
not doing most of the talking 
express empathy
develop discrepancy
dance w/ discord
support self efficacy