Smoking Cessation Flashcards
What is nicotine?
occurring substance in tobacco
most addictive agent
NOT carcinogenic
Smoking related with?
mental disorder
What is in the smoke/smoking condensate?
nicotine and vasoconstriction
CO
toxic and carcinogenic additives and chemical reactions
enters via ARTERIAL route (FASTER than venous)
7000 harmful chemicals enter smokers bloodstream
Smoke chemicals?
Lead and polonium hydrogen cyanide formaldehye aresenic methanol (rocket fuel)
Nicotine half life?
1-2hrs
approximately 6 hrs
Nicotine doses can be manipulated by?
puff volume
depth of inhalation
extent of dilution with room air
rate and intensity of puffing
Addictive nature of nicotine?
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
MAO A in the brain?
inhibiting MAOA blocks the dopamine and serotonin
Harman?
condesnation produce of acetaldheye and biogenic amines
What does Harman do?
inhibits MAO
passes BBB
What happens to the nicotine receptors when they quit?
goes back to the normal number of nicotine receptors
Nicotine receptors and Ach?
attaches to Ach and mimics actions of Ach
Menthol?
very addicted
Smoking: male vs female?
Male:
-true addiction
female:
-habit formation
E cig?
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
Tx?
first line: nicotine replacement therapy, bupropion, varenicline
second line: nortripyline, clonodine
future: topirimate
Vernicline?
start 1 wk before quit date
NRT?
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
How many NRT lozenges can you have?
no more than 20/day
NRT basal dose?
less than 10 CPD –> 14mg
+5cpd = +7mg
40cpd = 42mg
Short acting lozenge/gum?
2mg - small dose (20cpd)
Instruction for “gum”?
do not chew/sucked –> all goes to GI –> GI probs
puncture to get the drugs out
Motivational interviewing?
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
