Smoking cessation Flashcards

1
Q

What are e-cigarettes? (4 points)

A
  • battery powered devcies which heat a liquid (propylene glycol) to a vapour
  • liquid usually contains nicotine and falvouring
  • 466 brands and 7764 flavours in US
  • fruit, dessert, snacks, chocolate and alcohol most popular
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2
Q

What are the two target markets for the tobacco industry? (2 points)

A
  • youth: by branding, movies, celebraties and subliminal messages
  • smokers worried about their smoking via promotion by professionals, new cigs with filters, menthol and light or mild
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3
Q

Why is smoking cessation important? (4 points)

A
  • currently 6M deaths per year
  • smoking related diseases account for 1/10 adult deaths worldwide
  • 70% of deaths in developing countries
  • leading preventable cause of death
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4
Q

What are the 4 stages of the tobacco pandemic?

A

1) sub-saharn africa
2) china, japan, SE asia, latin america, north africa
3) eastern europe, southern europe
4) western europe, UK, USA, Canada, Aus

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5
Q

Why is smoking considered a chronic relapsing disease? (4 points)

A
  • persistent use despite obvious harm
  • withdrawal
  • loss of autonomy
  • chronic relapse
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6
Q

What are the components of a cigarette? (4 points)

A
  • cig smoke is a complex combo of over 7K chemicals incl. 40+ carcinogens
  • inhaled tar and CO are the greatest health risk
  • nicotine is the addictive component and this doesn’t cause cancer or heart disease
  • these chemicals have complex and profound effect on the body
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7
Q

How does nicotine affect the brain? (4 points)

A
  • combustion of tobacco releases tiny droplets of nicotine
  • these are absorbed through lungs -> bloodstream -> brain within 7-10 seconds
  • when first inhaled, brain deals with nicotine by changing its processes
  • most ppl are addicted within hours, days or weeks of their first cigarette
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8
Q

What are the two ways in which nicotine works to have an affect on the brain?

A
  1. sense of well being

2. ability to focus

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9
Q

Why is NRT not as effective in affecting mood than smoking?

A
  • mood fluctuates when they smoke, (upregulated receptors) and reduces after an hours
  • with NRT, the mood is already low, and after a few weeks has flatlined due to downregulated receptors
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10
Q

What are the major symptoms of nicotine withdrawal? (6 points)

A
  • can’t concentrate ( 2 weeks, 70%)

- irritability/aggression (10 weeks, 70%)

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11
Q

What are the three aspects to addiction?

A
  1. physiological triggers (treat with NRT)
  2. Internal triggers like thoughts/feelings (treat with mental and behavioural techniques)
  3. External triggers like habits and situations (also treat with mental and behavioural techniques)
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12
Q

How can you assess the level of nicotine addiction? (3 points)

A
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13
Q

What is the protocol for ppl who smoke within 60 min of waking? (3 points)

A
  • one high strength patch & one high strength gum/loz every hour
  • if not enough, 2 high strength patches etc.
  • to ensure withdrawal does not occur
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14
Q

Why do the # cig/day not measure addiction? (3 points)

A
  • with reduced opportunities to smoke, ppl can be smoking as few as 1/4 the number they used to smoke
  • compensatory smoking causes more inhalations and holding it down for longer
  • resulting in getting the same amount of nicotine and the CO, tars, chemicals and gases
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15
Q

How is nicotine delivery by NRT different to inhaled nicotine? (3 points)

A
  • NRT only reaches just above the trough of inhaled nicotine concentrations
  • one high strength NRT provides ~12ng of nicotine in the bloodstream
  • generally two high strength NRT delivery systems are needed to get close to inhlaed nicotine
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16
Q

What are the subsidised NRT products in NZ? (4 points)

A
  • Novatis Habitrol available in:
  • patches $5 for 8 weeks
  • gum “
  • lozenges “
17
Q

What are some examples of non-subsidised NRT products? (3 points)

A
  • Inhalator
  • quickmist
  • cooldrops
18
Q

How are NRT gums used? (5 points)

A
  • bite and park between gum and teeth (alternate prn)
  • peppery tingly feeling is nicotine passing through bloodstream
  • do not use if mouth ulcers
  • try to minimise amount of saliva swallowed
  • provides intermittent withdrawal relief
19
Q

How are lozenges used? (3 points)

A
  • moisten and park between gum and teeth
  • use as with gum
  • suitable with dentures
20
Q

How are patches used? (3 points)

A
  • apply to clean, dry, non hairy skin
  • used overnight to prevent morning withdrawal
  • slow continuous withdrawal relief
21
Q

What are the general guidelines for dosing the 24 hour patch? (6 points)

A
  • the sooner the time to 1st cig, the higher the patch dose
  • most ppl benefit from high strength patch, if unsure, try the high then the medium to see which suits
  • takes ~2-3h to get to full strength
  • if nauseous: too much nicotine
  • for best effect, press patch onto skin for 20seconds
  • if after co-therapy, px is still suffering from withdrawal, double or multiple patching may be required
22
Q

What are the general guidelines for dosing NRT gum and lozenges? (6 points)

A
  • sooner time to 1st cig, higher the dose
  • nicotine from gum/loz peaks after 20min
  • best used each hour, average 16 pieces/day, more if required
  • nausea=too much
  • bite, park or moisten and park
  • avoid drinking/eating when using gum/loz, and wait 10min after discarding
23
Q

How long should NRT be used for? (4 points)

A
  • minimum of 12 weeks after quitting
  • required for receptors in the brain to down regulate
  • use as long as required: 30 years of use with no identified long term effects
  • gum and loz can be used for preventing relapse
24
Q

What is the best thing to tell the Px about NRT? (5 points)

A
  • give clear rationale: NRT is for minimising withdrawal Sx so they can focus on changing their thoughts and behaviours
  • provides some of the nicotine that is missed, but much more slwoly
  • not like smoking,
  • clear instructions, give samples
  • a clean and safe delivery system so can be used for as long as necessary
25
Q

What are the common reasons for perceived failure of NRT? (2 points)

A
  • incorrect use

- unrealistic expectations

26
Q

What are examples of incorrect use with NRT? (4 points)

A
  • underdosing
  • not used for long enough
  • intermittent use
  • concurrent smoking