Smoking cessation Flashcards
What are e-cigarettes? (4 points)
- 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
What are the two target markets for the tobacco industry? (2 points)
- 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
Why is smoking cessation important? (4 points)
- 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
What are the 4 stages of the tobacco pandemic?
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
Why is smoking considered a chronic relapsing disease? (4 points)
- persistent use despite obvious harm
- withdrawal
- loss of autonomy
- chronic relapse
What are the components of a cigarette? (4 points)
- 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
How does nicotine affect the brain? (4 points)
- 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
What are the two ways in which nicotine works to have an affect on the brain?
- sense of well being
2. ability to focus
Why is NRT not as effective in affecting mood than smoking?
- 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
What are the major symptoms of nicotine withdrawal? (6 points)
- can’t concentrate ( 2 weeks, 70%)
- irritability/aggression (10 weeks, 70%)
What are the three aspects to addiction?
- physiological triggers (treat with NRT)
- Internal triggers like thoughts/feelings (treat with mental and behavioural techniques)
- External triggers like habits and situations (also treat with mental and behavioural techniques)
How can you assess the level of nicotine addiction? (3 points)
What is the protocol for ppl who smoke within 60 min of waking? (3 points)
- 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
Why do the # cig/day not measure addiction? (3 points)
- 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
How is nicotine delivery by NRT different to inhaled nicotine? (3 points)
- 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
What are the subsidised NRT products in NZ? (4 points)
- Novatis Habitrol available in:
- patches $5 for 8 weeks
- gum “
- lozenges “
What are some examples of non-subsidised NRT products? (3 points)
- Inhalator
- quickmist
- cooldrops
How are NRT gums used? (5 points)
- 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
How are lozenges used? (3 points)
- moisten and park between gum and teeth
- use as with gum
- suitable with dentures
How are patches used? (3 points)
- apply to clean, dry, non hairy skin
- used overnight to prevent morning withdrawal
- slow continuous withdrawal relief
What are the general guidelines for dosing the 24 hour patch? (6 points)
- 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
What are the general guidelines for dosing NRT gum and lozenges? (6 points)
- 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
How long should NRT be used for? (4 points)
- 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
What is the best thing to tell the Px about NRT? (5 points)
- 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
What are the common reasons for perceived failure of NRT? (2 points)
- incorrect use
- unrealistic expectations
What are examples of incorrect use with NRT? (4 points)
- underdosing
- not used for long enough
- intermittent use
- concurrent smoking
