Smoking Cessation Flashcards
Health Benefits
~30 minutes: BP and HR decrease
8-12 hours: carbon monoxide levels in lungs return to level of non-smoker
1 yr: CV risk decreases by 50%
5-10 years stroke risk decreased to non-smoker level and cancer risk decreased by 50%
Withdrawal Symptoms
Peak in 24-48 hours and can last weeks to months Cravings Headache Restlessness Impaired concentration Irritability, impatient, frustration Insomnia
Stages of Change
Precomtemplation Contemplation Preparation Action Maintenance
Precontemplation
Patient is NOT planning on changin in the next 6 months
Contemplation
Patient is CONSIDERING a behavior change within the next 6 months
Prepartion
Patient is PLANNING to make a behavior change within the next 30 days
Action
Patient is ACTIVELY ENGAGED in the desired behavior for less than 6 months
Maintenance
Patient has been ENGAGED in the desire behavior for >/= 6 months
1 pack of cigarettes =
20 cigarettes
Patient’s WILLING to Quit =
ASK about quitting ADVISE patient to quit ASSESS readiness to quit ASSIST with quit plan ARRANGE appropriate follow up
Patient’s UNWILLING to Quit =
RELEVANCE to values/goals RISKS to health/money REWARDS if patients were to quit ROADBLOCKS ID and addressed REPETITION
Fagerstrom Nicotine Dependence Scoring
0-2: Very low dependence 3-4: Low 5: Medium 6-7: High 8-10: Very high
Exclusions for Self-Treatment
o Severe heart disease ( recent MI, irregular beat, severe angina)
o High blood pressure that isn’t controlled
o Pregnancy/breast feeding
o
Patch MOA
Stimulate nicotine receptors, replace nicotine from cigarettes while tapering to reduce severity of withdrawal and cravings
Nicotine Patches: If >10 cigs/day
Start 21 mg patch applied daily for 4-6 weeks
Then 14 mg patch/day for 2 weeks
Then 7 mg patch/day for 2 weeks
Nicotine Patch Counseling
- Place patch on hairless area between neck and waist, rotate site with each application
- Wash hands before and after applying or removing
- Do NOT cut patches
- Due to not wanting to wear the patch overnight due to vivid dreams, leads to cravings in the morning
Lozenge and Gum Counseling
- Avoid eating or drinking for 15 minutes before and during lozenge use
- Provides PRN nicotine replacement or could be scheduled
Gum Dosing: If first cigarette is within 30 minutes of waking
1 piece of 4 mg gum every 1-2 hr for weeks 1-6
1 piece of 4 mg gum every 2-4 hr for weeks 7-9
1 piece of 4 mg gum every 4-8 hr for weeks 10-12
Gum Dosing: If first cigarette is greater than 30 minutes of waking
1 piece of 2 mg gum every 1-2 hr for weeks 1-6
1 piece of 2 mg gum every 2-4 hr for weeks 7-9
1 piece of 2 mg gum every 4-8 hr for weeks 10-12
Gum Chewing:
Chew and park: chew until peppery taste then park the gum between check and gums for about 30 minutes or taste dissipates
Max Dose for Gum
No more than 24 pieces//day
Lozenges Dosing: If first cigarette is within 30 minutes of waking
One 4 mg lozenges every 1-2 hr for weeks 1-6
One 4 mg lozenges every 2-4 hr for weeks 7-9
One 4 mg lozenges every 4-8 hr for weeks 10-12
Lozenges Dosing: If first cigarette is greater than 30 minutes of waking
One 2 mg lozenges every 1-2 hr for weeks 1-6
One 2 mg lozenges every 2-4 hr for weeks 7-9
One 2 mg lozenges every 4-8 hr for weeks 10-12
Max Lozenge Dose
20 lozenges/day
