Smoking Cessation

Question 1

most important modifiable risk factor for CV dx?

Answer 1

quitting smoking

Question 2

smoking increases metabolism of what drugs?

Answer 2

estradiol
caffeine
heparin

Question 3

smoking doubles the clearance of what drugs?

Answer 3

antipsychotics

antidepressants

Question 4

chronic nicotine use results in permanent increase in what?

Answer 4

of receptors

Question 5

some s/s of nicotine withdrawal?

Answer 5

depressed mood 
sleep disturbances 
irritable 
difficulty concentrating
anxiety
restlessness
decreased HR 
increased weight gain or appetite 
craving

Question 6

main barrier to tobacco intervention?

Answer 6

Fear of weight gain

Question 7

nicotine patch (OTC):

Answer 7

<10 cigs=14 mg
>10 cigs=21 mg

LOT: 12 weeks

apply to clean skin on upper trunk/arms

16-24 hours

cons: slow onset, skin rxn, insomnia

CI: pregnancy, acute CV dx

Question 8

nicotine gum:

Answer 8

<25 cigs=2mg
>25 cigs=4mg

chew and park
slow, buccal absorption

LOT: 8-10 weeks

acidic foods decrease absorption

up to 24 pieces/day

need to correctly chew and pakr, Nausea, heartburn, sore mouth/throat burning

Question 9

nicotine lozenge:

Answer 9

dose based on time to first cigarette

< 30 min=4mg
>30 min =2mg

suck on it, up to 20 per day

insomnia, N, hiccups, heartburn, coughing

Question 10

nicotine inhaler:

Answer 10

LOT: 3-12 weeks
6-16 cigs a day

lower blood nicotine levels
rx only

Question 11

Nicotine nasal spray:

Answer 11

1-2 does per hr
1 dose=2 speays

RX only
LOT:6-8 weeks

use enough to control withdrawl symptoms

rapid delivery, up to 40 doses

nasal irritation, rhinitis, coughing, watery eyes

Question 12

nicotine meds can be combined with what and not what?

Answer 12

bupropion

varenicline

Question 13

a good combo of NRT would we what?

Answer 13

Patch + gum

Question 14

Bupropion:

Answer 14

dopamine and Norepinephrine effects

less weight gain (need to gain 100 lbs to diminish health benefits)

start 7-10 days prior to quit date

LOT: 7-12 weeks or longer

CI: seizures, eatinf disorders, electrolytes abnormalities, MAOI

NOT dangerous to smoke

monitor BP

SI: insomnia, dry mouth, HA, rash

Question 15

Varenicline:

Answer 15

alpha4 beta 2 nicotine receptor

paratial agonist/antagonist

releases lower amount of dopamine into brain than smoke

blocks nicotine from binding to receptor (prevents reward of smoking)

optimal duration: 12-24 weeks

MC SE: Nausea

Question 16

Bupropian/varenicline: FDA BBW:

Answer 16

changes in behavior
hostility/agitation
depressed mood
suicidal ideation, behavior, attempts