Smoking Cessation

Question 1

What are the stages of change for smoking cessation?

Answer 1

• pre-contemplation
• contemplation
• preparation
• action
• maintenance
• relapse

Question 2

What are the main components in cigarettes

Answer 2

• benzene
• formaldehyde
• acetone
• tar
• nicotine

Question 3

What AE are smoking associated with?

Answer 3

• cancer (lung, pancreas, kidney, bladder, lip, oral cavity, and esophagus/larynx)
• cardiovascular effects
• delayed wound healing
• dermatologic effect
• endocrine(insulin resistance)
• musculoskeletal effects-increased risk of lumbar disease decrease and delayed bone healing
• pregnancy: low birth weight, preterm or extremely preterm births
• COPD
• sexual dysfunction: erectile dysfunction 2x more likely

Question 4

Non-pharm things for smoking

Answer 4

• support from family/co-workers
• set a quit date (no more smokes around)
• keep track of triggers - try to avoid triggers as much as possible
• try to break routine
• – suggest 2 common reduction techniques - systematically increase amount of time between cigarettes from easiest to hardest throughout the day
• smokers help line
• do not set quit date right before an event

Question 5

What is an e-cigarette vaporizing?

Answer 5

• propylene glycol, vegetable oil, flavouring and also sometimes nicotine

Question 6

What can e-cigarettes cause?

Answer 6

• popcorn lung (some case reports)

Question 7

Why are nicotine inhalers better for you than e-cigarettes?

Answer 7

-inhalers do not have propylene glycol

Question 8

What is the dosing of zyban?

Answer 8

• 150 mg daily for 3 days, and then 150 mg BID (SR)

Question 9

_____ disturbance can be a major issue with zyban

Answer 9

sleep (need to make sure there is an 8 hour dose here btw the 2 pills)

Question 10

What is the efficacy of bupropion?

Answer 10

• 18-19% efficacy around the year period (10% is for placebo)

Question 11

What are the major contraindications with zyban?

Answer 11

• seizure history, those that are receiving wellbut. for depression
• current or past hx of anorexia or bulimia
• alcohol or benzo withdrawal

Question 12

What are the main SE of zyban?

Answer 12

• insomnia, headache, appetite suppression, nausea, dry mouth

Question 13

What are the major DIs associated with zyban?

Answer 13

• carbamazepine

- antidepressant (2D6 inhibitors)

Question 14

What is the MOA associated with champix?

Answer 14

• partial agonist of the nicotine receptor

Question 15

What is the dosing of champix?

Answer 15

• 0.5 mg for 3 days, 0.5 mg BID for 4 days, then 1 mg BID for 2 weeks (declining renal fx, decrease dose)

Question 16

What is the efficacy of champix?

Answer 16

• 26%

Question 17

What are the AE associated with champix?

Answer 17

• nausea

- abnormal dreams

Question 18

Champix should be taken how?

Answer 18

• take after meal with a full glass of water to avoid nausea

Question 19

What disease states do you need to be aware of when giving someone champix?

Answer 19

• cardiovascular, seizures

Question 20

What is the efficacy of using a combination NRT product?

Answer 20

• 22%

Question 21

How do you know if a person is having withdrawal sx with nicotine?

Answer 21

• cravings for cigarettes
• mood changes and irritability
• headache
• weight gain
• trouble concentrating
• increased appetite
• depression
• anxiety
• trouble sleeping
• nightmares/bad dreams

Question 22

What are the signs of nicotine toxicity?

Answer 22

• nausea
• no nicotine cravings
• abdominal cramping
• agitation
• muscle twitches
• breathing rapidly
• coma
• confusion
• convulsions
• depression
• fainting
• headache

Question 23

What are the absolute CI associated with nicotine?

Answer 23

• free flap surgical patients- risking a lack of blood flow to the area would make a graft not take
• patients should not use an NRT 2 weeks before or 2 weeks after this
• also serious arrhythmias
• angina
• serious fracture
• orthopaedic surgery

Question 24

Smoking increases the clearance of what?

Answer 24

• caffeine!

- when someone stops smoking, you need to decrease their coffee intake by half

Question 25

What are the endpoints with smoking cessation products

Answer 25

• that they have stopped smoking
• no withdrawal sx
• decreased risk of things like lung cancer, cardiovascular disease, COPD, stroke
• SE are negative endpoints