Smoking Cessation Flashcards
Treating tobaccos is a ______ treatment
gold standard
smoking cessation is a treatment for ____
CVD
Smoking cessation in patients with CVD reduces risk of death by ____% and reduces risk of future cardiac events by ____%
36%
50%
Standard treatments reduce risk of death in patients with CVD by ____%
15-35%
Smoking and respiratory disease
- acute respiratory
- chronic respiratory
T/f it is best to quit smoking before you are 50
false!
Good at any age!
Stopping smoking at 30 results in ___ years life gained
10
Stopping smoking at 40 results in ____ years life gained
9
Stopping smoking at 50 results in ____ years life gained
6
Stopping smoking at 60 results in ____ years life gained
3
How many cigarettes in a pack?
20
How many packs are in a carton?
10
5 As to intervening
Ask Advise Assess readiness to quit Assist Arrange
What do you do if patient is not ready to quit?
enhance motivation (5 Rs)
What do you do if patient is ready to quit?
design treatment plan
What do you do if patient has recently quit?
relapse prevention
When should you follow up with smoking cessation?
1 week
1 month
**and many more
Stage 1 readiness to quit
not ready in next month
Stage 2 readiness to quit
ready to quit in next month
Stage 3 readiness to quit
recent quitter (within past 6 months)
Stage 4 readiness to quit
former tobacco user 9quit >6 months ago)
What are the recommendations for those in pregnant smokers?
no recommendation
- insufficient evidence of effectiveness
Who is pharmacotherapy not recommended for (smokers)?
- smokeless tobacco users
- smoking <10 per day
- adolescents (NRT minors Rx)
What is the recommended treatment in those who cannot use pharmacotherapy (smokers)?
behavioral counseling
What are the 3 pharmacologic methods to smoking cessation?
NRT
bupropion
varenicline
NRT rationale for use
- reduce physical withdrawal
- eliminate immediate, reinforcing effects of nicotine
- allows to focus on behavioral and psychological aspects
NRT approximately ___ the quit rates
doubles
NRT vs smoking
- No carbon monoxide
- no oxidants
- absorbed more slowly
- absorbed via venous system
- flat dose response curve
- 7000 chemicals not present
t/f smoking is a flat dose response curve
false!
dose dependent
NRT precautions
- patients with underlying CVD
- recent MI
- serious arrhythmias
- serious or worsening angina
Nicotine gum dosing
2mg >30 mins from waking
4mg <30 mins from waking
do not use more than ____ pieces of gum per day
24
t/f you need to taper on gum
true
T/F do not eat or drink 15 mins before or while using gum
True
Side effects of gum
Mouth soreness Hiccups Dyspepsia Jaw ache May stick to dental work
Lozenge dosing
2mg >30 min from waking
4mg <30 min from waking
Do not use more than _____ lozenges per day
20
How long does it take to dissolve lozenge?
20-30 mins
How long does the gum usually last?
30 mins
T/f transdermal patch avoids hepatic first pass metabolism
True
How long does nicotine delivery last in patch?
24 hours
Dosing of patch if you smoke <10 cigs per day
14mg x 6 weeks
7mg x 2 weeks
What is the dosing if you smoke >10 cigs per day?
21mg x 4 weeks
14mg x 2 weeks
7mg x 2 weeks
T/f it is okay to cut the patch to adjust dosing
False
T/f you must remove patch before MRI procedures
True
Side effects of patch within 1st hour
Mild itching
Burning
Tingling
Other side effects of patch
Vivid dreams
Headache
When should you contact doctor with patch?
If skin stays red >4 days or swells or rash
Bupropion MOA
Affect DA and NE
Bupropion clinical effects
Decrease cravings
Decrease withdrawal symptoms
Bupropion CI
- seizure disorder
- wellbutrin
- MAOI
- anorexia or bulimia
- undergoing abrupt discontinuation of alcohol or sedatives
Burprion warning and precaution
Suicide risk
Bupropion side effects
- insomnia
- dry mouth
- nausea
When should you recommend taking 2nd dose of burporpion?
By 5pm
Who should use bupropion in caution?
- history of seizure
- history of cranial trauma
- meds that lower seizure threshold
- severe hepatic cirrhosis
- depressive or psychiatric disorders
Bupropion dosing
150mg QAM 3 days
150mg BID 7-12 weeks
**8 hours apart
When should you start bupropion?
1-2 weeks prior to quit date
T/f you must taper off of bupropion
False
Varenicline MOA
Competitively inhibits binding of nicotine
Varenicline clinical effects
- decrease symptoms of withdrawal
- block DA stimulation (reinforcement and reward)
Varenicline warnings and precaution
Risk of suicide
Varenicline ADE
- nausea
- headache
- insomnia
- abnormal dreams
Varenicline dosing
1-3 0.5mg QD
4-7 0.5mg BID
8-end 1mg BID
Up to 12 weeks
When should you start taking varenicline?
1 week prior to quit date
Which smoking cessation medication may give vivid or unusual dreams?
Varenicline
What is recommended 1st line in smoking cessation?
Long acting patch + short acting NRT
Bupropion + patch
What therapies can be recommended, but not first line?
Long term patch + gum (2mg)
Long term patch + nasal spray
Standard patch + inhaler
Standard patch + bupropion
