Smoking Cessation

Question 1

What is the number one preventable cause of death in America?

Answer 1

smoking

Question 2

Tobacco cessation intervention is cost effective relative to what 2 comparisons?

Answer 2

1. other preventive interventions

2. costs incurred from medical treatments for conditions caused by smoking

Question 3

How long does a smoking cessation intervention have to be to be broadly effective?

Answer 3

Brief < 3 min

Question 4

On average, how many years of life do tobacco quitters gain?

Answer 4

11 to 12 years of life

Question 5

What are the 5 A’s of tobacco intervention from the clinical practice guidelines?

Answer 5

Ask - about use 
Advise - to quit
Assess - willingness
Assist - in quitting 
Arrange - for follow up

Question 6

What are the 4 elements of a quit plan? (STAR)

Answer 6

S - set a quit date
T- tell others
A- anticipate challenges
R - remove products and paraphernalia

Question 7

How do you build motivation to quit? (5 Rs)

Answer 7

relevance, risks, rewards, roadblocks and repetition

Question 8

what are 3 things you can do to tailor treatments to difficult to treat smokers?

Answer 8

 Flexible quit date that encourages smoking reduction as an initial goal
 Treatment sampling and practice quit attempts
 Supplement standard behavioral counseling with mood management counseling

Question 9

What are the 3 most common types of medications for smoking cessation?

Answer 9

nicotine replacement therapy (of which there are 5 types)
varenicline
bupropion

Question 10

What intervention can double or triple quit rates?

Answer 10

pharmacotherapy

Question 11

Pharmacotherapy for smoking cessation should not be combined, true or false

Answer 11

false - combinatorial therapy has the best results

Question 12

Most smokers don’t want to quit, true or false

Answer 12

false - most do. On average 67.4 5 are interested in quitting and 55.4% have made a past-year quit attempt

Question 13

Physician intervention on smoking is effective, true or false

Answer 13

True! but screening and assistance is under utilized by physicians

Question 14

Physician intervention on smoking is not dose responsive, true or false

Answer 14

false - the more you intervene the more successful you are, and quitting is beneficial at any age

Question 15

What are some flexible options for cessation?

Answer 15

smoking reduction
flexible quit date or preloading approach
treatment sampling/”Practice” attempts
managing negative mood

Question 16

What is the mechanism of buproprion?

Answer 16

blocks reuptake of dopamine and or norepinephrine

** not safe in seizure patients

Question 17

What are common bothersome side effects of smoking cessation pharmacotherapy?

1. doesn’t work
2. trades addictions
3. cause cancer
4. cause rashes
5. increased heart attack risk
6. insomnia
7. nausea
8. expensive

Answer 17

Insomnia - just don’t use it at night and make sure to put it on in the morning

Nausea - verenicline

dry mouth - bupropion

Question 18

What is the mechanism of varenicline for smoking cessation?

Answer 18

alpha4beta2 agonist/antagonist of nicotinic acetylcholine receptor

Question 19

Do any of the smoking cessation drugs have black box warnings for suicidal ideation?

Answer 19

NO! it’s been removed

Question 20

Which trial showed that varenicline does not increase risk of suicide?

Answer 20

EAGLES trial compared varenicline, bupropion, patch and placebo, found 1;1;1;1 risk

Question 21

What is the most effective drug out of the drugs available for smoking cessation?

Answer 21

varenicline

or combination NRT are the two best options