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Year 2 Sem 1 Integrated Theory > Smoking cessation > Flashcards

Smoking cessation Flashcards

1
Q

Understand which groups are more likely to smoke

A
  • Prisoners
  • People with mental illnesses
  • Homeless people
  • Drug treatment groups
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2
Q

List the reasons as to why people smoke and explain why it is important to know this information

A
  • Addiction: satisfy cravings
  • Emotions: stressed, upset, bored or happy
  • Pleasure: to enjoy self reward
  • Social pressure: be a part of the crowd
  • Habits: linked to something

Understanding these triggers can help people to recognize them and plan to cope with quitting.

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3
Q

Understand how smoking affects general health

A
  • Increases risk of infections
  • Higher need for medical care services than non smokers
  • Increases risk of complications after surgery (slower wound healing, respiratory complications) and a lower survival rate after surgery due to body damage
  • Require longer hospitalizations
  • Absence from work because of illness
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4
Q

Describe the effects of smoking on pregnant women

A
  • Greater risk of ectopic pregnancy
  • Greater risk of miscarriage
  • Greater risk of having a premature and/or low birth weight baby
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5
Q

Describe the effects of smoking on children

A

• The risk of Sudden Infant Death Syndrome is increased in babies of mothers who smoke during pregnancy or after birth

Passive smoking or environmental tobacco smoke can effect the health of children:
• Suffer from asthma and other respiratory infections
• Have more middle ear infections
• Have an increased risk of meningococcal disease

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6
Q

Describe the effects of smoking on adolescents

A

• Adolescents become addicted more quickly due to brain development

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7
Q

Describe the effects of smoking on adults

A 
Increases the risk of:
• CVD
• Cancer
• Infertility
• Diabetes
• Premature ageing
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8
Q

List possible reasons that can help a client stay smoke- free

A
  • There is a stigma related to being a smoker
  • You have restricted access to places, activities
  • There is a high cost associated with smoking
  • It will help you reduce medication
  • It will relieve the stress of neuroadaptation to nicotine (addiction cycle)
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9
Q

Explain why smoking is damaging to pregnancy

A
  • When a pregnant woman smokes, about 4000 chemicals enter her bloodstream
  • The placenta doesn’t filter them out, so they go straight to the baby
  • These enter the baby’s bloodstream then brain, heart, kidneys and so on. In effect, the baby is smoking.
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10
Q

Understand the statement “how you smoke is as important as how many you smoke”

A
  • Smokers will unconsciously smoke in a way that meets their need for nicotine(titration)
  • If cutting down , they will drag harder on next cigarette, taking more carbon monoxide and tar deeper into the lungs
  • If wearing a NRT patch, they will drag lighter as they already have some nicotine in bloodstream
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11
Q

Compare the dangers of waterpipe smoking to cigarettes

A

• The waterpipe smoker may inhale as much smoke in one session as a cig smoker would inhale smoking 50-100 cigs

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12
Q

Understand the effects of smoking on oral health

A
  • Smokers are more likely to have periodontal disease than non-smokers
  • Increased risk of cancer
  • Are less responsive to periodontal treatment than non-smokers
  • Have higher incidences of complications after a tooth extraction
  • Experience greater tooth loss than non-smokers
  • Are more likely to have oral leukoplakia (white patch)
  • Have delayed healing and are more vulnerable to infection
  • Are not recommended to have implants due to healing vulnerability
  • Have stained teeth & restorations
  • Have bad breath and impaired taste
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13
Q

Describe the following oral effects of smoking:

  • Nicotine stomatitis
  • Smoker’s melanosis
  • Hairy tongue
  • Oral candidiasis
A
  • Nicotine stomatitis: Palate becomes white with little red spots that project out. Theses red spots mark the opening of the duct of the gland. It is caused by high temperatures in the mouth
  • Smoker’s melanosis: brown spots in the mouth
  • Hairy tongue: overgrowth of papillae that become stained either green, yellow, black, brown or white. It doesn’t look nice and causes halitosis
  • Oral candidiasis: Fungal infection due to weakened immune system
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14
Q

Describe the link between periodontal disease and smoking

A
  • The presence of bacterial species is more important in periodontitis pathogenesis than the amount of plaque and debris
  • Smokers have higher periodontal pathogens e.g. bacteroides forsythus than non-smokers
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15
Q

Describe how smoking affects soft tissue

A
  • Smoking/ nicotine have a vasoconstrictive effect and reduce the blood to gingiva. • Thus, there is impaired delivery of oxygen and nutrients to gingiva
  • Smoking impairs tissue repair ability to junctional epithelium
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16
Q

Explain the pathophysiology of smoking

A
  • Nicotine replaces the role of acetylcholine in the brain and causes the release of a lot of dopamine
  • It is inhaled and delivered to the blood in seconds, and hits the brain in ten seconds
  • There is a short- half life of 20- 40 minutes. Thus, smokers need to constantly “top- up”
17
Q

List the triggers for smoking

A
  • People
  • After meals
  • Alcohol
  • Driving
  • Watching TV
  • As a reward after an activity
  • Drinking coffee/ cola
18
Q

List and explain the 5 A’s in helping a person quit smoking

A

Ask
• Use the routine screening form
• “How do you feel about your smoking at present”
• Always record responses

Advise
• Give clear, personalized advice as this helps increases abstinence rates
• “When you stop smoking your periodontal/ gingivitis symptoms will improve”

Assess
• Willingness to quit: are you interested in quitting
• Level of dependence: through a Fagestrom test for nicotine dependence

Assist
• Give information on why smoking is addictive
• Tell them to use pharmacotherapy
• Teach patients to write down a plan in the event they face a trigger
• Tell them to keep oral NRT patched with them at all times to help with triggers/ cravings

Arrange (a follow up)
• Is client returning to you for follow-up?
• Do they need a referral to GP/Community Health/cessation expert?•Have you made Quitline fax referral?
•If they don’t want a referral, have they taken a “Quitline” brochure?

19
Q

What should smokers do prior to surgery?

A
  • It is recommended that that 2 weeks prior they use NRT to allow for some cardiovascular repair prior to anaesthesia
  • Wounds and scars will also heal at a better rate in the absence of smoking
20
Q

List the symptoms of nicotine withdrawal with 24 hours of cessation

A
  • Depressed
  • Insomnia,
  • Irritability frustration or anger,
  • Anxiety,
  • Difficulty concentrating,
  • Restlessness,
  • Decreased heart rate,
  • Increased appetite or weight gain

These symptoms cause clinically significant distress and are not due to a general medical condition nor better accounted for by another mental disorder

21
Q

Describe the link between smoking and depression

A
  • Smoking helps relieve depression
  • Conversely some smokers become severely depressed after stopping smoking
  • Neurochemical effects of nicotine, including release of dopamine, norepinephrine and serotonin resemble effects of some antidepressent medications
22
Q

Briefly describe NRT

A
  • Very low risk of nicotine toxicity from NRT
  • Very low risk of dependence on NRT
  • It is safer than smoking tobacco
  • NRT products give lower peak-plasma concentrations of nicotine at a slower pace and, as a result, lack the rapid onset of pharmacological action achieved with a cigarette
23
Q

List the types of NRT treatments available

A

Nicotine patch

Nicotine gum

Nicotine lozenge

Nicotine mist

24
Q

Describe nicotine patches

A
  • Patches are only recommended in pregnancy when a woman’s nausea is too great to tolerate oral NR
  • Only the 16 hour/ 15mg patch is suitable, with an 8 hours ‘off’ period overnight.
  • For those who smoke in the morning, they should apply at night
  • Apply to hairless skin and non -fatty areas so it is faster to absorb
  • Rotate patch around the body to avoid skin irritation
  • May have sleep disturbances/ vivid dreams. If so, then take the patch in the morning
25
Q

Describe nicotine gum

A 
• Start chewing after waking up
• Bite until peppery taste then park in cheek
• When the taste fades, chew again
• Use 1 per hour
Don't drink fluids with the gum
26
Q

Describe nicotine lozenge

A

• Nicotine is absorbed through lining of mouth
• Move lozenge from one side to other until it is completely dissolved (park in cheek, do not suck or chew)
• Do not eat or drink with the lozenge in mouth
May get hiccups, heart burn or nausea

27
Q

Describe nicotine mist

A
  • Sprayed inside cheek or under tongue in the morning
  • Have a “mist” not a “squirt”
  • 64 sprays/ day
28
Q

List the contraindications of NRT and pregnancy/ lactating mothers

A
  • Special precaution for use of NRT patches in pregnancy,16 hr only
  • This is due to unknown detrimental effects on developing brain caused by chronic delivery of nicotine levels
  • Lactating mothers should not use patches
29
Q

Describe the “cut down then stop” method of cessation

A
  • Good for people who may not be ready to quit but who want to move towards it, or who smoke high volume
  • Smoker chooses one cigarette to miss, same time every day for a week or uses oral NRT instead
  • Next week, choose another cig to drop
  • Over 6 months aim to reduce by half
30
Q

Describe the basics of E- cigarettes and Vapes

A
  • Electrical device that simulates the act of smoking by producing an inhaled vapor bearing the physical sensation, appearance, and often the flavor (with or without nicotine content) of inhaled tobacco smoke, without its odor
  • The device heats up propylene glycol-based liquid solution into a vapor that is inhaled into lungs. This is the same for vaping
31
Q

Understand the legal status of nicotine in Australia

A
  • Nicotine is a poison under the Poisons Act
  • Need to be licensed to “hold or possess”
  • No prohibition on importation, therefore it is legal to import into Australia
32
Q

Acknowledge the effect of drug interactions with smoking cessation

A
  • Some medications need to be reduced as client reduces nicotine e.g. some anti-psychotics, antihypertensives, insulin, anti-depressants, benzodiazepines.
  • Same meds will need to be increased if client relapses
  • Halve caffeine intake
  • Limit or stop alcohol for a couple of weeks(relapse factors)
33
Q

Discuss the effect of second-hand smoking, and define “sidestream” smoking as well as “mainstream” smoking

A
  • Sidestream smoke: drifts from the end of a burning cigarette
  • Mainstream smoke: breathed out by the smoker
  • Some components of smoke linger in the air for hours, breaking down into even more harmful chemicals. These particles can settle onto the clothes of a non-smoker who may inhale the
  • Even in homes where parents reported never having smoked inside the house , children still had measurable levels of cotinine (a by-product of nicotine) in their hair. This would be caused by close contact after the parent has finished smoking a cigarette.
  • This also means that smokers are inhaling the leftover harmful gases and particulate matter as well
34
Q

Discuss the efficacy of ventilation when smoking

A
  • Total removal of tobacco smoke through ventilation or filtration is technically and economically impractical
  • Many of the carcinogens and compounds can be re-circulated through buildings’ ventilation systems and into non-smokers apartments or offices.
  • It is almost impossible to achieve separation from smoke, even outdoors if you are within a few metres from the source
  • Cars are a place where people often smoke in the belief that the rush of air through the window will be sufficient ventilation, but this is not true
35
Q

Discuss referring patients to the Quitline

A
  • Takes advantage of smoker’s motivation at the time of a brief intervention
  • Can provide the high level of support needed at beginning of quitting process
  • Patient feels that some practical help has been offered

Year 2 Sem 1 Integrated Theory (14 decks)

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