Smoking Cessation, Somatization + Stress Flashcards

1
Q

Non smokers most common lung cancer

A

adenocarcinoma

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2
Q

Risks of smoking

A

Cancer
Heart dz
Stroke
Complications in pregnancy
COPD

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3
Q

What are the 5 As?

A

Ask
Advise to quit
Assess willingness to quit
Assist in quit attempt
Arrange FU within 1 wk of quitting

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4
Q

What is the STAR method?

A

Set a date
Tell family + friends
Anticipate challenges
Remove tobacco products

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5
Q

What are the 5 stages of change?

A

pre contemplation, contemplation, preparation, action, maintenance

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6
Q

What are the 5 Rs?

A

Relevance
Risks
Rewards
Roadblocks
Repetition

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7
Q

Benefits of quitting

A

Leading cause of preventable death (6.5-9y premature death)
Financial gains (1ppy = $3650 per year)
Somebody who smokes a pack a day will smoke through almost $1 million after forty years (if they had invested that money)
Reduce risks of erectile dysfunction
8h - Carbon monoxide eliminated
24h - Risk of heart attack begins to drop
2w - Improved in lung function, walking easier
1mo - Decreased coughing, nasal congestion, shortness of breath
1y - Risk of coronary heart disease halved
5y - Risk of stroke same level as non-smokers
10y - Risk of mouth, throat and esophageal cancer halved, death rate from lung cancer also halved
15y - Risk of heart attacks similar to that of non-smokers

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8
Q

Describe an action plan for smoking cessation

A

Quit day
Tell family, friends, coworkers about quitting for support
Remove tobacco products from environment
Exercise program
Alternative oral behaviours (gum, lozenges)
Obstacles (withdrawal, weight gain, triggers)
Support groups (eg. 1-800-QUIT-NOW)
Combining counselling and smoking cessation medication is more effective than either alone
Counselling by a variety or combination of delivery formats (self-help, individual, group, helpline, web-based)
Multiple counselling sessions
Practical counselling on problem solving skills or skill training
Regular follow-up to assess response, provide support and modify treatment as necessary
Peak withdrawal at 2-3d
Highest relapse at 2-3w

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9
Q

What dose of NRT patch should people have based on number of cigs?

A

<10 cigs/d = 14mg
>10 cigs/d = 21mg
6weeks, then reduce by half for 2wks

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10
Q

What dose of NRT gum should people have based on number of cigs?

A

<20 cigs/d = 2mg
>20 cigs/d = 4mg

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11
Q

Dose of inhaler + spray of NRT

A

Inhaler
4mg x 80 puffs

Spray
0.5mg each nostril q1H

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12
Q

What meds could you offer?

A

Varenicline
Bupropion SR
Nortriptyline
Clonidine

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13
Q

When should you start and what are the SE of varenicline?

A

Start 1 wk before quitting
SE: nausea, insomnia, strange dreams

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14
Q

When should you start and what are the SE of bupropion, + CI?

A

Start 1 wk before quitting
CI: sz, ED
SE: HTN, insomnia, dry mouth

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15
Q

When should you start and what are the SE of nortriptyline?

A

Start 10-28d before quitting
SE: sedation, dry mouth, blurred vision, retention

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16
Q

When should you start and what are the SE of clonidine?

A

Start 3d before quitting
SE: dry mouth, dizziness, sedation, constipation, hypotension

17
Q

Sx of somatisation

A

Multiple symptoms in different organ systems
Vague S+S
Chronic course
Presence of psych disorder
Hx of extensive diagnostic testing

18
Q

Rx of somatisation

A

Early + certain diagnosis
Limit number of physicians involved in care
Focus on psychosocial
Minimise med investigations
Minimise psychotropic drugs

19
Q

Criteria for somatic symptom disorder

A

> 1 somatic symptom that is distressing
Excessive thoughts/ feelings/ behaviours related to symptom:
- disproportionate thoughts re seriousness
- persistent high level of anxiety
- excessive time/ energy devoted to health

20
Q

Criteria for illness anxiety disorder

A

Preoccupation with having an illness
Somatic symptoms are not present or mild
High level of anxiety about health
Excessive health related behaviour
Illness preoccupation

21
Q

Criteria for conversion disorder

A

> 1 symptoms of altered voluntary motor or sensory function
Incompatibility between symptoms + recognised medical condition
Symptoms cannot be medically explained

22
Q

,Criteria for factitious disorder

A

Falsification of S+S
Presents self as ill
Deceptive behaviour is evident

23
Q

Acute stress disorder Criteria

A

Exposure to actual/ threatened death, serious injury or sexual violation
Intrusive sx: recurrent memories, dreams, flashbacks, prolonged distress
Negative mood
Dissociative sx: altered sense of reality, amnesia
Avoidance sx
Arousal sx: sleep disturbance, hypervigilance, irritable
3d - 30 days from incident

24
Q

Adjustment disorder
Criteria

A

Within 3mo of stressor
Marked distress out of proportion to severity of stressor
Significant impairment
Sx do not persist beyond 6mo after stressor removed

25
Q

PTSD Criteria

A

Exposure to actual/ threatened death, serious injury or sexual violation
Intrusive sx: recurrent memories, dreams, flashbacks, prolonged distress
Negative mood
Dissociative sx: altered sense of reality, amnesia
Avoidance sx
Arousal sx: sleep disturbance, hypervigilance, irritable
Duration >30d

26
Q

PTSD Management

A

CBT
Fluoxetine, paroxetine, sertraline, venlafaxine
Trazodone or prazosin for nightmares

27
Q

Sx linked to stress

A

HA, fatigue, pain

28
Q

Difference between night terrors and nightmares?

A

Nightmares occur during REM sleep (later in the night), children are usually awakened by them and can recall the experience.

Night terrors occur during non-REM sleep (first few hours of the night), children are not awake during the episode and do not recall the experience.

29
Q

When to avoid bupropion

A

sz disorder, ED, alcohol withdrawal, MAOi use, allergy