Smoking Cessation, Somatization + Stress Flashcards
Non smokers most common lung cancer
adenocarcinoma
Risks of smoking
Cancer
Heart dz
Stroke
Complications in pregnancy
COPD
What are the 5 As?
Ask
Advise to quit
Assess willingness to quit
Assist in quit attempt
Arrange FU within 1 wk of quitting
What is the STAR method?
Set a date
Tell family + friends
Anticipate challenges
Remove tobacco products
What are the 5 stages of change?
pre contemplation, contemplation, preparation, action, maintenance
What are the 5 Rs?
Relevance
Risks
Rewards
Roadblocks
Repetition
Benefits of quitting
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
Describe an action plan for smoking cessation
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
What dose of NRT patch should people have based on number of cigs?
<10 cigs/d = 14mg
>10 cigs/d = 21mg
6weeks, then reduce by half for 2wks
What dose of NRT gum should people have based on number of cigs?
<20 cigs/d = 2mg
>20 cigs/d = 4mg
Dose of inhaler + spray of NRT
Inhaler
4mg x 80 puffs
Spray
0.5mg each nostril q1H
What meds could you offer?
Varenicline
Bupropion SR
Nortriptyline
Clonidine
When should you start and what are the SE of varenicline?
Start 1 wk before quitting
SE: nausea, insomnia, strange dreams
When should you start and what are the SE of bupropion, + CI?
Start 1 wk before quitting
CI: sz, ED
SE: HTN, insomnia, dry mouth
When should you start and what are the SE of nortriptyline?
Start 10-28d before quitting
SE: sedation, dry mouth, blurred vision, retention
When should you start and what are the SE of clonidine?
Start 3d before quitting
SE: dry mouth, dizziness, sedation, constipation, hypotension
Sx of somatisation
Multiple symptoms in different organ systems
Vague S+S
Chronic course
Presence of psych disorder
Hx of extensive diagnostic testing
Rx of somatisation
Early + certain diagnosis
Limit number of physicians involved in care
Focus on psychosocial
Minimise med investigations
Minimise psychotropic drugs
Criteria for somatic symptom disorder
> 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
Criteria for illness anxiety disorder
Preoccupation with having an illness
Somatic symptoms are not present or mild
High level of anxiety about health
Excessive health related behaviour
Illness preoccupation
Criteria for conversion disorder
> 1 symptoms of altered voluntary motor or sensory function
Incompatibility between symptoms + recognised medical condition
Symptoms cannot be medically explained
,Criteria for factitious disorder
Falsification of S+S
Presents self as ill
Deceptive behaviour is evident
Acute stress disorder Criteria
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
Adjustment disorder
Criteria
Within 3mo of stressor
Marked distress out of proportion to severity of stressor
Significant impairment
Sx do not persist beyond 6mo after stressor removed
PTSD Criteria
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
PTSD Management
CBT
Fluoxetine, paroxetine, sertraline, venlafaxine
Trazodone or prazosin for nightmares
Sx linked to stress
HA, fatigue, pain
Difference between night terrors and nightmares?
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.
When to avoid bupropion
sz disorder, ED, alcohol withdrawal, MAOi use, allergy
