Smoking Cessation, Somatization + Stress

Question 1

Non smokers most common lung cancer

Answer 1

adenocarcinoma

Question 2

Risks of smoking

Answer 2

Cancer
Heart dz
Stroke
Complications in pregnancy
COPD

Question 3

What are the 5 As?

Answer 3

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

Question 4

What is the STAR method?

Answer 4

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

Question 5

What are the 5 stages of change?

Answer 5

pre contemplation, contemplation, preparation, action, maintenance

Question 6

What are the 5 Rs?

Answer 6

Relevance
Risks
Rewards
Roadblocks
Repetition

Question 7

Benefits of quitting

Answer 7

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

Question 8

Describe an action plan for smoking cessation

Answer 8

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

Question 9

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

Answer 9

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

Question 10

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

Answer 10

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

Question 11

Dose of inhaler + spray of NRT

Answer 11

Inhaler
4mg x 80 puffs

Spray
0.5mg each nostril q1H

Question 12

What meds could you offer?

Answer 12

Varenicline
Bupropion SR
Nortriptyline
Clonidine

Question 13

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

Answer 13

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

Question 14

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

Answer 14

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

Question 15

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

Answer 15

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

Question 16

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

Answer 16

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

Question 17

Sx of somatisation

Answer 17

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

Question 18

Rx of somatisation

Answer 18

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

Question 19

Criteria for somatic symptom disorder

Answer 19

> 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

Question 20

Criteria for illness anxiety disorder

Answer 20

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

Question 21

Criteria for conversion disorder

Answer 21

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

Question 22

,Criteria for factitious disorder

Answer 22

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

Question 23

Acute stress disorder Criteria

Answer 23

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

Question 24

Adjustment disorder
Criteria

Answer 24

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

Question 25

PTSD Criteria

Answer 25

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

Question 26

PTSD Management

Answer 26

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

Question 27

Sx linked to stress

Answer 27

HA, fatigue, pain

Question 28

Difference between night terrors and nightmares?

Answer 28

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.

Question 29

When to avoid bupropion

Answer 29

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