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Board Review > SmokingCessationFC > Flashcards

SmokingCessationFC Flashcards

1
Q

general tx algorythm for tobacco

A
  1. use one singe agent
  2. Use 2 nicotine products
  3. Use nicotine product +buproprion
  4. 2 nicotine products plus bupoprion.
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2
Q

required vaccines for smokers

A

pneumococcal (23) and Flu each fall

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3
Q

The 5 A’s

A

Ask about tobacco use
Advise to quit
Assess (ready to quit? / challenges)
Assist (w/ meds)
Arrange (F-)

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4
Q

Nicoderm CQ

A

that is th patch

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5
Q

habitrol

A

nicotine patch

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6
Q

Commit

A

nicotine lozenge

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7
Q

nicorelief and Nicorrette

A

nicotine gum or lozenge

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8
Q

Nicotine Replacement Therapy (NRT) routes

A

Nicotine gum THRIVE
Nicotine inhaler
Nicotine nasal spray
Nicotine patch Nicoderm CQ
Nicotine lozenge (COMMIT) BRAND NAME

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9
Q

what are the OTC NRT brands

A

Nicorette, Nicorelief, Thrive

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10
Q

SE OF OTC brands of NRT

A

Side effects: dyspepsis, mouth soreness, hiccups, jaw aches

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11
Q

CI OF OTC brands of NRT

A

-CI: recent MI (within 2 weeks), life-threatening arrhythmia, severe or worsening angina, pregnancy

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12
Q

what dose of nicotine to use if pt > 25 cig/day

A

-Use 4mg if smoke >25 cigs/day

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13
Q

advantage of brands of OTC NRT

A

Reduces or delays weight gain

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14
Q

Counseling for Gum (THRIVE)
how to chew park
what types of food interefere

A

-Gum should be chewed slowly until “peppery” or “flavored” taste emerges, then “parked” between cheek and gum to facilitate nicotine absorption through the oral mucosa (30 mins)
-Acidic beverages interfere with the buccal absorption of nicotine, so eating and drinking anything except water should be avoided for 15 mins before and after

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15
Q

how ofte should patients be using the gums?

A

-Patient often do not use enough gum to obtain optimal clinical effects. Instruct to use at least 1 piece q1-2h

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16
Q

nicotrol inhaler OTC or RX ?

A

Rx

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17
Q

why is it good? The nicotrol inhaler?

A

mimics the smoking action and provides coping mechanism

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18
Q

SE of nicotrol inhaler

A

Side effects: local irration in the mouth and throat, coughing, rhinitis, headache

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19
Q

CI to nicotrol inhaler

A

-CI: recent MI (within 2 weeks), life-threatening arrhythmia, severe or worsening angina, pregnancy

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20
Q

Counseling for nicotrol inhaler

A

-Frequent, continuous puffing for 20 mins
-Only good for one day. 1 cartridge= 1 day
Clean mouthpiece with soap and water regularly
in cold weather, the inhaler and cartridge should be kept in an inside pocket or other WARM areas
-Acidic beverages interfere with the buccal absorption of nicotine, so eating and drinking anything except water should be avoided for 15 mins before and after

21
Q

Nicotrol Nasal Spray
adr
ci
adv fastest or slowest?
avoid in

A

RX
Side effects: nasal irritation, nasal congestion, changes in taste and smells
CI: recent MI (within 2 weeks), life-threatening arrhythmia, severe or worsening angina, pregnancy
Fastest delivery system (rapid relief)
Avoid in severe reactive airway disease

22
Q

Counseling for Nasal Spray

A

Patient should not sniff, swallow, or inhale through the nose while administering doses, as this increases irritating effects
the spray is best delivered with the head tilted slightly back

23
Q

Nicotine Patch
Se
ci
Dose

how to change dose if sleeping issues

A

OTC or Rx
Side effects: local skin reactions, insomnia, vivid dreams
CI: recent MI (within 2 weeks), life-threatening arrhythmia, severe or worsening angina, pregnancy
Use 21mg if smoke >10 cigs/day
-Worn for 24 hours, or for 16 hours to avoid insomnia

24
Q

Counseling for Patch

A

as soon as Patient wakes in morning, place the patch on a relatively hairless area, typically between the neck and waist, rotating the site to reduce irritation
use hydrocortisone or triamcinolone for skin irriation

25
Q

Nicotine Lozenge
Se
Ci
not shown to be effective in whom
dose?

A

OTC (COMMIT)
Side effects: nausea, hiccups, heartburn
-CI: recent MI (within 2 weeks), life-threatening arrhythmia, severe or worsening angina, pregnancy
not shown to be effective in pregnant smokers
Use 4mg if 1st cig is <30 mins after waking

26
Q

Counseling for Lozenge

A

Allow lozenge to dissolve in the mouth
-Acidic beverages interfere with the buccal absorption of nicotine, so eating and drinking anything except water should be avoided for 15 mins before and after
-Patients should use 1 lozenge every 1-2 hours

27
Q

which brand of buproprion is for smoking cessation?

A

zyban

28
Q

which brand of buproprion is for depression?

A

wellbutrin

29
Q

Buproprion moa
can use in combo w/
bbw
ci
adr

A

Blocks reuptake of dopamine and/or norepinephrine and Blocks nicotinic receptors
Can be used in combo with NRT
BBW: serious neuropsychiatric events
Contraindications: seizures, eating disorders, abrupt withdrawal of EtOH, BZDs, barbs, or AEDs
Warnings: Avoid use in pilots, air traffic controllers, commercial truckers, bus drivers
Side effects: tachycardia, dry mouth, insomnia, tremors/seizures, NO sexual dysfunction

30
Q

Counseling for Bupropion
how long to start working
max dose

A

-Takes about 1 week for medication to start working. Set a date to stop smoking during the second week of starting bupropion
-Do not exceed 450 mg/day
Contact healthcare provider if noticeable changes in agitation, hostility, depression, or behavior occurs

31
Q

Varenicline (Chantix)
moa
bbw
adr
dose adjust in

A

Partial neuronal alpha4-beta2 nicotinic receptor agonist
not recommended in combo with NRTs
BBW: serious neuropsychiatric events
-Warning: angioedema, hypersensitivity, serious skin reactions, and avoid use in pilots, air traffic controllers, commercial truckers, bus drivers, cardiac issues even MI, DREAMS
Side effects: nausea, abnormal dreams, constipation, flatulence, vomiting
Dose adjust if CrCl <30

32
Q

Counseling for Vareniciline
how long to work
w/ or w/o food

A

-Takes about 1 week for medication to start working. Set a date to stop smoking during the second week of starting vareniciline
Take after eating and with a full glass of water
Contact healthcare provider if noticeable changes in agitation, hostility, depression, or behavior occurs
Caution about serious skin reactions
use Caution driving or operation machinery

33
Q

dosing nictoine gum THRIVE

A

25 cigg- 4 mg gum

6 weeks:1 q 1-2 hrs
3 weeks 1 gum q 2-4 hrs
3 weeks: 1 gum 4-8 hrs

34
Q

max nicotine piece

A

24

35
Q

gum based on cut off

A

25 ciggs- week interval 6, 3, 3

36
Q

nioine nasal spray dose

A

1 spray in each nostril per hr.

37
Q

nicotine patch dosing

A

> 10 cigs use 21 mg x 6 weeks
14 mgs x 2 weeks
7 mgs x 2 weeks

< 10 mg
14 mg x 6 week
7 mg x 2 weeks

38
Q

nicotine patch dosing cut off

A

10 ciggs
more 21 x 6, 14 mg x 2, 7 mg x 2

less only last part

39
Q

nicotine lozenge based on

A

when you wake up and smoke
< 30 mins: 4 mg lozenge
> 30 mins: 2 mg lozenge

40
Q

nicotine lozenge dose max amt

A

20 lozenges daily.
MINIMUM 9 lozenge

41
Q

max pieces of gum

A

24

42
Q

you have to show what before buying products

A

identification of age

43
Q

gum cause weigt gain?

A

nope reduce or lose infact.

44
Q

which two do you start before the quit date

A

bupropion SR and varenicline (chantix)

45
Q

varenicline dosing

A

dosing will increase from 0.5 mg daily to 1 mg BID in 8 days.

46
Q

which combos are okay?

A

patch + (GUM, NASAL SPRAY, LOZENGE)

47
Q

17 year old smoker- ADVICE

A

CANNOT USE NICOTINE OTC PRODUCTS FDA PROHIBITS- do nicotine counseling.

48
Q

BBW for sucidal issues

A

Varencycline and bupropion (zyban)

49
Q

pregnancy

A

ACOG recommends bupropion (pregnancy category C) and other sources recommend nicotine replacement (which is not thought to be very effective in pregnancy).

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