Tobacco Cessation Flashcards
An alkaloid that is contained in the leaves of
plants
As is distributed quickly through the
bloodstream and crosses the blood–brain barrier
Reaches the brain within 8–20 seconds with
inhalation
The elimination half-life in the body is
around two hours.
metabolized in the liveR
Nicotine
How long is the elimination half-life of the nicotine in the body?
2 hours
How long does nicotine take to reach the brain?
8-20 seconds
Nicotine is metabolized in the _____
Liver
- Stimulates adrenal glands
- Releases adrenaline – surge causes immediate release of glucose
- Increased heart rate, breathing activity, and blood pressure
- Pancreas produces less insulin – causing increased blood sugar or glucose
- Dopamine released – feeling of contentment is higher
- Acetylcholine and Norepinephrine released – concentration and memory
- Increased levels of beta-endorphin – reducing anxiety
Nicotine
For chewing tobacco, dipping tobacco, snus and
snuff, the amount released into the body tends to
be ______ than smoked tobacco
much greater
Research indicates development of brain continues to
occur until the age of ____
25
______ changes the way synapses are formed,
can harm the parts of the brain that control attention and
learning.
It in e-cigarettes and other tobacco products
can also prime the adolescent brain for addiction to other
drugs such as cocaine.
Nicotine
Treatment should address the ____ and _____ aspects of dependence
physiological
and the behavioral
\_\_\_\_\_\_ symptoms Symptom Duration Chest tightness A few days Constipation, stomach pain 1-2 weeks Cough, dry throat A few days Cravings for tobacco Frequent in first 2-3 days Depressed mood, irritable 1-4 weeks Dizziness 1-2 days Difficulty concentrating A few days Fatigue 2-4 weeks Hunger Up to several Weeks Insomnia 1 week
Withdrawal symptoms
Most withdrawal symptoms subside in about ____
1 week
Benefits of \_\_\_\_\_\_ Time Benefit 20 minutes Blood pressure returns to normal 8 hours Normal oxygen blood level 24 hours Carbon monoxide eliminated from lungs – start to clear mucus 48 hours Nicotine is eliminated Smell and taste improve 3 days Lung capacity begins to improve Breathing become easier 2-12 months Circulation improves 5 years Risk of lung cancer decreases 10-15 years Reduced risk of other cancers
Quitting smoking
BENEFITS OF _________
Decreased risk of Oral, Head and Neck Cancer
Decreased risk of tooth decay
Decreased progression of gum recession
Decreased risk of High Cholesterol
Decreased risk of High Blood Pressure
Decreased risk for Heart Attack or Stroke
QUITTING SMOKELESS TOBACCO
What are the 5 A’s of cessation?
Ask Advise Assess Assist Arrange
What are the 4 things we must check with a physician before pharmacotherapy?
Hypothyroidism
Insulin-dependent diabetes
Active peptic ulcer
Anti-depressant medications
150 mg sustained release tablet Begin taking 1 week prior to quitting Double dose after 3 days Advantages: Easy to use Can be used with Nicotine Replacement Therapy Adverse Effect: Insomnia, dry mouth, nervousness/difficulty concentrating, rash, constipation, seizu
BUPROPION SR
ZYBAN
How long should the aids be used to increase success rate in cessation?
12 weeks
0.5 mg and 1.0 mg tablet
Days 1-3: take one 0.5 mg tablet in the AM
Days 4-7: take 0.5 mg tablet twice daily
Weeks 2-12: take 1.0 mg tablet twice daily
Advantages:
Easy to use and offers a new mechanism of action for
patients who have failed with other agents
Adverse Effects:
Nausea, insomnia, vivid dreams, constipation, vomiting,
Neuropsychiatric Symptoms (behavior changes, agitation,
depressed mood, suicidal ideation or behavior)
VARENICLINE
CHANTIX®
2 mg (smoke < 25 cig/day) or 4 mg (smoke ≥ 25 cig/day)
Week 1-6: 1 piece every 1-2 hours
Week 7-9: 1 piece every 2-4 hours
Week 10-12: 1 piece every 4-8 hours
Max of 24 pieces per day. No food or beverage 15 min before or
during use
Advantages:
May delay weight gain and satisfy oral cravings
Adverse Effects:
Mouth/jaw soreness, hiccups, dyspepsia
(GUM – NICORETTE, ZONNIC)
2 mg (smoke > 30 min after waking) and 4 mg (smoke ≤ 30
min after waking)
Week 1-6: 1 lozenge every 1-2 hours
Week 7-9: 1 lozenge every 2-4 hours
Week 10-12: 1 lozenge every 4-8 hours
Max. of 20 lozenges/day. No food or beverage 15 min. before or during use.
Do not chew or swallow lozenge
Advantages:
May delay weight gain and satisfy oral cravings
Adverse Effects:
Nausea, hiccups, cough, heartburn, headache, insomnia
(LOZENGE – COMMIT, ZONNIC)
7 mg, 14 mg, 21 mg (24 hour release)
Advantages:
Provides consistent Nicotine for 24 hrs, easy to use.
Adverse Effects:
Local skin reaction, headache, insomnia, vivid dreams
-Set and forget
(TRANSDERMAL PATCH - NICODERM CQ)
0.5 mg metered spray per 50 mcL 1-2 doses per hour 8-40 doses/day Maximum 5 doses/hr One dose = 2 sprays (1 per nostril) Advantages: Patients can titrate therapy to help with withdrawal Adverse Effects: Nasal/throat irritation, rhinitis, tearing, sneezing, headache, cough
(NASAL SPRAY – NICOTROL NS)
10 mg cartridge – delivers 4 mg inhaled nicotine vapor
6-16 cartridges/day
Begin with 1 cartridge every 1-2 hours
Best effects with continuous puffing for 20 min.
Advantages:
Patients can titrate amount to manage withdrawal and
mimics hand-to-mouth ritual
Adverse Effects:
Mouth/throat irritation, cough, headache, rhinitis, dyspepsia
(ORAL INHALER – NICOTROL)
Do all smoking tobacco products contain carcinogens?
Yes
When inhale cigarette (directly or secondhand) inhaling more than ______ chemicals
7,000 chemicals
____ chemicals are known carcinogens in cig smoke
69
The following are consequences linked to \_\_\_\_\_\_\_ exposure Children Adults • Middle ear disease • Respiratory symptoms • Impaired lung function • Lower respiratory illness • SIDS • Nasal irritation • Lung cancer • Coronary heart disease • Reproductive effects in women – Low birth weight
Secondhand smoke exposure
______ is the leading cause of cancer related
death in US for both men and women
Lung cancer
Smoking accounts for more than ____% of lung
cancer cases reported in men
90%
Smoking accounts for more than __% of lung
cancer cases reported in women
89%
Smokeless tobacco CONTAINS OVER ____ CHEMICALS
KNOWN TO CAUSE CANCER
28 chemicals
Approximately \_\_\_\_\_\_ Americans are diagnosed with OPC (oral and/or pharyngeal cancer)
42,000
____% of OPC can be attributed to tobacco use, heavy
alcohol consumption and in many cases both
75%
___% of leukoplakia’s caused by tobacco use
70%
Act of inhaling and exhaling the aerosol, often referred to as vapor, which is produced by an e-cigarette or similar device.
E-cigarettes do not produce tobacco smoke, but rather an aerosol, often mistaken for water vapor, that actually consists of fine particles.
Vaping
What are the 4 components of aerosol?
Volatile organic compounds
Nicotine
Ultrafine particles
Heavy metals – nickel, tin, lead
Use nicotine salts Higher nicotine concentrations Potential to be more addictive 3% and 5% nicotine solutions available 2 flavors – Menthol, Virginia Tobacco Each pod contains same amount of nicotine as an entire pack of cigarettes
JUUL device
Uses nicotine salts
Higher nicotine concentrations
Potential to be more addictive
1.8%, 2.4%, and 5.0%
3 flavors – Golden Tobacco, Menthol, Rich Tobacco
Each pod contains same amount of nicotine as an
entire pack of cigarettes**
VUSE
Name given to vaping-related lung illness
High prominence in late 2019 and early 2020
As of February 18, 2020– 2,807 hospitalized cases
69 deaths associated with this across the states
Associated with Vitamin E acetate
EVALI
