Tobacco Cessation Flashcards
NICOTINE
An alkaloid that is contained in the leaves of plants
Distributed quickly through the — and
crosses the —
bloodstream
blood–brain barrier
Distributed quickly through the bloodstream and
crosses the blood–brain barrier
Reaches the brain within— with inhalation
Elimination half-life of nicotine is around —
8–20 seconds
two hours
Nicotine is metabolized in the —
liver
NICOTINE EFFECT
* Stimulates
adrenal glands
* Releases adrenaline – surge causes immediate release of glucose
NICOTINE EFFECT
* Increased (3)
heart rate, breathing activity, and blood pressure
NICOTINE EFFECT
Pancreas produces less
insulin – causing increased blood sugar or glucose
NICOTINE EFFECT
Dopamine released –
Acetylcholine and Norepinephrine released –
feeling of contentment is higher
concentration and memory
NICOTINE EFFECT
Increased levels of
beta-endorphin – reducing anxiety
The amount of nicotine absorbed by the body
from smoking depends on:
(3)
type of tobacco
whether the smoke is inhaled
whether a filter is used
Amount released into the body tends to be much
greater in
smokeless tobacco
Research indicates development of brain continues to
occur until the age of —
25
Nicotine changes the way — are formed
synapses
can harm the parts of the brain that control attention and
learning
The nicotine in e-cigarettes and other tobacco products
can also prime the adolescent brain for
addiction to other
drugs such as cocaine.
Surgeon General
HOW IMPACTS YOUTH/YOUNG ADULTS
(6)
Depression
Anxiety
Mood disorders
Addiction
Difficulty paying attention
Reduced impulse control
NICOTINE ADDICTION
-MORE THAN A “BAD HABIT”
cycle (5)
Use of
Nicotine
Stimulates
Dopamine
Release
Causes
Pleasurable
Feelings
Repeated use
of Nicotine
Tolerance
Develops
Body will
create more
—
over time
nicotine
receptor sites
TOBACCO DEPENDENCE:
A 2-PART PROBLEM
Physiological
Behavioral
Physiological
The addiction to nicotine
tx
Medications for cessation
Behavioral
The habit of using tobacco
tx
Behavior change program
Treatment should address the (2) aspects of dependence.
physiological
and the behavioral
WITHDRAWAL SYMPTOMS
(10)
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
BENEFITS OF QUITTING SMOKING
20 minutes
8 hours
24 hours
48 hours
3 days
2-12 months
5 years
10-15 years
Blood pressure returns to normal
Normal oxygen blood level
Carbon monoxide eliminated from lungs –
start to clear mucus
Nicotine is eliminated, Smell and taste improve
Lung capacity begins to improve, Breathing become easier
Circulation improves
Risk of lung cancer decreases
Reduced risk of other cancers
BENEFITS OF QUITTING SMOKELESS TOBACCO
Decreased risk for:
(6)
oral, head and neck cancer
tooth decay
progression of gum recession
high cholesterol
high blood pressure
heart attack or stroke
1 year post cessation
Nicotine
Transdermal
patches
–%
Nicotine
Gum and
Lozenges
–%
Non Nicotine
Chantix
–%
Non Nicotine
Zyban
–%
23
27
22-24
16
THE 5 A’S
ASK about tobacco USE
ADVISE tobacco users to QUIT
ASSESS READINESS to make a quit attempt
ASSIST with the QUIT ATTEMPT
ARRANGE FOLLOW-UP care
Ask about tobacco use
(3)
◼ “Do you ever smoke or use any type of tobacco?”
◼ “Do you use any form of e-cigarette or vaping device?”
◼ “Do you, or does someone in your household smoke?”
Figure up pack year:
Number of cigs per day/20 x number of years of smoking = number of pack years
Advise tobacco users to quit (clear, strong, personalized)
◼ “I realize that quitting is difficult. It is the most important thing you
can do to protect your health now and in the future. I have training
to help my patients quit, and when you are ready, I will work with
you to design a specialized treatment plan.”
◼ Best results if you can personalize this and be open, non-judgmental
◼ Assess readiness to make
a quit attempt
Assist with the quit attempt
◼ Not ready to quit:
◼ Ready to quit:
◼ Recently quit:
provide motivation
design a treatment plan
relapse prevention
ARRANGE
THE 5 A’S (CONT’D)
Number of sessions: Estimated quit rate*
0 to 1:
2 to 3:
4 to 8:
More than 8:
12.4%
16.3%
20.9%
24.7%
Transtheoretical Change
Model
(Stages of Change)
(7)
Relapse
Pre-contemplation
Contemplation
Preparation
Action
Maintenance
Termination
Relapse:
Pre-contemplation:
Contemplation:
Preparation:
Action:
Maintenance:
Termination:
Falling back into previous behavior patterns
No intention to change
Aware problem exists but no commitment to action
Intent on taking action to address the problem
Active modification of behavior
Sustained change, new behavior replaces old
Not falling back into previous behavior
Quit-line
available 24
hours a day, 7 days a
week. FREE service
that is available in
multiple languages.
Confidential,
personalized support is
available from
Trained
Quit Coaches.
CESSATION OPTIONS
(9)
Cold Turkey (no additional help)
Nicotine Replacement Therapy (NRT’s)*
Medications*
Behavioral Therapy
Combination Therapy
Hypnotherapy – Reveri app
Acupuncture
Yoga, meditation
Herbs
Behavioral Therapy
(2)
Counselor/Coach, app/tech use, telephone counseling (1-800-QUITNOW)
Apps – QuitNow!, KWIT, Smoke Free, Quitters Circle, Quick Tracker
Combination Therapy
Multiple uses of NRTs, NRTs and medications
GUIDELINES FOR PHARMACOTHERAPY
All tobacco users can benefit
Check with physician if pt has:
(4)
Hypothyroidism
Insulin-dependent diabetes
Active peptic ulcer
Anti-depressant medications
BUPROPION SR
(ZYBAN)
— mg sustained release tablet
Begin taking — week prior to quitting
Double dose after — days
150
1
3
BUPROPION SR
(ZYBAN)
Advantages:
(2)
Easy to use
Can be used with Nicotine Replacement Therapy
BUPROPION SR
(ZYBAN)
Adverse Effect:
(6)
Insomnia, dry mouth, nervousness/difficulty
concentrating, rash, constipation, seizures
VARENICLINE
(CHANTIX®)
— mg tablet
Days 1-3:
Days 4-7:
Weeks 2-12:
0.5 mg and 1.0 mg
take one 0.5 mg tablet in the AM
take 0.5 mg tablet twice daily
take 1.0 mg tablet twice daily
VARENICLINE
(CHANTIX®)
Advantages:
Easy to use and offers a new mechanism of action for
patients who have failed with other agents
VARENICLINE
(CHANTIX®)
Adverse Effects:
(6)
Nausea, insomnia, vivid dreams, constipation, vomiting,
Neuropsychiatric Symptoms (behavior changes, agitation,
depressed mood, suicidal ideation or behavior)
NICOTINE REPLACEMENT THERAPY OPTIONS
(GUM – NICORETTE, ZONNIC)
— mg (smoke < 25 cig/day or — mg (smoke ≥ 25 cig/day)
Week 1-6:
Week 7-9:
Week 10-12:
Max of — pieces per day. No food or beverage – min before or
during use
2, 4
1 piece every 1-2 hours
1 piece every 2-4 hours
1 piece every 4-8 hours
24, 15
NICOTINE REPLACEMENT THERAPY OPTIONS
(GUM – NICORETTE, ZONNIC)
Advantages:
May delay weight gain and satisfy oral cravings
NICOTINE REPLACEMENT THERAPY OPTIONS
(GUM – NICORETTE, ZONNIC)
Adverse Effects:
(3)
Mouth/jaw soreness, hiccups, dyspepsia
NICOTINE REPLACEMENT THERAPY OPTIONS
(LOZENGE – COMMIT, ZONNIC)
– mg (smoke > 30 min after waking) and – mg (smoke ≤ 30
min after waking)
Week 1-6:
Week 7-9:
Week 10-12:
Max. of – lozenges/day. No food or beverage – min. before or during use.
Do not chew or swallow lozenge
2, 4
1 lozenge every 1-2 hours
1 lozenge every 2-4 hours
1 lozenge every 4-8 hours
20, 15
NICOTINE REPLACEMENT THERAPY OPTIONS
(LOZENGE – COMMIT, ZONNIC)
Advantages:
May delay weight gain and satisfy oral cravings
NICOTINE REPLACEMENT THERAPY OPTIONS
(LOZENGE – COMMIT, ZONNIC)
Adverse Effects:
(6)
Nausea, hiccups, cough, heartburn, headache, insomnia
NICOTINE REPLACEMENT THERAPY OPTIONS
(TRANSDERMAL PATCH - NICODERM CQ)
– mg, – mg, mg (24-hour release)
≤ 10 cigarettes/day
– mg/day for 6 weeks
– mg/day for 2 weeks
> 10 cigarettes/day
– mg/day for 6 weeks
– mg/day for 2 weeks
– mg/day for 2 weeks
7, 14, 21
14
7
21
14
7
NICOTINE REPLACEMENT THERAPY OPTIONS
(TRANSDERMAL PATCH - NICODERM CQ)
Advantages:
Provides consistent Nicotine for 24 hrs, easy to use.
NICOTINE REPLACEMENT THERAPY OPTIONS
(TRANSDERMAL PATCH - NICODERM CQ)
Adverse Effects:
(4)
Local skin reaction, headache, insomnia, vivid dreams
NICOTINE REPLACEMENT THERAPY OPTIONS
(NASAL SPRAY – NICOTROL NS)
— mg metered spray per 50 mcL
— doses per hour
— doses/day
Maximum – doses/hr
One dose = – sprays
0.5
1-2
8-40
5
2 (1 per nostril)
NICOTINE REPLACEMENT THERAPY OPTIONS
(NASAL SPRAY – NICOTROL NS)
Advantages:
Patients can titrate therapy to help with withdrawal
NICOTINE REPLACEMENT THERAPY OPTIONS
(NASAL SPRAY – NICOTROL NS)
Adverse Effects:
(6)
Nasal/throat irritation, rhinitis, tearing, sneezing,
headache, cough
NICOTINE REPLACEMENT THERAPY OPTIONS
(ORAL INHALER – NICOTROL)
– mg cartridge – delivers – mg inhaled nicotine vapor
— cartridges/day
Begin with 1 cartridge every —
Best effects with continuous puffing for —
10, 4
6-16
1-2 hours
20 min.
NICOTINE REPLACEMENT THERAPY OPTIONS
(ORAL INHALER – NICOTROL)
Advantages:
Patients can titrate amount to manage withdrawal and
mimics hand-to-mouth ritual
NICOTINE REPLACEMENT THERAPY OPTIONS
(ORAL INHALER – NICOTROL)
Adverse Effects:
(5)
Mouth/throat irritation, cough, headache, rhinitis, dyspepsia
UMKC has a Tobacco Cessation Program that is
free for patients wanting to participate
Program consists of:
(3)
Prep-work by the student
Initial Visit Appointment
Follow-Up Visit Appointment(s)