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PHRM 852 > Tobacco Cessation > Flashcards

Tobacco Cessation Flashcards

1
Q

What are the 7 FDA-approved medications for smoking cessation?

A
  • nicotine gum
  • nicotine lozenge
  • transdermal nicotine patch
  • nicotine oral inhaler
  • nicotine nasal spray
  • bupropion SR
  • varenicline (chantix)
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2
Q

What strengths do the gum and lozenges come in?

A
  • 2 mg
  • 4 mg
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3
Q

What are the pros of the gum/lozenges?

A
  • oral sub for tobacco
  • can titrate to manage withdrawal symptoms
  • might delay weight gain
  • used in combo with other agents
  • inexpensive
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4
Q

What are the cons for lozenges?

A
  • frequent dosing –> poor adherence
  • GI side effects

short-acting

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5
Q

What are the cons of the gum?

A
  • frequent dosing –> poor adherence
  • GI side effects
  • Dental work / jaw issues impede use
  • requires proper chewing technique
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6
Q

What strength does the nicotine patch come in?

A
  • 21 mg
  • 14 mg
  • 7 mg
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7
Q

What are the pros of the patch?

A
  • once-daily dosing
  • can be used in combo
  • consistent level over 24 hrs
  • discrete method
  • inexpensive
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8
Q

What are the cons of the patch?

A
  • can’t be acutely titrated for withdrawal symptoms
  • not recommended for use with dermatologic conditions
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9
Q

What strength does the inhaler come in?

A
  • 10 mg cartridge that delivers 4 mg

Rx only

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10
Q

What are the pros of the inhaler?

A
  • oral substitute
  • can titrate to manage withdrawal
  • mimics hand-to-mouth ritual
  • can be used in combo
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11
Q

What are the cons of the inhaler?

A
  • frequent dosing –> poor adherence
  • cartridges are less effective in cold environments ( < 60 F)
  • costly
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12
Q

What strength does the nasal spray come in?

A
  • 10 mL bottle
  • 0.5 mg per spray

Rx only

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13
Q

What are the pros of the nasal spray?

A
  • can titrate to more closely manage withdrawal symptoms
  • can use in combo
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14
Q

What are the cons of the nasal spray?

A
  • frequent dosing –> poor adherence
  • nasal irritation
  • not recommended for use w nasal disorders
  • costly
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15
Q

What strength is the bupropion SR?

A

150 mg

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16
Q

What are the pros of bupropion?

A
  • twice daily oral dosing
  • might be beneficial in pts w depression
  • can use in combo with NRT
  • relatively cheap
17
Q

What are the cons of bupropion?

A
  • seizure risk is increased
  • several contraindications and precautions / more extensive screening
  • patients must be monitored for potential neuropsychiatric symptoms
18
Q

What are the strengths of varenicline?

A
  • 0.5 mg
  • 1 mg
19
Q

What are the pros of varenicline?

A
  • twice daily oral dosing
  • offers a different mechanism of action than other options
  • most effective agent for cessation when used as monotherapy
20
Q

What are the cons of varenicline?

A
  • nausea (28%)
  • insomnia/sleep disturbances
  • patients must be monitored for neuropsychiatric symptoms
  • costly
21
Q

What are the 5 A’s?

A
  • ask about tobacco use
  • advise tobacco users to quit
  • assess readiness to quit
  • assist with the quit attempt
  • arrange follow-up care
22
Q

When do withdrawal symptoms manifest?

A

1 to 2 days

23
Q

When do withdrawal symptoms peak?

A

within the first week

24
Q

When do withdrawal symptoms subside?

A

2-4 weeks

25
Q

What are the 5 R’s and what are they used for?

A
  • relevance
  • risks
  • rewards
  • roadblocks
  • repetition
  • counseling strategies for those not ready to quit
25
Q

When is bupropion typically initiated?

A

1-2 weeks before the quit date

26
Q

When is varenicline typically initiated?

A

1 week before the quit date

27
Q

What are the criteria for high risk patients that should be referred?

A
  • pregnant or planning to become pregnant
  • CVD with hear attack in past 2 weeks, history of arrythmias or irregular heartbeat, unstable angina or experiences chest pain with strenuous activity
  • history of mental health disorders AND is perceived to not be stable

PHRM 852 (7 decks)

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