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PHRM 852 > Tobacco cessation > Flashcards

Tobacco cessation Flashcards

1
Q

what is the indiana tobacco quitline

A

1-800-QUIT-NOW

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2
Q

which former us surgeon general said cigarettes are the most important public health issue of our time?

A

C. everett koop

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3
Q

which pts have the most to benefit by quitting

A

CVD, respiratory disorders, DM, cancer, pregnancy and lactation, mental health

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4
Q

what is the half life for nicotine

A

2h

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5
Q

when do withdrawal sx manifest

A

within the first 1-2 days

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6
Q

when do withdrawal sx peak

A

within the first week

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7
Q

when do withdrawal sx subside

A

within 2-4 weeks

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8
Q

what are some nicotine withdrawal Sx

A

irritatability/frustration/anger
anxiety
difficulty concentrating
restlessness/impatience
depressed modd
insomnia
increased appetite, weight gain, cravings

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9
Q

what are the effects of clinician interventions

A

compared to pts who receive no assistance from a clinician, pts who receive assistance are 1.7-2.2 times as likely to quit successfully for 5 or more months

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10
Q

what are the 5 A’s

A

ask, advise, assess, assist, arrange

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11
Q

what is indiana protocol for tobacco cessation

A

provide appropriate behavioral counseling AND/OR
refer pt to other resources for assistance, such as the IN tobacco quitline

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12
Q

what is the 5 R’s method for enhancing motivation

A

Relevance, risks, rewards, roadblocks, repetition

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13
Q

what are some stress management suggestions

A

deep breathing, shifting focus, taking a break

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14
Q

what is the success rate for pts who use the quitline and a medication for cessation

A

28.1%

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15
Q

when will the quitline contact pts of receiving referral

A

within 24-48 hours

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16
Q

how many attempts with the quitline make to reach referred pts

A

5 attempts

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17
Q

will the quitline leave a voicemail?

A

only if permission was given in referral information

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18
Q

what are other referral resources

A

becomeanex.org
smokefree.gov

19
Q

what are first line pharmacotherapies

A

nicotine gum, nicotine lozenge, transdermal nicotine patch, nicotine oral inhaler, nicotine nasal spray, bupropion SR tabs, varenicline tabs

20
Q

nicotine gum and lozenge strength

A

2, 4mg; various flavors

21
Q

nicotine gum and lozenge pros

A

oral substitute for tobacco
can titrate to manage withdrawal Sx
might delay weight gain
used in combination with other agents to manage situational urges
relatively inexpensive

22
Q

nicotine gum and lozenge cons

A

frequent dosing = poor adherence
GI SEs
dental work/jaw issues
proper chewing technique is necessary

23
Q

nicotine gum directions

A

chew slowly.
stop chewing at first sign of peppery tase or tingling sensation.
park between cheek and gum.
chew again when peppery tase or tingle fades.

24
Q

transdermal nicotine patch strength

A

21, 14, 7mg

25
Q

transdermal nicotine patch pros

A

once daily dosing.
can use in combination with other agents; delivers consistent nicotine levels over 24h.
of all nicotine replacement products; use is least obvious.
relatively inexpensive

26
Q

transdermal nicotine patch cons

A

cannot be titrated to acutely manage withdrawal Sx.
not recommended for use with dermatologic conditions.

27
Q

nicotine inhaler strength

A

10mg cartridge delivers 4mg inhaled vapor for absorption across buccal mucosa

28
Q

nicotine inhaler pros

A

oral substitute.
can be titrated.
mimics hand to mouth ritual of smoking.
can use in combination with other agents to manage situational urges.

29
Q

nicotine inhaler cons

A

frequent dosing = poor adherence.
cartridges might be less effective in cold environments.
cost of tx

30
Q

nicotine nasal spray strength

A

10ml bottle; 0.5mg per spray

31
Q

nicotine nasal spray pros

A

can titrate to more closely manage withdrawal Sx.
can use in combination with other agents to manage.

32
Q

nicotine nasal spray cons

A

frequent dosing = poor adherence.
nasal admin; nasal irritation.
not recommended for use with chronic nasal disorders or severe reactive airway disease.
cost of tx.

33
Q

bupropion SR

A

150mg tablets

34
Q

bupropion pros

A

BID
might be beneficial in pts with depression
can use in combination with NRT
relatively inexpensive

35
Q

bupropion cons

A

seizure risk is increased.
several CI and cautions.
more extensive screening.
pts must be monitored for potential neuropsychiatric Sx.

36
Q

varenicline strength

A

0.5mg and 1mg tablets

37
Q

varenicline pros

A

BID
offers a different MOA than other options.
most effective agent for cessation when used as monotherapy.

38
Q

varenicline cons

A

nausea: take after eating and with a full glass of water
insomnia/sleep disturbances.
pts must be monitored for potential neuropsychiatric Sx.
cost of tx

39
Q

varenicline quit approaches

A
  1. FIX QUIT approach:
    set quit date for 1 week after starting
    continue tx for 12 weeks
  2. FLEXIBLE quit approach:
    start taking varenicline and pick a quit date between 8-35 days from tx initiation
    continue tx for 12 weeks
  3. GRADUAL QUIT approach:
    starting taking varenicline and reduce smoking by 50% within the first 4 weeks, an additional 50% in next 4 weeks, and continue until complete abstinence by 12 wks
40
Q

what does combo NRT consist of

A

long acting formulation + short acting formulation

41
Q

PK drug interactions with tobacco smoke - drugs that may have a decreased effect due to induction of CYP1A2

A

bendamustine
caffeine
clozapine
olanzapine
tasimelteon
theophylline

42
Q

drug interactions - tobacco smoke and caffeine

A

constituents in tobacco smoke induce CYP1A2 enzymes, which metabolize caffeine - caffeine levels increase 56% upon quitting.
decrease caffeine intake by 50% when quitting

43
Q

what do smokers who use OCs have an increased risk of

A

stroke, MI, thromboembolism

44
Q

common reasons for relapse: no medication/non-adherence

A

chooses to use no med.
daily non-adherence undermines tx effects.
insufficient duration of overall therapy

PHRM 852 (10 decks)

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