Tobacco Cessation Flashcards
NRT therapy and cessation
What are the five A’s of tobacco cessation?
- Ask
- Advise
- Assess
- Assist
- Arrange
Refs to add later:
https://www.nicotinedependenceclinic.com/en/teach/Documents/Pharmacotherapy%20Algorithm%20JAN2018%20updated.pdf
and
https://www.albertahealthservices.ca/assets/info/trp/if-trp-tct-5a-approach-in-brief-and-intensive-settings.pdf -> add more later
What does dosing generally look like for Nicotine Patches?
Wean down if they abstained
- 21 mg per day for 6 weeks
- 14 mg per day for 2 weeks, followed by 7 mg per day
Source for adding in NRT products: left off at gum
https://www.albertahealthservices.ca/assets/info/trp/if-trp-tct-summary-of-tobacco-cessation-pharmacotherapy-nrt.pdf
What are the indications for Nicotine patches?
Partial relief of nicotine withdrawal symptoms. This
treatment should be used as part of a comprehensive behavioural smoking-cessation program.
- can be combined with bupropion (anti-depressant and smoking aid) and short acting nrt prodcuts
Contraindications for Nicotinic patches
Previous acute hypersensitivity
reaction
* Immediate post-myocardial
infarction period
* Life-threatening arrhythmias
* Severe or worsening angina
pectoris
* Recent cerebral vascular
accident
Precautions for nicotine patches?
Precautions
- Pregnancy
- Nursing mothers
- Generalized skin disorders
How long does it Nicotine Gum take affect?
15 mins
How long does Nicotine inhaler take affect?
15 mins
How long does Nicotinic mouth spray take affect?
Immediate release with a effect within 60 seconds
Why is bupropion paired with other NRT products?
Bupropion is a ant depressive drug that antagonizes the effect of nicotine (reduces the craving feeling)
Combo therapy options for smoking cessation
How are smoking cessation approaches different for pregnant women?
https://www.albertahealthservices.ca/assets/info/trp/if-trp-baby-steps-help-guide-knowledge-topic-7-aids-to-quit-during-pregnancy-and-breastfeeding.pdf
Nicotine weaning strategies for pregnant women (need to confirm if its right with Erin)
Patches not ideal but a better option than gum (higher conc). Cold turkey would be the best case scenario.
What immediate affects does nicotine have on the body
- Increased normal HR
- High BP
- Increased RR
- Low blood sugar
- Enhanced memory and improved concentration
- Appetite suppression
Major risk factors for Tobacco and Nicotine exposure
- Glance and acknowledge
Mouth, throat, esophageal, larynx, bladder, pancreas, kidney, breast, cervical, some types of leukemia (overall, smoking causes 30% of cancer deaths)
- COPD
- Lung Cancer
- IPF
- Cardiovascular disease
- Diabetes
- Infertility
- Pregnancy complication
- Tooth/gum disease
Vaping risks/trends
Popcorn lung and EVALI
- Both diseases originate from chemicals found within the e cigs
- Diacetyl found in e cigs (not as freq now)
- Vitamin E was causing EVALI
What is EVALI?
Lung disease that can develop due to vaping.
- Symptoms include shortness of breath, cough, and chest pain.
- Treatments include steroids and antibiotics.
What is primary goal for smoking cessation if weaning is possible (but not stopping)?
Harm reduction
- suggest alternatives in the mean time as you work with the patient
what are the benefits of using Tobacco Cessation Pharmacology?
It provides a clean source of nicotine
- NRT combined w/CBT counselling is the gold standard for tobacco cessation
What are the five R’s of Motivational Interviewing for Tobacco Cessation?
- Relevance: why is quitting relevant to health, family, social situation?
- Rewards: potential benefits of quitting - health, money, taste & smell
- Risk: Acute (shortness of breath), chronic (CVD, cancer, COPD)
- Roadblocks: withdrawal symptoms, fear of failure, weight gain
- Repetition: repeat MI every time the patient visits the clinic
How many cigarettes in a pack?
20
3 questions to ask when assisting with smoking cessation
- How would you like to quit, cold turkey or with assistance?
- Do you want to quit abruptly or gradually?
- What type of assistance do you need? pharmacotherapy or counselling?
Starting NRT Doses for a light smoker
- <10 CPD
- Start with 14mg patch x1-4 weeks
and
- One short acting NRT (Gum, Lozenge, mouth spray or inhaler)
3 pharmacotherapy routes?
- Varenicline
- Bupropion
- NRT (i.e gum, lozenges, mouthspray, or inhaler)
What is the purpose of NRT products
They are supposed to assist with breakthrough cravings prn
- i.e gum, lozenges, mouthspray, or inhaler)
Starting NRT Doses for a moderate smoker
- 10-29 CPD
- Start with 21mg patch x1-4 weeks
and
- One short acting NRT (Gum, Lozenge, mouth spray or inhaler)
Starting NRT Doses for a heavy smoker
- 30+ CPD
- Start with 28mg patch (21+7mg patches) x1-4 weeks
and
- One short acting NRT (Gum, Lozenge, mouth spray or inhaler)
Maintenance recommendations at 1-4 week follow up if still smoking 10+CPD
Add a 21mg patch to current dose and 1 short acting NRT dose
Maintenance recommendations at 1-4 week follow up if still smoking 6-9 CPD
Add 14mg patch to current dose and 1 short acting NRT dose
Maintenance recommendations at 1-4 week follow up if still smoking 1-5 CPD
Add a 7mg patch to current dose and 1 short acting NRT dose
