Tobacco Cessation Flashcards
pack year, DDI, vaccinations, NRT and other tx, counseling
what are the 5 As of cessation counseling
Ask about tobacco use
Advise about quitting
Assess readiness to quit
Assist in quit attempt
Arrange follow up
what are the 5 NRT options
patch
inhaler
nasal spray
gum
lozenge
T or F
patch plus gum/lozenge/bupropion is less effective than patch alone
false
patch plus gum/lozenge/bupropion is more effective than patch alone
how to electric cigarettes help in smoking cessation
they dont!! not recommended
what drugs interact with smoking
R warfarin
theophylline
clozapine
olanzapine
fluvoxamine
caffeine
are all 1A2 substrates
1A2 is induced by smoking
if a patient is on warfarin 2mg PO QD for mechanical heart valve clot ppx and is a chronic smoker at 2 ppd for the past 15 years. They are interested in smoking cessation.
what is the pack year hx?
will warfarin need to be adjusted?
2ppd x 15 years = 30 pack year hx
warfarin is metabolized by 1A2 which is induced by smoking
patient may need a lower warfarin dose without smoking onboard
pack year equation
= ppd x years smoked
why is smoking CI with BC?
clot risk
what vaccines are recommended in smokers
pneumococcal
influenza
NRT should be avoided in …
pregnancy
immediate post-MI period
life-threatening arrhythmias
severe or worsening angina
1 pack = ____ cigarettes
20
how many cigarettes is 2.5 ppd
30
what is the nicotine patch dosing based on
number of cigs per day
nicotine patch dosing
</= 10 cigs a day: 14mg patch x6weeks then 7mg patch x2weeks
> 10 cigs a day: 21mg patch x6weeks, then 14mg patch x2weeks then 7mg patch x2 weeks
ADE NRT patch
skin irritation
vivid dreams
how are the NRTs gum and lozenge dosed
based on time to first cig in the morning
gum/lozenge dosing
first cig </= 30 min after waking: 4mg q1-2h x6weeks, 4mg q2-4h x3weeks, 4mg q4-8h x3weeks
first cig >30 min after waking: 2mg q1-2h x6weeks, 2mg q2-4h x3weeks, 2mg q4-8h x3 weeks
smoking cessation tx good for avoiding weight gain
lozenge
gum
bupropion
ADE of all NRTs
insomnia
HA
dizziness
nervousness
dyspepsia
bupropion SR
dosing
BBW
CI
ADE/SE
START ONE WEEK BEFORE QUIT DATE
150mg po QAM x3d then 150mg BID thereafter up to 6 months
BBW: suicidality in adolescents
CI: seizure, acute etoh or sedative cessation, hx anorexia/bulimia, linezolid, methylene blue
SE: insomnia, tremor, weight loss, neuropsych events
varenicline
dosing
BBW
SE
START 1 WEEK BEFORE QUIT DATE
0.5mg PO QD x3d, then 0.5mg PO BID x4d, then 1mg PO BID thereafter for 12 weeks total
BBW: serious neuropsych, daywalking, dreams, CVD risk, HSR, car accidents, seizures
SE: NAUSEA
which treatments should be avoided in epilepsy and seizure disorders
bupropion
varenicline
which treatments should be avoided in COPD/asthma
inhaler
nasal spray
which treatments should be avoided in dentures
gum
