Tobacco Cessation

Question 1

what are the 5 As of cessation counseling

Answer 1

Ask about tobacco use
Advise about quitting
Assess readiness to quit
Assist in quit attempt
Arrange follow up

Question 2

what are the 5 NRT options

Answer 2

patch
inhaler
nasal spray
gum
lozenge

Question 3

T or F
patch plus gum/lozenge/bupropion is less effective than patch alone

Answer 3

false
patch plus gum/lozenge/bupropion is more effective than patch alone

Question 4

how to electric cigarettes help in smoking cessation

Answer 4

they dont!! not recommended

Question 5

what drugs interact with smoking

Answer 5

R warfarin
theophylline
clozapine
olanzapine
fluvoxamine
caffeine
are all 1A2 substrates

1A2 is induced by smoking

Question 6

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?

Answer 6

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

Question 7

pack year equation

Answer 7

= ppd x years smoked

Question 8

why is smoking CI with BC?

Answer 8

clot risk

Question 9

what vaccines are recommended in smokers

Answer 9

pneumococcal
influenza

Question 10

NRT should be avoided in …

Answer 10

pregnancy
immediate post-MI period
life-threatening arrhythmias
severe or worsening angina

Question 11

1 pack = ____ cigarettes

Answer 11

20

Question 12

how many cigarettes is 2.5 ppd

Answer 12

30

Question 13

what is the nicotine patch dosing based on

Answer 13

number of cigs per day

Question 14

nicotine patch dosing

Answer 14

</= 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

Question 15

ADE NRT patch

Answer 15

skin irritation
vivid dreams

Question 16

how are the NRTs gum and lozenge dosed

Answer 16

based on time to first cig in the morning

Question 17

gum/lozenge dosing

Answer 17

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

Question 18

smoking cessation tx good for avoiding weight gain

Answer 18

lozenge
gum
bupropion

Question 19

ADE of all NRTs

Answer 19

insomnia
HA
dizziness
nervousness
dyspepsia

Question 20

bupropion SR
dosing
BBW
CI
ADE/SE

Answer 20

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

Question 21

varenicline
dosing
BBW
SE

Answer 21

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

Question 22

which treatments should be avoided in epilepsy and seizure disorders

Answer 22

bupropion
varenicline

Question 23

which treatments should be avoided in COPD/asthma

Answer 23

inhaler
nasal spray

Question 24

which treatments should be avoided in dentures

Answer 24

gum

Question 25

which treatments should be avoided in MRI

Answer 25

patch

Question 26

which treatments should be avoided in skin conditions

Answer 26

patch

Question 27

when should patients avoid food and drinks while on the lozenge or gum

Answer 27

15 minutes before dose and during the dose