Tobacco Cessation Flashcards
Tobacco use is…
BAD
What is the highly addictive drug present in tobacco?
Nicotine
Pathophys of nicotine addiction
nicotine stimulates brain nicotinic cholinergic receptors releasing dopamine and other neurotransmitters in the brains reward system
Nicotine
acute effects
chronic effects
withdrawal
acute effects:
- increases HR, BP, RR
- Increased energy
- increased ability to concentrate
- ability to overcome fatigue
Chronic effects:
- yellow stains of teeth and fingers
- skin is drier and more wrinkled
- hair is thinner
Withdrawal:
- Anxiety
- difficulty concentrating
- sleep disruption
Cardiovascular disease and stroke conditions related to tobacco
- raises triglycerides
- lowers HDL
- damage cells that line blood vessels
- causes thickening and narrow of blood vessels
- causes clots to form
COPD conditions related to tobacco
- weakened lungs defense against infections
- narrow air passages
- causes swelling in the air tubes
- destroys air sacs
Pregnancy conditions related to tobacco
- damage sperm and ED
- premature birth
- birth defects
- SIDS
Bone and Tissue conditions related to tobacco
- Osteoporosis
- delayed bone healing after fracture
- gum disease
Poisons in tobacco smoke can damage a cell’s DNA causing the cell to begin to grow out of control and create a _______ _______
cancerous tumor
What are the three types of smokeless tobacco?
Chewing tobacco
- loose leaf or plug tobacco
- nicotine is absorbed through the mouth tissue
Snuff
- cans or pouches
- nicotine absorbed through mouth tissue (can also be inhaled through nose)
Snus
- small pouches
- has fewer tobacco-specific nitrosamines that are known to cause cancer
Components of E-Cigarettes
liquid:
- nicotine
- propylene glycol
- flavorings
- others
vapor:
-little is known about the health effects
How can you test for smoke/secondhand smoke?
measure the amount of cotinine (the bodys byproduct of nicotine) in salavia, urine, or blood
Secondhand smoke
effects on children
effects on adults
children:
- ear infections
- asthma attacks
- respiratory sx/infections
- SIDS
adults
-increased risk of lung cancer and CV disease
What is the goal of Nicotine Replacement Therapy (NRT)?
How long is NRT recommended for after smoking cessation?
Can NRT products be used while the smoker is still smoking?
to provide nicotine to a smoker without using tobacco while a smoker tried to break the habit
2-3 months
yes
Examples of NRT products
OTC
Rx
OTC
- patch
- gun
- lozenge
Rx
- nasal spray
- oral inhaler
Transdermal Nicotine Patch
- What makes this special?
- How long do the patches last?
- light smoker dosing (less than 10 cigs/day)
- heavy smoker dosing (more than 10 cigs/day)
- SE
- SE if patch is too strong
-What makes this special?
Provides the most continuous nicotine delivery
-How long do the patches last?
16 hours or 24 hours
-light smoker dosing (less than 10 cigs/day)
start on quit day, start with 14 mg/day strength for 6 weeks, followed by 7 mg/day for 2 weeks
-heavy smoker dosing (more than 10 cigs/day)
start on quit day with 21 mg/day for 6 weeks, followed by 14 mg/day for 2 weeks, finish with 7 mg/day for 2 weeks
-SE skin irritation (most common) dizziness nausea sleep problems/ unusual dreams headache muscle aches and stiffness -SE if patch is too strong tachycardia nausea over stimulation
What can be used with the patch to help control nicotine cravings and withdrawal sx?
short acting agents like: gum lozenge nasal spray inhaler
Nicotine gum
where is the nicotine absorbed?
directions
SE
nicotine absorbed through the oral mucosa
chew one piece every 1-2 hours for 6 weeks with gradual reduction over the next 6 weeks for a total duration of 3 months
Use “chew and park” method repeated for 30 minutes
Se
- nausea
- vomiting
- abd pain
- constipation
Nicotine Lozenge
directions
SE
- placed in mouth and dissolves over 30 min
- use one lozenge every 1-2 hours for 6 weeks with gradual reduction over the next 6 weeks
- max dose is 5 lozenges every 6 hours or 20/day
SE
- mouth irritation
- hiccups
- N/V
Nasal spray
requires what?
directions
SE
requires a Rx
1 or 2 sprays/hr for about 3 months with a max dose of 10 sprays/hr or 80 sprays/day
(each spray contains about 0.5 mg of nicotine)
SE
- nasal irritation
- runny nose
- watery eyes
Oral inhalers requires what? directions SE what makes this special?
requires a Rx
Inhale/puff 6-16 cartridges for the first 6-12 weeks, then a gradual decrease over the next 6-12 weeks
SE
- coughing
- mouth or throat irritation
- upset stomach
*most expensive of the NRTs
Medical Therapy options
varenicline (chantix)
bupropion (wellbutrin, zyban)
Varenicline AKA MOA SE Concerns Directions
AKA
- chantix
MOA
-agonizes and blocks alpha-4 beta-2 nicotine acetylcholine receptors, reducing nicotine withdrawal AND reducing pleasure reward
SE
- Nausea*
- Constipation
- Sleep disturbances
- Unusal dreams
Concerns
- BBB** for Risk of SUICIDE (monitor smokers with depression)
- May have higher risk of MI and STROKE
Directions (can smoke for one week after starting) -0.5mg for 3 days -0.5 mg twice daily for 4 days -1mg twice daily for the rest of the 12 week therapy
Bupropion AKA MOA First line therapy for who SE Directions
AKA
-wellbutrin, zyban
MOA
-Unknown
First line therapy for who
-smokers with schizophrenia
SE
- Insomnia
- Dry mouth
- HA
Directions
- start 1-2 weeks before stop date
- 150mg/day for 3 days then 150 mg twice/day thereafter for 12 weeks
What are the 5 stages of change?
Stage1- pre-conteplation stage 2- contemplation stage 3- preparation (set quit date) stage 4- action stage 5- maintenance
What are the 5 A’s?
Ask Advise Assess Assist Arrange
alternative therapy cessation techniques
hypnosis
acupuncture
behavioral therapy
motivational therapy
sx of nicotine withdrawal
intense craving for nicotine tingling in hands and feet sweating nausea headaches
How do you calculate pack years?
number of pack years= packs/day X years as a smoker
or
number of pack years= number of cigarettes smoked per day/20 X number of years smoked
