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Pulmonology > Tobacco Cessation > Flashcards

Tobacco Cessation Flashcards

1
Q

Tobacco use is…

A

BAD

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2
Q

What is the highly addictive drug present in tobacco?

A

Nicotine

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3
Q

Pathophys of nicotine addiction

A

nicotine stimulates brain nicotinic cholinergic receptors releasing dopamine and other neurotransmitters in the brains reward system

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4
Q

Nicotine
acute effects
chronic effects
withdrawal

A

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
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5
Q

Cardiovascular disease and stroke conditions related to tobacco

A
  • raises triglycerides
  • lowers HDL
  • damage cells that line blood vessels
  • causes thickening and narrow of blood vessels
  • causes clots to form
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6
Q

COPD conditions related to tobacco

A
  • weakened lungs defense against infections
  • narrow air passages
  • causes swelling in the air tubes
  • destroys air sacs
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7
Q

Pregnancy conditions related to tobacco

A
  • damage sperm and ED
  • premature birth
  • birth defects
  • SIDS
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8
Q

Bone and Tissue conditions related to tobacco

A
  • Osteoporosis
  • delayed bone healing after fracture
  • gum disease
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9
Q

Poisons in tobacco smoke can damage a cell’s DNA causing the cell to begin to grow out of control and create a _______ _______

A

cancerous tumor

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10
Q

What are the three types of smokeless tobacco?

A

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
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11
Q

Components of E-Cigarettes

A

liquid:

  • nicotine
  • propylene glycol
  • flavorings
  • others

vapor:
-little is known about the health effects

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12
Q

How can you test for smoke/secondhand smoke?

A

measure the amount of cotinine (the bodys byproduct of nicotine) in salavia, urine, or blood

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13
Q

Secondhand smoke
effects on children
effects on adults

A

children:

  • ear infections
  • asthma attacks
  • respiratory sx/infections
  • SIDS

adults
-increased risk of lung cancer and CV disease

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14
Q

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?

A

to provide nicotine to a smoker without using tobacco while a smoker tried to break the habit

2-3 months

yes

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15
Q

Examples of NRT products
OTC
Rx

A

OTC

  • patch
  • gun
  • lozenge

Rx

  • nasal spray
  • oral inhaler
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16
Q

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
A

-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
17
Q

What can be used with the patch to help control nicotine cravings and withdrawal sx?

A 
short acting agents like:
gum
lozenge
nasal spray
inhaler
18
Q

Nicotine gum
where is the nicotine absorbed?
directions
SE

A

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
19
Q

Nicotine Lozenge
directions
SE

A
  • 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
20
Q

Nasal spray
requires what?
directions
SE

A

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
21
Q 
Oral inhalers
requires what?
directions
SE
what makes this special?
A

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

22
Q

Medical Therapy options

A

varenicline (chantix)

bupropion (wellbutrin, zyban)

23
Q 
Varenicline 
AKA
MOA
SE
Concerns
Directions
A

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
24
Q 
Bupropion
AKA
MOA
First line therapy for who
SE
Directions
A

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
25
Q

What are the 5 stages of change?

A 
Stage1- pre-conteplation
stage 2- contemplation
stage 3- preparation (set quit date)
stage 4- action
stage 5- maintenance
26
Q

What are the 5 A’s?

A 
Ask
Advise
Assess
Assist
Arrange
27
Q

alternative therapy cessation techniques

A

hypnosis
acupuncture
behavioral therapy
motivational therapy

28
Q

sx of nicotine withdrawal

A 
intense craving for nicotine
tingling in hands and feet
sweating
nausea
headaches
29
Q

How do you calculate pack years?

A

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

Pulmonology (15 decks)

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