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pulmonology > Tobacco cessation > Flashcards

Tobacco cessation Flashcards

1
Q

Tobacco use causes what percent of all lung cancer deaths in men and women?

A
  • 90%
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2
Q

What is the pathophys of nicotine addiction?

A
  • nicotine is a highly addictive drug in tobacco
  • the cravings can begin within days of the first use
  • nicotine stimulates brain nicotinic cholinergic receptors releasing dopamine and other neurotransmitters in the brain’s reward center
  • nicotine activates the brain’s reward system during pleasurable activities similar to that of addictive drugs
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3
Q

Acute effects of tobacco use?

A
  • increases HR, BP, and RR
  • increases energy
  • increased ability to concentrate
  • ability to overcome fatigue
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4
Q

What are the chronic effects of tobacco use?

A
  • yellow stains of teeth and fingers
  • skin is drier and more wrinkled
  • hair is thinner
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5
Q

Withdrawals from tobacco use?

A
  • anxiety
  • difficulty concentrating
  • sleep disruption
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6
Q

What are the medical conditions related to tobacco?

A 
- smoking causes a large range of health conditions:
CVD
stroke
COPD: emphysema, chronic bronchitis
pregnancy (low birth weight)
bone and tissue health
affects teeth and gums
delayed wound healing
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7
Q

Why is tobacco use a RF for CVD and stroke?

A
  • raises TGs
  • lowers HDL
  • damage cells that line blood vessels
  • causes thickening and narrowing of blood vessels
  • causes clots to form
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8
Q

How does tobacco use lead to COPD?

A
  • poisons in cigarette smoke can weaken lungs’ defense against infections, narrow air passages, causes swelling in air tubes and destroys air sacs
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9
Q

What effects does tobacco use have on pregnancy?

A
  • damage sperm and ED
  • premature birth
  • birth defects: cleft palate
  • SIDs
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10
Q

What effects does tobacco use have on bone and tissues?

A
  • osteoporosis
  • delayed bone healing after fracture
  • gum disease
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11
Q

Why are different types of cancers related to tobacco use?

A
  • smoking itself can cause cancer and it also blocks your body from fighting it
  • poisons in tobacco smoke weaken the body’s immune system to fight off the cancer cells
  • 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
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12
Q

What cancers are related to smoking?

A
  • almost all cancers in the body
  • mouth, nose, throat
  • larynx
  • trachea
  • esophagus
  • lungs
  • stomach
  • pancreas
  • liver
  • kidneys and ureters
  • bladder
  • colon and rectum
  • cervix
  • bone marrow and blood (leukemia)
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13
Q

What cancers are linked to smokeless tobacco?

A
  • esophagus
  • mouth and throat
  • pancreas
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14
Q

What are the 3 types of smokeless tobacco?

A
  • chewing tobacco: loose leaf or plug tobacco, nicotine is absorbed through the mouth tissue
  • snuff: finely ground tobacco in cans or pouches, nicotine is absorbed through the mouth tissue, dry snuff in powder form is used by sniffing or inhaling the powder up the nose
  • snus: from Sweden and Norway. commonly packaged in small pouches. Has fewer tobacco specific nitrosamines (TSNAs) that are known to cause cancer
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15
Q

Who usually uses smokeless tobacco?

A
  • about 3.5% of people 12 and older
  • more high school students use compared to young adults
  • the route is different, but the nicotine addiction is the same
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16
Q

What are the harmful health effects of smokeless tobacco?

A
  • mouth, tongue, cheek, gum and throat cancer
  • esophageal, stomach, and pancreatic cancer
  • increased risk of heart disease and stroke
  • leukoplakia
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17
Q

Who uses e-cigs?

A
  • increase use in adults, high school and middle school kids since 2010
  • most are current smokers
  • most report purpose of use is for smoking cessation
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18
Q

How does an e-cig work?

A
  • contains a battery that activates a heating device, atomizing liquid nicotine inside a cartridge and producing a vapor that is inhaled
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19
Q

First gen ECs?

A
  • cigalikes
  • disposable
  • re-chargeable with pre filled cartridges
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20
Q

Second gen ECs?

A

-refillable with liquids

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21
Q

3rd gen ECs?

A
  • mods

- able to adjust atomizer - burn liquid hotter - get more nicotine out

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22
Q

What are the components of an E-cig?

A 
- liquid components:
nicotine (Not followed by FDA)
propylene glycol/glycerol
flavorings 
other components
- vapor: little is known about health effect
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23
Q

What are the public health concerns about E-cigs?

A
  • appeal to youth

- reverse changing social norms about acceptability of cigarette smoking

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24
Q

How should you counsel a pt on use of ECs?

A
  • not approved by FDA
  • probably less harmful than conventional cigs
  • if smokers want to use E cigs to quit, up to provider to support use
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25
Q

Second hand smoke exposure rates?

A
  • 88 million nonsmokers exposed 07-08
  • today: half of children b/t ages 3-18 are exposed regularly
  • body begins to metabolize nicotine from the smoke, producing a byproduct called cottoning, which can be measured by testing saliva, urine or blood for cotinine
26
Q

What are the effects of secondhand smoke on children?

A
  • ear infections
  • asthma attacks
  • respiratory sxs
  • resp. infections
  • SIDs
27
Q

What are the effects of secondhand smoke on adults?

A
  • CVD: increases risk 25-30%
  • causes around 34000 heart disease death annually
  • lung cancer: increases risk 20-30% - causes more than 7300 lung cancer deaths annually
28
Q

What are the goals of nicotine replacement therapies? (NRT)

A
  • goal is to provide nicotine to a smoker w/o using tobacco while a smoker tries to break the habit
  • the use of long acting NRT in combo with a short acting NRT is preferred
  • initial dosing is based on the number of cigarettes smoked daily
  • NRT is recommended for 2-3 months after smoking cessation
  • NRT products can be used while the smoker is still smoking
29
Q

What NRT products are available?

A
  • 3 OTC products:
    patch, gum and lozenge
  • 2 Rx:
    nasal spray, and oral inhaler
30
Q

Describe the transdermal nicotine patch?

A

(OTC)
- provides the most continuous nicotine delivery
- patch provides a 16 and 24 hour release
16 hr: usually helps for light average smoker
24 hr: helps with morning cravings
- doses available: 21, 14, and 7
- light smokers: less than 10 cigs/day - should start on quit day and start with 14 mg/day strength for 6 weeks, followed by 7 mg/day for 2 weeks
- heavy smokers: more than 10 cigs a day - should start on quit day with 21 mg/day for 6 weeks followed by 14 for 2 weeks and then 7 mg/day for 2 weeks

31
Q

What are the SEs of the transdermal nicotine patch?

A
  • skin irritation (most common)
  • dizziness
  • nausea
  • sleep problems and unusual dream
  • HA
  • muscle aches and stiffness
  • SE if patch is too strong:
    tachycardia, nausea and overstimulated
32
Q

What are the short acting NRT agents?

A
  • nicotine gum
  • lozenge
  • nasal spray
  • inhaler
  • these should be used in combo with the patch to help control nicotine cravings and withdrawal sxs
33
Q

Describe the nicotine gume (OTC)?

A
  • most common short acting NRT used
  • chewing the gum releases nicotine that is absorbed through the oral mucosa
  • doses available: 2 mg for light smokers
    and 4 mg: for those that smoke more than 25 cigs a day
  • chew one piece of gum every 1-2 hours for 6 weeks with gradual reduction over the next 6 weeks for a total duration of 3 months
  • chew and park method and then repeat for 30 minutes
34
Q

What are the SEs of nicotine gum?

A
  • Nausea
  • vomiting
  • abdominal pain
  • constipation
  • hiccups (air in the stomach)
35
Q

Describe the nicotine lozenge (OTC)?

A
  • place in mouth and it dissolves over 30 minutes
  • doses:
    2 mg for most smokers
    4 mg for smokers who smoke within 30 min after waking
  • use one lozenge q 1-2 hours for 6 weeks with gradual reduction over the next 6 weeks
  • max dose is 5 lozenges every 6 hours or 20 lozenges per day
  • good for pts that cant chew gum (bad jaw, or dentition)
36
Q

SEs of lozenges?

A
  • mouth irritation
  • hiccups
  • N/V
37
Q

Describe the nasal spray (Rx)?

A
  • delivers nicotine directly to the nasal mucosa where it is absorbed
  • 1 or 2 sprays/hr for about 3 months with a max dose of 10 sprays/hr for 80 sprays a day
  • each spray contains about 0.5 mg of nicotine
38
Q

SEs of nasal spray?

A
  • nasal irritation
  • runny nose
  • watery eyes
  • b/c of SEs limits use (caution use in asthma, nasal polyps, any sensitivity in Upper respiratory tract)
39
Q

Describe oral inhalers (Rx)?

A
  • consist of nicotine cartridge and a thin plastic tube that mimics a cigarette
  • smoker inhales puffs on the tube and produces a vapor of nicotine that is absorbed in the mucosa of the mouth so it gives the sensation of the cigarette
  • downfall: easier to get e-cig, most expensive of NRTs, vapor rarely reaches the lungs
40
Q

SEs of oral inhalers?

A
  • coughing
  • mouth or throat irritation
  • upset stomach
41
Q

What 2 medical therapies are available for tobacco cessation?

A
  • varenicline (chantix)

- Bupropion (wellbutrin, zyban)

42
Q

MOA of Varenicline?

A
  • agonizes and blocks alpha-4-beta-2 nicotine acetylcholine receptors
  • works in 2 ways:
    1. binds to and produces partial stimulation of alpha-4 beta 2 nicotine receptor, thereby reducing nicotine withdrawal
  • since the drug binds to alpha 4 beta 2 it blocks nicotine from binding to the receptor reducing the pleasure reward
43
Q

SEs of varenicline?

A
  • Nausea (low dose and titrating up will reduce nausea)
  • constipation
  • sleep disturbance
  • unusual dreams
44
Q

What are the 2 main concerns of Varenicline?

A
  • neuropsychiatric SEs:
    risk of suicide (BBW) so monitor smokers with depression
  • Cardiovascular SEs:
    may have higher risk of MI or stroke
45
Q

Administration of varenicline?

A
  • start 0.5 mg daily for 3 days
  • 0.5 mg 2x for 4 days
  • 1 mg 2x daily for rest of 12 week therapy
46
Q

MOA of Bupropion?

A
  • unknown, thought to act by enhancing CNS noradrenergic and dopaminergic release
  • may benefit smokers who are concerned about post cessation wt gain
  • considered 1st line therapy for smokers with schizophrenia
  • CI for smokers with seizure disorder
47
Q

SEs of bupropion?

A
  • insomnia
  • dry mouth
  • HAs
48
Q

Administration of Bupropion?

A
  • start 1-2 weeks prior to stop date
  • 150 mg/day for 3 days
  • then 150 mg 2x a day for 12 weeks
49
Q

How much more likely are smokers going to quit when they see a provider that advises on cessation?

A
  • 1.6x more likely to quit
  • providers must ask about smoking history
  • advise smokers to quit
  • assist smoker with plan to stop
  • determine smokers desire: 5 stages of change and 5 As for assessing tobacco use and quitting
50
Q

What are the 5 stages of change?

A
  • step 1: pre-contemplation
  • step 2: contemplation (thinking about quitting but not quite ready)
  • step 3: preparation (set a quit date)
  • stage 4: action
  • stage 5: maintenance
51
Q

What are the 5 As?

A
  • ask
  • advise
  • assess
  • assist
  • arrange
52
Q

What are some useful strategies for cessation?

A
  • get rid of ashtrays
  • drink a lot of water
  • avoid smoke filled places
  • track money saved
  • exercise
  • eat healthy, avoid alcohol
  • reflect on why you want to quit
  • call a friend or support line
  • think of yourself as a non-smoker
53
Q

What are alternative cessation therapies?

A
  • hypnosis
  • acupuncture
  • behavioral therapy
  • motivational therapy
54
Q

What is nicotine withdrawal? sxs?

A
  • usually begins 30 minutes after the last use of tobacco
  • sxs will usually peak in 2-3 days
  • sxs will usually subside over the next 3-4 weeks, however some smokers it may take a couple of months
    sxs: intense craving for nicotine, tingling in the hands and feet, sweating, nausea, HAs, and feeling irritable
55
Q

What are the health benefits of smoking cessation?

A
  • within 20 minutes: BP, HR and peripheral circulation improve
  • in 24 hrs CO levels drop
  • within 48 hrs nicotine is eliminated and taste and smell improve
  • 2-12 weeks lung fxn can improve 30%
  • 3-9 months: SOB and coughing decrease
  • 1 year: risk of MI reduced 50%
  • 10 years: risk of lung cancer: reduced by 50%
56
Q

How do you calculate pack years?

A
  • packs smoked per day x years smoked

- or (number of cigs a day/20)x number of years smoked

57
Q

What groups have highest rates of tobacco use?

A
  • american indians and alaska natives
58
Q

Health conditions linked to tobacco use?

A
  • CV
  • COPD/cancer
  • pregnancy complications
59
Q

smokeless tobacco is most prevalent in which age group?

A
  • kids
60
Q

Second hand smoke effects on children?

A
  • infections

- asthma

61
Q

What is first line medical therapy for tobacco cessation?

A

Varenicline (Chantix) - **suicide risk

pulmonology (20 decks)

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