Tobacco Cessation

Question 1

1 cause of preventable death in the U.S.

Answer 1

Tobacco Use.

480,000 deaths every year

Question 2

In 2014, tobacco industries spent a total of 9 billion

Answer 2

On advertising and promotion for their products in the U.S.

Question 3

Nicotine is considered to be more addictive than…

Answer 3

cocaine, heroin, or alcohol.

Nicotine inhaled via a cig can reach the brain in 5 heartbeats

Question 4

High alkalinity of nicotine found in cigs greatly increases what?

Answer 4

Nicotine absorption and dependence

Question 5

Risks of using smokeless tobacco.

Answer 5

Leukoplakia (white lesions in mouth)
Dental caries
Cancer
-Esophageal, pharynx, larynx, stomach, pancreatic

Question 6

Average hookah sessions is equivalent to what?

Answer 6

Smoking a pack of cigs in 30 min

Question 7

A single 30 min hookah session has been shown to cause..

Answer 7

Increases in COHb, blood pressure, heart rate, and respiratory rate.

Shows a decrease in pulmonary function tests.

Question 8

Electronic cigs have seen an increase or decrease in the past few years?

Answer 8

967% increase.

Electronic cigs emit a propylene glycol vapor when activated.

Question 9

Harms of E-cigs:

1. Youth:
2. Current smokers:
3. Society & non-smokers:

Answer 9

1. Nicotine poisoning, increase in initiation of conventional cig use, future disease risk.
2. Slows cessation and may not allow for complete cessation. (benefit: reduced disease for those who switch to e-cigs)

3.Renormalization of nicotine and smoking.
Secondhand aerosol exposure

Question 10

What percent of people want to quit smoking?

Answer 10

70%.

Counseling and medications are more effective together than alone

Question 11

What percent of adult smokers began smoking before the age of 20?

Answer 11

80%

Question 12

What is the tobacco control act?

Answer 12

Cigs can no longer contain flavors (except menthol)

Cig packaging can no longer contain the words “light”, “low”, or “mild”

Question 13

Nicotine addiction is a chronic disease.

Answer 13

This addiction represents one of the most challenging addictions to break .

The average tobacco user will make 11 quit attempts before quitting for good.

Premature discontinuation of tobacco cessation medications often results in relapse.

Question 14

What are the 5 A’s?

Answer 14

Ask, Advise, Assess, Assist, Arrange

Question 15

Which medications for tobacco cessation can be combined?

Answer 15

Nicotine patch can be combined with bupropion, varenicline, and a short-acting NRT (gum, lozenge, inhaler, nasal spray)

Bupropion can be combined with a short-acting NRT (gum, lozenge, inhaler, nasal spray), a nicotine patch and varenicline.

Question 16

Nicotine patch (long-acting) characteristics:

Answer 16

Match 1mg of nicotine in patch to # of cigs smoked/day

Patch must be rotated to a new location daily

Most common adverse effects: Application site irritation and vivid dreams

Question 17

Nicotine gum (short-acting) characteristics:

Answer 17

Dose based on # of cigs/day or time to first cig
->20 CPD or <30 min to 1st cig = 4mg

Less than or equal to 20 CPD or greater than or equal to 30 min to 1st cig =2mg

Chew and park method for optimal drug release.

Nausea and upset stomach can occur, especially if used incorrectly

Question 18

Nicotine lozenge characteristics:

Answer 18

Dose same as gum.

Delivers 25% higher dose of nicotine than gum

Use and adverse side effects similar to gum

Question 19

Nicotine inhaler (short-acting) characteristics:

Answer 19

10 mg nicotine cartridges, each delivering 4 mg of nicotine

Nicotine is absorbed through the lining of the cheek

Each cartridge is designed for 20 min of active puffing

Cough and throat irritation are the most common side effects

Question 20

Nicotine Nasal Spray (short-acting) characteristics:

Answer 20

Use 1 spray in each nostril every 1 to 2 hours PRN

Fastest delivery of nicotine of all currently available products

Nose and eye irritation are common but subside over time

Question 21

Non-nicotine medications:

Answer 21

Bupropion sustained-release:

• Targets dopamine receptors
• Initiate 1 to 2 weeks prior to quit date
• Insomnia, diarrhea, and dry mouth are most common side effects
• Caution with seizure disorder or conditions that increase risk of seizure

Varenicline: (use this for as long as it takes)

• Nicotine partial agonist
• Initiate 1 week prior to quit date
• Vivid dreams and nausea are most common side effects

Question 22

Extended duration treatment?

Answer 22

Refers to use of Rx beyond typical 12 week treatment duration

Recent article showed no benefit using nicotine patch beyond 24 weeks (adherence rates were low, smh)

Increasing treatment duration of varenicline from 12 to 24 weeks significantly reduced relapse and increased abstinence rates

Question 23

Average smoker will gain how many pounds?

Answer 23

7 to 19 pounds within 8 years of quitting vs. continued smoker who will gain 4 to 5 pounds

Question 24

The most effective tobacco cessation medication for delaying weight gain is…

Answer 24

Bupropion

Question 25

Smoking prevalence rates are between _______ in people diagnosed with depression, bipolar disorder, or schizophrenia.

Answer 25

60-80%

Nearly half of all cigs smoked in the U.S. are consumed by people with mental illness.

Question 26

1-800-QUIT-NOW

Answer 26

Statewide line linking patients to trained counselors.

Offers up to 8 weeks of nicotine patches, gum, or lozenges to qualified individuals.