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Pharm III > Tobacco Cessation > Flashcards

Tobacco Cessation Flashcards

1
Q

USPHS and USPSTF recommendations

A

Identify ever tobacco user
Provide advice to quit and practical counseling no matter how brief (behavioral therapy)
Motivate health behavior change (MI)
Combine brief behavioral tx with effective and approved pharmacotherapy for everyone making a quit attempt
-Exceptions include contraindications and special populations where evidence is poor

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2
Q

The 5 A’s about tobacco cessation

A

Ask about smoking
-ID and document tobacco use status for every pt at every visit
Advise to quit
Assess willingness to quit
Assist in quitting
Arrange f/u
-Preferably within the first week after the quit date

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3
Q

Ways of prepping for quit day

A

Emotional
Physical
Therapeutic
Medical preparation

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4
Q

Motivational interviewing

A

Pt-centered to elicit behavioral change
Goal: help pt resolve ambivalence without evoking resistance
Use of open-ended questions
Affirm positive behaviors and strengths
Paraphrase their comments
Emphasize personal choice through summaries

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5
Q

Affirmation

A

Helps individuals acknowledge positive behaviors and strengths

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6
Q

Reflective listening

A

Paraphrasing individuals’ comments lets them know you heard what they said

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7
Q

Summary statements

A

Pull together allowing for transitions; emphasize personal choice

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8
Q

What are the five principals of motivational interviewing?

A 
Develop discrepancy
Express empathy
Amplify ambivalence
Roll with resistance
Support self-efficacy
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9
Q

Developing discrepancy

A

Create a gap between where the person is and where they want to be
Pt can realize that their current behavior is not leading them towards goals

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10
Q

Expressing empathy

A

Listen to put yourself in their shoes

Critical to minimize resistance

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11
Q

Amplifying ambivalence

A

Ambivalence is nl

Verbalizing can help pts explore both sides they are dealing with

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12
Q

Rolling with resistance

A

Resistance is also nl
Do not argue- seek clarification to encourage pts to determine solutions they think will work
Emphasize personal choice and control

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13
Q

Supporting self-efficacy

A

Pt must believe that change is possible AND attainable

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14
Q

Non-pharmacologic cessation methods

A

Counseling and behavioral therapies
Two types of counseling and behavioral therapies result in higher abstinence rates
-Practical counseling (problem-solving skills)
-Support and encouragement

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15
Q

Practical counseling

A

Recognize danger situations
-Alcohol, stress, triggers, other users
Develop coping skills
-Avoid triggers, lifestyle change, distract from urge

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16
Q

Support

A

Encouragement
-Options to help, belief in ability to be successful
Caring
-How pt feels, willingness to help
Talk it out
-Why pt wants to quit, pt concerns, discuss successes the pt has, anticipated difficulties

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17
Q

Who benefits from tx?

A

Psychological disorders
Low SES
Limited formal education

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18
Q

No recommendation for tx due to data

A 
Children and adolescent smokers (inconclusive)
Light smokers (excluded from studies)
Non-cigarette tobacco users (excluded from studies)
Pregnant smokers (safety)
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19
Q

1st line monotherapy

A

NRT
Bupropion
Varenicline

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20
Q

Forms of NRT

A 
Gum
Patch
Lozenges
Inhalers
Nasal sprays
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21
Q

1st line combos

A

Long-term (>14 wks) nicotine patch + other NRT (gum, lozenge, or spray)
Nicotine patch + nicotine inhaler
Nicotine patch + bupropion SR

22
Q

Who needs long-term meds?

A

Smokers who report persistent withdrawal sx
Smokers who have had relapse after stopping medication
Smokers at higher risk for relapse
-More dependent (>20 CPD; smokes within 30 mins of waking)
-Other smokers in household
-Psychiatric comorbidity (include substance abuse hx)
Smokers who desire long-term therapy

23
Q

MOA of bupropion SR

A

Norepinephrine/dopamine reuptake inhibitor and nicotine antagonist

24
Q

Dose of Bupropion SR

A

Begin 1-2 wks before quit date
150 mg daily x 3 days, then 150 mg BID
Duration: 12 wks- 6 mos

25
Q

CIs of bupropion SR

A

Hx seizures

Eating disorder

26
Q

SE of bupropion SR

A 
Appetite decrease
Vivid dreams
Increase BP
Insomnia
Dry mouth
27
Q

Counseling for bupropion SR

A

Early second dose
Monitor BP
Keep smoking until the actual quit day
Can continue after quit period for comorbid depression, anxiety

28
Q

MOA of varenicline (Chantix)

A

Nicotinic receptor partial agonist

29
Q

Dose of varenicline (Chantix)

A

Begin 7 days before quit date

0.5 mg daily x 3 days, then 0.5 mg BID x 4 days, then 1 mg BID (quit date) x 3-6 mos

30
Q

Precautions for varenicline (Chantix)

A

CrCl <30- reduce dose
0.5 mg BID max
ESRD 0.5 mg daily max

31
Q

SEs of varenicline (Chantix)

A

Nausea
Insomnia
Vivid/strange dreams

32
Q

Counseling for varenicline (Chantix)

A

Take with food to decrease nausea

33
Q

Patch dose

A

7 mg, 14 mg, 21 mg based on smoking; step down every 2-6 wks

34
Q

SEs of patch

A

Local skin reaction
Insomnia
Vivid dreams

35
Q

Counseling for patch

A

Less than 1/2 ppd, try lozenge or gum instead of patch
If side effects at nigh, put on patch in morning instead
If patch falls off, don’t replace, get a new one

36
Q

Gum dose

A 
2 mg (1 PPD)
4 mg (> 1 PPD) q1-2 h
37
Q

Precautions of gum

A

CV pts within 2 wks of MI
Serious arrhythmias, or unstable angina
No more than 24 pieces per day

38
Q

SEs of gum

A

Mouth soreness
Hiccups
Dyspepsia

39
Q

Counseling for gum

A

Chewing technique

No drinking except water for 15 mins before or during

40
Q

Lozenge dose

A

2 mg if > 30 mins

4 mg if < 30 mins

41
Q

Precautions of lozenge

A

No more than 20 lozenges per day

42
Q

SEs of lozenge

A

Nausea
Hiccups
Heartburn

43
Q

Counseling for lozenge

A

Rotate around in the mouth near cheek, don’t bite it

44
Q

Inhaler dose

A

4 mg per cartridge

45
Q

Precautions of inhaler

A

Mouth/throat irritation

46
Q

SEs of inhaler

A

Cough

Rhinitis

47
Q

Counseling for inhaler

A

Schedule use

May use cartridge for 24 hrs after opening

48
Q

Nasal spray dose

A

0.5 mg spray per nostril q1-2 hr (max 40 per day)

49
Q

Precautions of nasal spray

A

Severe reactive airway dz

Highest peak and thus highest risk of dependence

50
Q

SE of nasal spray

A

Nasal irritation
Smell and taste changes
Nasal congestion

51
Q

Counseling for nasal spray

A

Spraying technique (prime, tilt head back; no sniff, swallow, or inhale)

52
Q

Populations to use 6 mo tx plan

A 
Past substance abuse
Unable to quit on quit date
Comorbid illness
Persistent urges to smoke
Higher dependence

Pharm III (8 decks)

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