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OTC > Tobacco Cessation > Flashcards

Tobacco Cessation Flashcards

1
Q

Tobacco is the leading cause of…

A

known preventable death

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2
Q

Smoking causes more deaths per year than all of the following combined:

A
  • HIV
  • Illegal drug use
  • alcohol use
  • motor vehicle accidents
  • firearm-related incidents
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3
Q

Smoking increases the risk of…

A
  • coronary heart disease x2-4
  • stroke x2-4
  • lung cancer in men x25 and women x25.7
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4
Q

Smoking can cause cancer in…

A

almost anywhere in the body

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5
Q

Smoking during pregnancy can lead to…

A
  • preterm delivery
  • stillbirth
  • LBW
  • SIDS
  • ectopic pregnancy
  • orofacial clefts in infants
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6
Q

Correlated factors for smoking:

A
  • 25-44 YO
  • non-hispanic american Indians/Alaskan natives
  • lower education levels
  • < federal poverty level
  • differs by state (WV has highest and UT has lowest)
  • mental illness
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7
Q

Second-hand smoke increases the risk of…

A
  • SIDS
  • respiratory infections
  • ear infections
  • severe asthma
  • slowed lung growth
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8
Q

Marketing regulation of 1965:

A

federal cigarette labeling and advertising act

- surgeon general’s warning on cigarette packaging

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9
Q

Marketing regulation of 1971:

A

broadcast advertising banned

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10
Q

Marketing regulation of 1990:

A

cigarette ban on flights and interstate busses

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11
Q

What happened in 1994?

A

Mississippi filed lawsuit

  • big tobacco for Medicaid costs
  • first of 22 states to file suit
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12
Q

Marketing regulation of 1995:

A

President Clinton announced FDA to regulate sales and advertising to minors

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13
Q

T/F: cigarettes are the only marketed consumable product, that when used persistently, will kill half or more of its users

A

T

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14
Q

On June 18, 2021, the US will…

A

change packaging

- warnings prominently on packaging

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15
Q

In 2021, warning labels in the US will…

A
  • occupy top 50% of package area on the front and back

- at least 20% of advertisements

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16
Q

How can nicotine can induce and sustain chemical dependence?

A
  • psychoactive effects
  • used in highly controlled or compulsive manner
  • reinforce behavioral patterns
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17
Q

Pharmacologic process of smoking is similar to…

A
  • heroin

- cocaine

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18
Q

Pathophysiology of smoking:

A

stimulates mesolimbic dopaminergic system in midbrain

  • dopamine reward pathway
  • induces pleasant or rewarding effects
  • promotes continued use
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19
Q

Cigarette smoke has an EPA of…

A 
class A carcinogen
- no safe level of exposure for humans
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20
Q

Cigarette smoke has a complex mixture of…

A
  • nitrogen
  • CO
  • ammonia
  • hydrogen cyanide
  • benzene
  • nicotine
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21
Q

Nicotine:

A
  • distilled when burned
  • carried in tar droplets to small airways
  • absorbed into arterial circulation
  • readily penetrates CNS
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22
Q

Effects of nicotine on brain:

A
  • decreased appetite
  • decreased anxiety and tension
  • increased mood
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23
Q

Effects of nicotine on heart:

A
  • increases heart rate

- increases blood pressure

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24
Q

Nicotine will affect:

A
  • brain
  • heart
  • endocrine
  • nervous
  • metabolic
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25
Q

Chronic users of smoking:

A
  • develop tolerance to nicotine

- abrupt cessation triggers withdrawal

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26
Q

Withdrawal symptoms:

A
  • irritability, frustration, anger
  • anxiety, depression
  • loss of concentration
  • insomnia, restlessness
  • cravings
  • impaired performance
  • constipation
  • dizziness
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27
Q

Timeline of withdrawal symptoms:

A
  • manifest 1-2 days
  • peak in 1 week
  • dissipates 2-4 weeks
  • appetite and weight gain may persist for > 6 months
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28
Q

Drug interactions:

A
  • increased toxicity of some drugs
  • CYPP450 enzyme inducer
  • caffeine exposure increased 56%
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29
Q

Significant drug interactions w/…

A

combination hormonal contraceptives

  • increased clotting risk
  • increased risk of CV effects
  • greater risk if > 35 YO/ > 15 cigs a day
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30
Q

Primary treatment goal for smoking:

A

complete, long term abstinence from all nicotine products

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31
Q

Treatment goals for smoking:

A
  • help patients quit tobacco
  • prevent relapse
  • utilize appropriate pharmacotherapy and counseling
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32
Q

General approach to quitting:

A
  • no treatment (cold turkey)
  • tobacco cessation counseling
  • pharmacotherapy
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33
Q

What percentage of quitters fail by going cold turkey?

A

95%

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34
Q

Tobacco cessation counseling helps…

A
  • increases odds of quitting

- longer and more frequent beneficial

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35
Q

Pharmacotherapy will help…

A

increases odds of quitting

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36
Q

What is the best approach for quitting smoking?

A

counseling and pharmacotherapy

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37
Q

Exclusions for self treatment:

A
  • serious heart disease
  • irregular heartbeat
  • uncontrolled HTN
  • pregnancy
  • breastfeeding
  • < 18
  • active PUD
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38
Q

Comprehensive counseling has the 5A’s. What are they?

A
  • ask patients if they use tobacco
  • advise users to quit
  • assess readiness to quit
  • assist patients to quit
  • arrange follow up care
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39
Q

Info about asking patients about tobacco use:

A
  • routine component of care
  • consider asking about secondhand smoke
  • “do you ever smoke or use any type of tobacco?”
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40
Q

Info about advising patients about tobacco use:

A
  • clear, strong, and personalized
  • sensitive and convey concern
  • “strongly encourage you to quit”
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41
Q

Info about assessing patients for tobacco use:

A
  • not all patients are ready to quit when approached
  • “what are your thoughts about quitting?”
  • “something you are willing to do in the next month?
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42
Q

Classifications for assessing patients for quitting:

A
  1. not ready to quit in next month
  2. ready to quit in next month
  3. recent quitter in past 6 months
  4. former user > 6 months ago
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43
Q

Info about assisting patients with quitting:

A
  • be empathetic
  • acknowledge quitting is challenge
  • goal is to maximize success
  • encourage counseling and medication
44
Q

Info about arranging follow up with patients who are quitting:

A
  • multiple counseling interactions are preferred

- follow up is crucial

45
Q

Intervals of following up with recent quitter:

A
  • week 1
  • month 1
  • periodically after
46
Q

Better quitting success comes from…

A

more and longer contacts

47
Q

Precontemplation counseling:

A
  • always ask permission first
  • use open-ended questions
  • motivational interviewing
48
Q

Counseling:

A
  • group and individual is effective

- self-help material alone is not effective

49
Q

Most successful tips for quitting:

A
  • social support
  • problem-solving training
  • stress management
  • relapse prevention
  • > 4 sessions
  • > 10 minute sessions
50
Q

Motivational interviewing techniques:

A
  • develop discrepancy
  • express empathy
  • amplify ambivalence
  • roll w/ resistance
  • support self-efficacy
51
Q

Motivational interviewing:

A
  • always ask permission first

- use open-ending questions

52
Q

Info about developing discrepancy:

A
  • patient is smoking and knows it’s harmful
  • can’t acknowledge that quitting is important
  • will tend not to want to talk about it, so try to have honest discussion
53
Q

Techniques of how to develop discrepancy:

A
  • readiness ruler

- decisional matrix

54
Q

How to express empathy:

A
  • understand patient’s POV
  • people want to feel understood
  • no judgement zone
55
Q

How to amplify ambivalence:

A
  • explore two sides of thought to amplify ambivalence

- help bring quitting to forefront of patient’s mind

56
Q

Rolling w/ resistance:

A
  • avoid “righting reflex”

- humans resist change

57
Q

Techniques for rolling with resistance:

A
  • ask permission
  • offer advice
  • emphasize choice
  • elicit response
  • voice confidence
58
Q

How to support efficacy:

A
  • many lack confidence to change (want to increase it)

- maintain positive tones b/c patients will lean toward negative

59
Q

Reminders for helping people quit:

A
  • stay positive
  • don’t be judgmental
  • utilize motivational interviewing
  • remember how difficult it is for patients
60
Q

T/F: some pharmacological agents double quit rates

A

F, all agents double quit rates

61
Q

What are the 7 FDA approved first-line agents?

A
  • NRT gum
  • NRT lozenge
  • NRT patches
  • NRT nasal spray
  • sustained release buproprion
  • varenicline
62
Q

Nicotine replacement therapy (NRT) is…

A

FDA approved for cigarette cessation

63
Q

MOA of NRT:

A

stimulates release of dopamine in the central NS

  • non-tobacco source of nicotine
  • reduces physiologic symptoms of withdrawal
  • allows focus on behavior change
  • no exposure to carcinogens
64
Q

NRT has…

A

lower, slower, and less-variable plasma levels

65
Q

General counseling for NRT:

A
  • don’t use tobacco products w/ it
66
Q

Adverse effects of nicotine:

A
  • nausea
  • vomiting
  • hyper-salivation
  • perspiring
  • abdominal pain
  • dizziness
  • weakness
  • palpitations
67
Q

Adverse effects of NRT:

A
  • headache
  • insomnia
  • abnormal dreams
68
Q

Dosage of NRT gum/lozenge:

A
  • 2mg - 4mg
  • buffering agent helps absorption in buccal mucosa
  • time to first cigarette (TTFC)
69
Q

Peak effectiveness of NRT gum/lozenge:

A

30 minutes

70
Q

Duration of NRT gum/lozenge:

A

2-3 hours

71
Q

Strength selection for NRT gum/lozenge during 1st cigarette < 30 minutes after waking:

A

4 mg

72
Q

Strength selection for NRT gum/lozenge during 1st cigarette > 30 minutes after waking:

A

2 mg

73
Q

How to taper gum/lozenge:

A
  • weeks 1-6: 1 piece Q 1-2 H
  • weeks 7-9: 1 piece Q 2-4 H
  • weeks 10-12: 1 piece Q 4-8 H
74
Q

Adverse effects of gum/lozenge:

A
  • general NRT adverse effects
  • unpleasant taste
  • mouth irritation
  • jaw soreness/fatigue
  • hiccups
  • dyspepsia
75
Q

How to use the NRT gums:

A
  • chew and park method
  • gum lasts about 30 minutes
  • don’t excess 24 pieces a day
76
Q

What is the chew and park method:

A
  • chew slowly several times
  • stop chewing when you feel “peppery” sensation (around 15 chews)
  • park gum between cheek and gum
  • when tingling goes away, resume chewing
  • rotate “parking” locations
77
Q

Why do you rotate parking locations?

A

it reduces mouth irritation

78
Q

NRT lozenge use:

A
  • place in mouth and allow to dissolve
  • warm, tingling sensation is normal
  • don’t chew or swallow
  • occasionally rotate in mouth to reduce irritation
  • don’t excess 20 lozenges/day
79
Q

Standard lozenges dissolve within…

A

20-30 minutes

80
Q

Mini lozenges dissolve within…

A

10 minutes

81
Q

NRT patch dosages:

A

7 mg, 14 mg, 21 mg

- based on # of cigarettes/day

82
Q

NRT patches deliver…

A

continuous, low levels or nicotine

83
Q

Each NRT patch lasts…

A

about 24 H

84
Q

Composition of NRT patch:

A
  • waterproof surface layer
  • nicotine reservoir
  • adhesive layer
  • disposable protective liner
85
Q

NRT patch dosing if one smokes > 10 cigarettes per day:

A
  • 21 mg/day for 4 weeks
  • 14 mg/day for 2 weeks
  • 7 mg/day for 2 weeks
86
Q

NRT patch dosing if one smokes < 10 cigarettes per day:

A
  • 14 mg/day for 6 weeks

- 7 mg/day for 2 weeks

87
Q

Adverse effects of NRT patch:

A
  • local skin reactions at application site
  • rotate application site
  • change brands
  • nonrx hydrocortisone cream
  • sleep disturbances, so can remove patch at night
88
Q

How to use NRT patch:

A
  • apply to clean, dry, hairless area same time every day with firm pressure for about 10 seconds
  • rotate application site
  • apply for no more than 24 H
  • don’t cut
  • can shower and swim with it
89
Q

How to choose therapy based on patient factors:

A
  • comorbidities
  • smoking habits
  • gum difficult w/ dental work/dentures
90
Q

How to choose therapy based on patient preferences:

A
  • frequent vs infrequent dosing

- perceptions from past attempts

91
Q

E-cigarettes are the most common…

A

teen “tobacco” product in the US b/c of availability, alluring ads, e-liquid flavor, and belief of safety over cigarettes

92
Q

E-cigarettes risks:

A
  • nicotine addiction
  • mood disorders
  • aerosol related lung damage
  • affects attention and learning in teens
  • affects decision making and impulse control in teens
93
Q

US e-cigarettes regulations:

A
  • 2016 FDA center for tobacco products (CTP), which is similar to tobacco regulations
94
Q

In 2018, US surgeon general declared…

A

vaping is a youth epidemic

95
Q

In 2020, FDA encourages…

A

smokers to switch to less harmful products such as e-cigarettes
- made it illegal to market to youth populations

96
Q

People with CVD should…

A
  • use NRT w/ caution because it can increase b.p. and h.r.

- use NRT w/ MD/DO supervision

97
Q

Pregnant people should…

A
  • look at risk/benefit
  • NRT has a category D: fetal harm
  • use NRT w/ MD/DO supervision
98
Q

No FDA approved products for…

A

adolescents

99
Q

Elderly people:

A
  • same recommendations as adult population

- pharmacologic therapy and counseling

100
Q

Stages of behavioral change:

A
  • precontemplation
  • contemplation
  • preparation
  • action
  • maintenance
101
Q

Precontemplation stage of behavioral change:

A

unaware of problem

102
Q

Contemplation stage of behavioral change:

A

aware of problem and of desired behavioral change

103
Q

Preparation stage of behavioral change:

A

intends to take action

104
Q

Action stage of behavioral change:

A

practices desired behavior

105
Q

Maintenance stage of behavioral change:

A

works to sustain behavioral change

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