Tobacco Cessation Flashcards
What type of therapy is most effective for smoking cessation?
Combination of 2 drugs
Are e-cigarettes recommended for smoking cessation?
NO - emerging health concerns
Non-nicotine chemicals in tobacco smoke induce what CYP enzyme?
1A2
What patient population should not take estrogen-containing oral contraceptives? Why?
Women >35
Increased risk of CV events
Treatment guidelines promote the use of behavioral counseling over drugs in what patients?
Pregnant women
Adolescents
Smokeless tobacco users
“Light” smokers (<10 cigs/d)
What vaccines should smokers receive?
19-64 - pneumovax 23
Annual flu
What nicotine patch strength should be used if patient smokes >10 cigs/d?
21mg
What nicotine patch strength should be used if patient smokes less than 10 cigs/d?
14mg
If a patient smokes their first cigarette >30 minutes upon waking, what strength of nicotine gum or lozenges should they use?
2mg
If a patient smokes their first cigarette 30 minutes or less upon waking, what strength of nicotine gum or lozenges should they use?
4mg
Minimum and max pieces of gum and lozenges per day
Min: 9/d x 6 weeks (both)
Max gum: 24/d
Max lozenge: 20/d
Nicotine replacement therapy warnings, SE, and notes
Warnings: avoid in immediate post-MI, avoid inhaler and nasal spray in asthma/COPD
SE: patch (vivid dreams), inhaler (mouth/throat irritation), nasal spray (nasal irritation)
What NRT should be d/c before undergoing an MRI?
Nicotine patch
Bupropion MOA
blocks neuronal reuptake of dopamine and/or NE
Varenicline MOA
partial neuronal alpha-4 beta-2 nicotinic receptor agonist causing low-level stimulation of the receptor while blocking the ability of nicotine to bind
What medications should be started before the quit date?
Varenicline and bupropion
At least 1 week
Bupropion BBW, CI, warnings, SE
BBW: increased risk of suicidal thinking
CI: seizures, anorexia/bulimia, MAOi, linezolid, or IV methylene blue
Warning: serious neuropsychiatric events
SE: dry mouth, insomnia, tremors, weight loss
Varenicline warnings, SE
Warnings: serious neuropsychiatric events, seizures
SE: nausea, insomnia, abnormal dreams, HA
Take after eating with full glass of water
What smoking cessation therapy should be used if the goal is to avoid weight bain
gum, lozenge, bupropion SR
What smoking cessation therapy should be used if patient also has depression
Bupropion
What smoking cessation therapy should be avoided if patient has dentures?
gum
What smoking cessation therapy should be avoided if patient has asthma/COPD
inhaler or spray
What smoking cessation therapy should be avoided if patient has skin condition
patch
What smoking cessation therapy should be avoided if patient has seizures
bupropion and varenicline
