Tobacco Cessation

Question 1

What type of therapy is most effective for smoking cessation?

Answer 1

Combination of 2 drugs

Question 2

Are e-cigarettes recommended for smoking cessation?

Answer 2

NO - emerging health concerns

Question 3

Non-nicotine chemicals in tobacco smoke induce what CYP enzyme?

Answer 3

1A2

Question 4

What patient population should not take estrogen-containing oral contraceptives? Why?

Answer 4

Women >35

Increased risk of CV events

Question 5

Treatment guidelines promote the use of behavioral counseling over drugs in what patients?

Answer 5

Pregnant women
Adolescents
Smokeless tobacco users
“Light” smokers (<10 cigs/d)

Question 6

What vaccines should smokers receive?

Answer 6

19-64 - pneumovax 23

Annual flu

Question 7

What nicotine patch strength should be used if patient smokes >10 cigs/d?

Answer 7

21mg

Question 8

What nicotine patch strength should be used if patient smokes less than 10 cigs/d?

Answer 8

14mg

Question 9

If a patient smokes their first cigarette >30 minutes upon waking, what strength of nicotine gum or lozenges should they use?

Answer 9

2mg

Question 10

If a patient smokes their first cigarette 30 minutes or less upon waking, what strength of nicotine gum or lozenges should they use?

Answer 10

4mg

Question 11

Minimum and max pieces of gum and lozenges per day

Answer 11

Min: 9/d x 6 weeks (both)
Max gum: 24/d
Max lozenge: 20/d

Question 12

Nicotine replacement therapy warnings, SE, and notes

Answer 12

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)

Question 13

What NRT should be d/c before undergoing an MRI?

Answer 13

Nicotine patch

Question 14

Bupropion MOA

Answer 14

blocks neuronal reuptake of dopamine and/or NE

Question 15

Varenicline MOA

Answer 15

partial neuronal alpha-4 beta-2 nicotinic receptor agonist causing low-level stimulation of the receptor while blocking the ability of nicotine to bind

Question 16

What medications should be started before the quit date?

Answer 16

Varenicline and bupropion

At least 1 week

Question 17

Bupropion BBW, CI, warnings, SE

Answer 17

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

Question 18

Varenicline warnings, SE

Answer 18

Warnings: serious neuropsychiatric events, seizures
SE: nausea, insomnia, abnormal dreams, HA
Take after eating with full glass of water

Question 19

What smoking cessation therapy should be used if the goal is to avoid weight bain

Answer 19

gum, lozenge, bupropion SR

Question 20

What smoking cessation therapy should be used if patient also has depression

Answer 20

Bupropion

Question 21

What smoking cessation therapy should be avoided if patient has dentures?

Answer 21

gum

Question 22

What smoking cessation therapy should be avoided if patient has asthma/COPD

Answer 22

inhaler or spray

Question 23

What smoking cessation therapy should be avoided if patient has skin condition

Answer 23

patch

Question 24

What smoking cessation therapy should be avoided if patient has seizures

Answer 24

bupropion and varenicline