Tobacco Cessation - Chapter 43 Flashcards
The 5 As Model for treating tobacco use
Ask
Advise
Assess
Assist
Arrange
The 5 As: Ask
Ask the patient about their tobacco use, and identify and document the patient’s tobacco use status, at every patient
The 5 As: Advise
Advise the patient to quit. In a professional manner, advise and urge every patient to quit
The 5 As: Assess
Assess the patients readiness to quit.
The 5 As: Assist
Assist in the quit attempts. Encourage the patient to quit and show them support each and everytime you see them. Offer any medications if applicable, as well as lozenges, gum, patches, etc.
The 5 As: Arrange
Arrange follow ups for the patient. Having regular follow ups can hold patients accountable and more likely to continue to stay on track!
Smoking is the ________ cause of preventable dealht in the US
leading
Known risk factors for smoking
Heart disease, stroke, pregnancy complications, COPD, cancers
Pack-year smoking history
Cigarette packs/day x number of years smoked
Phone number for national tobacco quit-lines
1-800-QUIT-NOW
What is one of the essential components of tobacco cessation
Counseling
What are the two counseling components of tobacco cessation?
Behavioral counseling and social support
Should medications be offered to every patient trying to quit
Yes - to all patients who do not have other contraindications
Why are medcation a recommended?
Help prevent withdrawals and symptoms like anxiety, depression, irritability, insomnia, poor concentratio, restlessness, increased appetite, and urges
What is the most effective strategy for quitting smoking?
Counseling + medications
Five nicotine replacement therapies
Gum
Lozenge
Inhaler
Nasal Spray
Patches
Two non-nicotine drugs
Bupropion and Varenicline
First line options
Replacement therapy
Non-nicotine therapy
Best first line options
Patch + one short acting
Varenicline + patch
In what populations is behavioral counseling preferred over any kind of drug therapies
Pregnant women (no nicotine at all)
Adolescents
Smokeless tobacco users
Light smokers
Are electronic cigarettes recommended for people who are trying to quit smoking?
No - there are even more health concerns with e cigarettes
Smoking induces which CYP enzyme?
CYP1A2
What medications can patients who quit smoking see supratherapeutic levels of due to CYP1A2 no longer being induced?
Caffeine
Theophylline
Fluvoxamine
Olanzapine
Clozapine
Warfarin
What medications should women who smoke and are over the age of 35 avoid?
Anything containing estrogen
What vaccines should smokers receive?
Influenza
Pneumoccoal
Nicotine patch status
OTC
Nicotine patch brand name
NicoDerm CQ
How are nicotine patches dosed?
Based on your daily number of cigarettes
Who should avoid nicotine patches?
Pregnant patients, patients with recent MI, have arrythmias, worsening angina,
Side effects of nicotine patches
Insomnia
Vivid dreams
Skin Irritation
Who is not allowed to purchase nicotine products?
Anyone under the age of 21. FDA prohibits it
Big counseling point for patches
Remove before getting an MRI
Which form of nicotine replacement therapy has the highest adhearence?
Patch
Nicotine gum brand name
Nicorette
How is nicotine gum dosed?
Based on the timing of first cigarette after wake up
Nicotine lozenge brand name
Nicorette Mini
How is nicotine lozenges dosed?
Based on the timing of first cigarette after wake up
Nicotine gum status
OTC
Nicotine lozenge status
OTC
Nicotine inhaler status
RX
Nicotine nasal spray status
RX
How long can you use a nicotine inhaler?
For up to 6 months
How long can you use nicotine nasal spray?
For up to 3 months
Nicotine main side effect
Insomnia
Nicotine Inhaler side effect
Mouth and throat irritation
Nicotine nasal spray side effect
Nasal irritation
Do not eat or drink for ______ minutes before or after using nicotine gum and lozenge
15
What strength of nicotine gum and lozenge helps delay weight gain associated with quitting smoking?
4 mg
Inhaler positive
It provides the hand to mouth motion and could be used as a coping mechanism in patients trying to quit
True or false: nasal spray has the lowest risk of dependence
False
Nasal Spray has the ______ delivery
Fastest
Bupropion MOA
Blocks neural reuptake of dopamine and/or norepinephrine, which reduces cravings and withdrawal symptoms
Bupropion should be started _____ before your quit date
1-2 weeks
Does bupropion need to be tapered when d/ced?
No
Bupropion BBW
Suicidal thoughts and behaviors especially in young adults and adolescents
Which form of Bupropion is used for smoking cessation?
SR
Contraindications for Bupropion
Seizure history
History of anorexia and or bulimia
Concurrent use with MAOI
IV use of Methylene Blue
Bupropion side effects
Dry Mouth
Insomnia
Tremors
Weight Loss
To decrease insomnia:
Take the first dose first thing in the morning, and the 2nd dose 8 hours later
Varenicline MOA
Partial neuronal alpha-4 beta-2 nicotinic receptor agonist
Varenicline should be started _____ before the quit date
1-2 weeks
Does Varenicline need to be tapered when d/ced?
No
True or False: Varenicline is recommended over bupropion?
True
True or False: Varenicline monotherapy is preferred over Varenicline + NRT
False
Varenicline side effects
Nausea
Insomnia
Vivid dreams
Headache
Ways to decrease nausea
Take right after eating with a full class of water
What to use to help slow the weight gain associated with quitting
Gum
Lozenge
Bupropion SR
What to use to help with depression and quitting
Bupropion SR
Avoid with dentures
Gum
Avoid with COPD/Asthma
Inhaler
Nasal Spray
Avoid with skin conditions
Patch
Avoid in patients with seizures
Bupropion
Varenicline
Steps to applying/removing the patch
Remove the old patch before placing a new one
1. Remove the backing of the patch and apply the sticky side to clean, hairless skin
2. Press firmly on the patch for ~15 seconds
3. Wear for up to 24 hours - if you have side effects around sleeping, remove the patch before bedtime
4. Discard the patch by folding the sticky ends together. You can place it back in the pouch and throw in the trash
5. Wash your hands after applying and removing the patch
6. Rotate the application site. Do not wear in the same place every time
7. Do not cut the patch or wear more than one at once
Steps for chewing gum
- Chew slowly until the tingly or peppery flavor occurs in the mouth
- Park the gum in the cheek
- When the tingly/peppery flavor goes away, slowly chew more until the flavor returns
- Repeat until most of the flavor is gone (Takes about 30 minutes)
- Do not eat or drink 15 minutes before or after chewing
Lozenges counseling points
Do not eat or drink for 15 minutes before or during use
Do not chew or swallow the lozenge, allow it to dissolve
It takes ~20-30 minutes to have it fully dissolve
May cause warm or tingling sensation
Do not use more than one lozenge at a time
Inhaler counseling points
Inhale deeply into the back of the throat or puff in short breaths
Each cartridge provides about 20 minutes of active puffing
Clean the mouthpiece with soap and water regularly
Keep at room temperature
Varenicline can ________ the effects of alcohol
Increase
