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Patient Care 3 > Tobacco Cessation Part II > Flashcards

Tobacco Cessation Part II Flashcards

1
Q

what is nicotine

A

an alkaloid that is contained in the leaves of plants

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2
Q

what is the mechanism of action of nicotine

A
  • distributed quickly through the bloodstream and crosses the blood-brain barrier
  • reaches the brain within 8-20 seconds with inhalation
  • elimination half-life of nicotine is around two hours
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3
Q

where is nicotine metabolized

A

in the liver

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4
Q

what is the nicotine effect

A
  • stimulates adrenal glands
  • releases adrenaline- surge causes immediate release of glucose
  • increased heart rate, breathing activity, and BP
  • pancreas produced less insulin- causing increased blood sugar or glucose
  • dopamine released- feeling of contentment is higher
  • acteylcholine and norepinephrine released- concentration and memory
    -increased levels of beta-endorphin reducing anxiety
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5
Q

the amount of nicotine absorbed by the body from smoking depends on:

A
  • type of tobacco
    -whether the smoke is inhaled
  • whether a filter is used
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6
Q

amount of tobacco released into the body is ______ in smokeless tobacco

A

much greater

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7
Q

development of brain continues to occur until the age of:

A

25 years old

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8
Q

how does nicotine impact brain development

A
  • nicotine changes the way synapses are formed
  • can harm parts of the brain that control attention and learning
  • the nicotine can prime adolescent brain for addiction to other drugs such as cocaine
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9
Q

how does tobacco impact youth/young adults

A
  • depression
  • anxiety
  • mood disorders
  • addiction
  • difficulty paying attention
  • reduced impulse control
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10
Q

what is the cycle of nicotine addiction

A
  • use of nicotine
  • stimulates dopamine release
  • causes pleasureable feelings
  • repeated use of nicotine
  • tolerance develops
  • body creates more nicotine receptor sites over time
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11
Q

what are the 2 parts of the issue of tobacco dependence

A

physiological and behavioral

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12
Q

what is the physiologcial component of tobacco dependence and what is the tx

A
  • the addiction to nicotine
  • tx: medications for cessation
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13
Q

what is the behavioral component of tobacco dependence and what is the tx

A
  • the habit of using tobacco
  • tx: behavior change program
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14
Q

treatment should address the _________ of dependence

A

physiological and behavioral aspects

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15
Q

what are withdrawl symptoms of tobacco cessation

A
  • chest tightness
  • constipation, stomach pain
  • cough, dry throat
  • cravings for tobacco
  • depressed mood, irritable
  • dizziness
  • difficulty concentrating
  • fatigue
  • hunger
  • insomnia
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16
Q

what are the benefits of quitting smoking

A
  • BP returns to normal
  • normal O2 blood level
  • carbon monoxide eliminated from lungs- start to clear mucus
  • nicotine is eilminated, smell and taste improve
  • lung capacity begins to improve breathing becomes easier
  • circulation improves
  • risk of lung cancer decreases
  • reduced risk of other cancers
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17
Q

decreased risks when quitting smokeless tobacco:

A
  • oral, head, and neck cancer
  • tooth decay
  • progression of gum recession
  • high cholesterol
  • high blood pressure
  • heart attack or stroke
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18
Q

what are the types of assistance in cessation

A
  • nicotine transdermal patches- 23%
  • nicotine gum and lozenges - 27%
  • non nicotine chantix: 22-24%
  • non nicotine Zyban: 16%
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19
Q

what are the 5 A’s to help our patients quit

A
  • ask: about tobacco use
  • advise: tobacco users to quit
  • assess: readiness to make a quit attempt
  • assist: with the quit attempt
  • arrange: follow up care
20
Q

what is the transtheoretical change model

A
  • pre-contemplation
  • contemplation
  • preparation
  • action
  • maintenance
  • termination or relapse
21
Q

what are the cessation options

A
  • cold turkey
  • nicotine replacement therapy
  • medications
  • behavioral therapy
  • combination therapy
  • hypnotherapy
  • acupuncture
  • yoga- meditation
  • herbs
22
Q

when using pharmacotherapy check with physician first if pt has:

A
  • hypothyroidism
  • insulin- dependent diabetes
  • active peptic ulcer
  • anti depressant medications
23
Q

describe bupropion SR- zyban, how to use, advantages

A
  • 150mg sustained release tablet
  • begin taking 1 week prior to quitting
  • double dose after 3 days
  • advantages: easy to use can be used with NRT
24
Q

what are the adverse effects o bupropion

A

-insomnia
- dry mouth
- nervousness/difficulty concentrating
- rash
- constipation
- seizures

25
Q

how many refills do you give for the starter pack of zyban

A

zero

26
Q

how many refills do you give for the maintenance pack of zyban

A

2

27
Q

describe varenicline and how to use

A
  • 0.5mg and 1.0mg tablet
  • days 1-3: take one 0.5mg tablet in the AM
  • days 4-7: take 0.5mg tablet twice daily
  • weeks 2-12: take 1.0mg tablet twice a day
28
Q

what are the advantages of varenicline

A

easy to use and offers a new mechanism of action for patients who have failed with other agents

29
Q

what are the adverse effects of varenicline

A
  • nausea, insomnia, vivid dreams, constipation, and vomitting
  • neuropsychiatric symptoms: behavior changes, agitation, depressed mood, suicidal ideation or behavior
30
Q

describe nicotine replacement therapy options (gum-nicorette, zonnic)

A
  • 2 mg (smoke less than 25 cig/day) or 4mg (smoke more than 25 cig/day)
  • week 1-6: 1 piece every 1-2 horus
  • week 7-9: 1 piece every 2-4 hours
  • week 10-12: 1 piece every 4-8 hours
  • max of 24 pieces per day, no food or drink 15 mins before or during use
31
Q

what are the advantages of nicotine replacement therapy options- gum

A

may delay weight gain and satisfy oral cravings

32
Q

what are the adverse effects of nicotine replacement therapy options- gum

A

mouth/jaw soreness, hiccups, dyspepsia

33
Q

describe nicotine replacement therapy options- lozenge- Commit and Zonnic

A
  • 2 mg (smoke more than 30 minutes after waking) or 4mg (smoke less than 30 minutes after waking)
  • week 1-6: 1 lozenge every 1-2 hours
  • week 7-9: 1 lozenge every 2-4 hours
  • week 10-12: 1 lozenge every 4-8 hours
  • max of 20 lozenges/day
  • no food or beverage 15 minutes before or during use
  • do not chew or swallow lozenge
34
Q

what are the advantages of nicotine replacement therapy options - lozenge

A

may delay weight gain and satisfy oral cravings

35
Q

what are the adverse effects of nicotine replacement therapy options- lozenge

A

nausea, hiccups, cough, heartburn, headache, insomnia

36
Q

how are nicotine replacement therapy options- transdermal patches used

A
  • 7mg, 14mg, 21 mg (24 hour release)
  • less than 10 cig/day: 14mg/day for 6 weeks and 7mg/day for 2 weeks
  • more than 10 cigs a day: 21mg/day for 6 weeks, 14mg/day for 2 weeks, 7mg/day for 2 weeks
37
Q

what are the advantages of nicotine replacement therapy options- transdermal patch

A
  • provides consistent nicotine for 24 hours
  • easy to use
38
Q

what are the adverse effects of nicotine replacement therapy options- transdermal patches

A
  • local skin reaction
  • headache
  • insomnia
  • vivid dreams
39
Q

describe how to use nicotine replacement therapy options- nasal spray

A

-0.5mg metered spray per 50mcL
- 1-2 doses per hour
- 8-40 doses/day
- maximum dose 5 doses/hour
- one dose= 2 sprays - 1 per nostril

40
Q

what are the advantages to the nasal spray nicotine replacement therapy options

A

patients can titrate therapy to help with withdrawal

41
Q

what are the adverse effects of nasal spray as a NRT

A

nasal/throat irritation, rhinitis, tearing, sneezing, headache, cough

42
Q

describe how to use the oral inhaler as an NRT

A
  • 10mg cartridge- delivers 4mg inhaled nicotine vapor
  • 6-16 cartridges/day
  • begin with 1 cartirdge every 1-2 hours
  • best effects with continuous puffing for 20 minutes
43
Q

what are the advantages of oral inhaler as an NRT

A
  • patients can titrate amount to manage withdrawal and mimics hand to mouth ritual
44
Q

what are the adverse effects of NRT oral inhaler

A

mouth/throat irritation, cough, headache, rhinitis, dyspepsia

45
Q

what does the UMKC tobacco cessation program consist of

A
  • prep work by the student
  • initial visit appointment
  • follow up visit appointments
46
Q
A

Patient Care 3 (22 decks)

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