Tobacco Cessation Part II Flashcards
what is nicotine
an alkaloid that is contained in the leaves of plants
what is the mechanism of action of nicotine
- 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
where is nicotine metabolized
in the liver
what is the nicotine effect
- 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
the amount of nicotine absorbed by the body from smoking depends on:
- type of tobacco
-whether the smoke is inhaled - whether a filter is used
amount of tobacco released into the body is ______ in smokeless tobacco
much greater
development of brain continues to occur until the age of:
25 years old
how does nicotine impact brain development
- 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
how does tobacco impact youth/young adults
- depression
- anxiety
- mood disorders
- addiction
- difficulty paying attention
- reduced impulse control
what is the cycle of nicotine addiction
- use of nicotine
- stimulates dopamine release
- causes pleasureable feelings
- repeated use of nicotine
- tolerance develops
- body creates more nicotine receptor sites over time
what are the 2 parts of the issue of tobacco dependence
physiological and behavioral
what is the physiologcial component of tobacco dependence and what is the tx
- the addiction to nicotine
- tx: medications for cessation
what is the behavioral component of tobacco dependence and what is the tx
- the habit of using tobacco
- tx: behavior change program
treatment should address the _________ of dependence
physiological and behavioral aspects
what are withdrawl symptoms of tobacco cessation
- chest tightness
- constipation, stomach pain
- cough, dry throat
- cravings for tobacco
- depressed mood, irritable
- dizziness
- difficulty concentrating
- fatigue
- hunger
- insomnia
what are the benefits of quitting smoking
- 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
decreased risks when quitting smokeless tobacco:
- oral, head, and neck cancer
- tooth decay
- progression of gum recession
- high cholesterol
- high blood pressure
- heart attack or stroke
what are the types of assistance in cessation
- nicotine transdermal patches- 23%
- nicotine gum and lozenges - 27%
- non nicotine chantix: 22-24%
- non nicotine Zyban: 16%
what are the 5 A’s to help our patients quit
- 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
what is the transtheoretical change model
- pre-contemplation
- contemplation
- preparation
- action
- maintenance
- termination or relapse
what are the cessation options
- cold turkey
- nicotine replacement therapy
- medications
- behavioral therapy
- combination therapy
- hypnotherapy
- acupuncture
- yoga- meditation
- herbs
when using pharmacotherapy check with physician first if pt has:
- hypothyroidism
- insulin- dependent diabetes
- active peptic ulcer
- anti depressant medications
describe bupropion SR- zyban, how to use, advantages
- 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
what are the adverse effects o bupropion
-insomnia
- dry mouth
- nervousness/difficulty concentrating
- rash
- constipation
- seizures
how many refills do you give for the starter pack of zyban
zero
how many refills do you give for the maintenance pack of zyban
2
describe varenicline and how to use
- 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
what are the advantages of varenicline
easy to use and offers a new mechanism of action for patients who have failed with other agents
what are the adverse effects of varenicline
- nausea, insomnia, vivid dreams, constipation, and vomitting
- neuropsychiatric symptoms: behavior changes, agitation, depressed mood, suicidal ideation or behavior
describe nicotine replacement therapy options (gum-nicorette, zonnic)
- 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
what are the advantages of nicotine replacement therapy options- gum
may delay weight gain and satisfy oral cravings
what are the adverse effects of nicotine replacement therapy options- gum
mouth/jaw soreness, hiccups, dyspepsia
describe nicotine replacement therapy options- lozenge- Commit and Zonnic
- 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
what are the advantages of nicotine replacement therapy options - lozenge
may delay weight gain and satisfy oral cravings
what are the adverse effects of nicotine replacement therapy options- lozenge
nausea, hiccups, cough, heartburn, headache, insomnia
how are nicotine replacement therapy options- transdermal patches used
- 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
what are the advantages of nicotine replacement therapy options- transdermal patch
- provides consistent nicotine for 24 hours
- easy to use
what are the adverse effects of nicotine replacement therapy options- transdermal patches
- local skin reaction
- headache
- insomnia
- vivid dreams
describe how to use nicotine replacement therapy options- nasal spray
-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
what are the advantages to the nasal spray nicotine replacement therapy options
patients can titrate therapy to help with withdrawal
what are the adverse effects of nasal spray as a NRT
nasal/throat irritation, rhinitis, tearing, sneezing, headache, cough
describe how to use the oral inhaler as an NRT
- 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
what are the advantages of oral inhaler as an NRT
- patients can titrate amount to manage withdrawal and mimics hand to mouth ritual
what are the adverse effects of NRT oral inhaler
mouth/throat irritation, cough, headache, rhinitis, dyspepsia
what does the UMKC tobacco cessation program consist of
- prep work by the student
- initial visit appointment
- follow up visit appointments
