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Pulmonology (inpt) > Tobacco dependence > Flashcards

Tobacco dependence Flashcards

1
Q

what does nicotine affect?

A

the dopaminergic system!!

acts as a CNS stimulatn

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2
Q

what does nicotine cause?

A

restlessness, insomnia, anxiety, increased GI motility

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3
Q

tobacco uses report what?

A

impoved attention, improved mood, decreased tension

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4
Q

what is cigarette smoking and prego associated w/

A

low birth weight

persistent pulmonary hTN of newborn!

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5
Q

nicotine w. drawal sx

A
  • intense craving
  • dysphoria
  • anxiety
  • increased appetiti
  • irritability
  • insomina
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6
Q

tx of nicotine addiction

A

-behavioral, meds

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7
Q

5 A’s molde for smoking cessation

A
  • Ask
  • Advise
  • Assess
  • Assist
  • Arrange for f/u
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8
Q

Fagerstrom Test

A

The higher the score on this questionnaire, the higher the level of dependence.

-score of 7 is indicative of high dependence

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9
Q

first line tx

A

NRT (patch, gum, lozenge, Nasal spray, inhaler)

  • bupropion (Zyban)
  • Varenicline (Chantix)
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10
Q

2cd line tx

A

nortripyline (pamelor)

clonidine (Catapres)

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11
Q

contraindicated to tx

A

prego, smokeless tobacco, light smokers, adolescents

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12
Q

NRT MOa

A

provides slower release of nicotine- less than cigs and releived physiologicala nd psychomotor w/drwal sx

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13
Q

NRT abuse potential?

A

little, bc they dont produce the pleasurable effects

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14
Q

NRT rationale

A
  • relieved w/d sx

- allows pt to focus onn behavioral and psyhcolocial aspects of tobacco cessation

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15
Q

NRT precautions

A

pts w/ underlying CVD

  • recent MI ( past 2 wks)
  • serious arrhythmias
  • serious or worsening angina
  • must be prescribd by a provider
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16
Q

what is NRT absolutely CI in?

A

preg -reserved for women who are unable to quit nonpharmacologically (use gum, inhaler, or nasal spray bc patch is more potent)

lactation

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17
Q

FDA approval in kids/adolescents?

A

nope

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18
Q

Nicotine Transdermal Patch

MOA

A

nicotine diffusively at a constant rate through the skin and Bloodstream- avoids first pass

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19
Q

Patch education

A

apply patch qd, dry hairless area

  • rotate sites
  • wash hands
  • pts can get wet w/ path on
  • Don’t cut patch to adjust dose
  • remove pt before MRI
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20
Q

how does the patch work?

A

contains a drug reserviour sandwiched bw a non-permeable back layer and a permeable adhesive layer that attches to the skin

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21
Q

patch ADR

A

localized skin irriation (erythema, pruritis, burningg)

  • insomnia
  • nightmares, vivid dreams
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22
Q

nicotine gum MOA

A

absorbed via buccal mucosa

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23
Q

treatment period for nicotine gum?

A

2-3 mths, should be gum free by 6-12 mnths

24
Q

when do nicotine plasma levels increase/peak?

A

peak at 30 mins after chwing

25
Q

how much gum per day?

A

one piece every 1-2 hours

26
Q

pt education/instructions

A
  • effectiveness may be reduced by some foods and drinks (acidic ph is below what is needed for optimal buccal absorptions)
  • dont’ eat or drink 15 mins before, during or after
  • always park in a diff part of the mouth
27
Q

gum ADR?

A

N/V, abdominal pain, hiccups,

  • tongue, moth, throat irriation
  • sore jaw
  • unpleasant tast
28
Q

gum relative CI?

A
  • TMJ
  • poor dentition
  • dentures
29
Q

nicotine lozenge

MOA

A

oral mucosa absorption

30
Q

what s the lozenge does dependent on/

A

time to first cigarette

31
Q

lozenge ADR

A

mouth irritation/ulcers
abdominal pain, N, V, D
HA, palpitations

32
Q

Lozenge Pt education

A

avoid acidic drinks, rotate site

33
Q

nicotine mini-lozenge

A

mini!!! dissolves up to 3 X faster

34
Q

Oral inhaler MOA

A

absorbed bia oral and pharyngeal mucosa

35
Q

dose of inhaler

A

each puff lasts about 20 minutes

36
Q

pt education for inhaler

A

not meant to be inhlaed by moth to lungs

37
Q

when in the inhaler not recommended?

A

severe airways reactivity

38
Q

how does the temp affect the inhaler?

A
  • Under colder conditions (<59F), less nicotine is delivered per puff. Conversely, under warmer conditions more nicotine is released per puff. Best results are achieved with frequent continuous puffing over 20 minutes. The inhaler should be used longer and more often at first to help control cigarette cravings. Less nicotine per puff is released from the inhaler compared to a cigarette.
39
Q

nicotine nasal spray

moa

A

provides a nicotine bolus mimicking nicotine burst from cig

40
Q

duration of trx (nasal spray?)

A

3 mnths

41
Q

ADR of nasal spray

A

local nasopharyngeal irritation

runny nose, sneezing, cough,, thraot and eye irriations, HA

42
Q

disadvantages of nasal spray

A

o Difficult to administer
o Unpleasant taste
o Poor compliance
o Potential for abuse / harm

43
Q

What to expect the first week using nasal spray?

A 
hot peppery feeling in back of throat/nose
o	Sneezing
o	Coughing
o	Watery eyes
o	Runny nose
44
Q

summary of NRT?

A
  • NRT should be offered to all smokers who are prepared to quit
  • All forms of NRT are effective and should be personalized to reflect patient needs
  • Combination NRT products are more efficacious than single NRT therapy
  • NRTs increase the rate of quitting 50-70%, regardless of setting
45
Q

Bupropion

MOA

A

Zyban

inhibits NE and DA uptakes, block nicotinic acetycholinergic receptors

46
Q

Bupropion pt education

A

start 1 wk prior to quit date

-if pt not made significant progress toward abstinence by 7th week- unlikely to quit and tx should be discontinued

47
Q

adr of bupropion

A

insomina, dry mouth,

suicide risk!!!

48
Q

bupropion CI

A

pts w/ sz disorder

  • hx of anorexia/bulemia
  • pts undergoing abrupt discontinuation of ethanol or sdative
49
Q

VareniclineMOA

A

nicotinic acetylcholine receptor partional agonist

-partially stimulates nicotine receptors in the brain to diminish craving and w/drwal sx

-blocks the effects of nicotine by occupying receptor sites-reducing the rewarding and reinforcing effects of smking
ch

50
Q

chantix dose duration

A

12 wks

51
Q

what to monitor when taking chantix?

A

renal

52
Q

pt eduction of chantix

A
  • Nausea (titrate)
  • Visual disturbances
  • Insomnia, abnormal dreams
  • Driving / operating machinery
  • Suicide risk – advise / document
  • Cardiovascular risk – advise / document
53
Q

Nortriptyline MOA

A

Tricyclic antidepressant

54
Q

nortriptyline ADR

A

dry mouth, sedation

55
Q

nortriptyline pt education

A

take at bedtime

56
Q

Clonidine moa

A

alpha adrenergic agonist

57
Q

clonidine ADR

A

dry mouth, sedation, Hypotension, dizzy

Pulmonology (inpt) (7 decks)

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