Tobacco Prevention

Question 1

The only consumer product when used as directed kills its consumer

Answer 1

Tobacco

Question 2

1 preventable cause of death in US

Most US deaths from behavioral causes due to ___

Answer 2

smoking

Question 3

almost half of americans who die prematurely from tobacco abuse have ___

Answer 3

chronic mental illness

Question 4

percentage of adults who smoke cigarettes

Answer 4

despite decr in smoking over last 50 years, little change in smoking since then

Question 5

Which patient populations are most susceptible to tobacco addiction

Answer 5

1) those with least info about health risks and least access to cessation
2) lower SES groups and less education
3) mental illness/substance abuse (HIV)
4) American Indians

Question 6

Health consequences of tobacco

Answer 6

1) 4000+ toxins
2) incr risk of everything
3) no decr in COPD and CAD despite 50% decr in smoking

Question 7

Most common disease assoc with cigarette smoking

Answer 7

Lung cancer

CAD

COPD

Question 8

Most common cancers assoc with smoking

Answer 8

1) lung
2) oral cavity, larynx, pharynx
3) esophagus
4) bladder

Question 9

Lung cancer is ___

Answer 9

dose response

use >40 cigarettes have doubled the risk of developing cancer compared to smokers

Question 10

what is the only inverention that will slow down or stop decline in pulm function

Answer 10

smoking cessation

Question 11

20% of death from CAD attributable to ___

Answer 11

tobacco

Question 12

smoking and pregnancy

smoking during pregnancy can lead to

Answer 12

1) perinatal deaths
2) low birth weight infants
3) pre-term
4) infertility, miscarriage, SIDS

Question 13

Consequences of second hand smoke

Answer 13

1) incr risk of COPD, heart disease … and MORTALITY

2) childhood exposure
incr pulm infection, asthma, SIDS

Question 14

17% of excess mortality due to additional things beyond most common 21 diagnoses

Answer 14

so wide range beyond what you would think

Question 15

Health benefits of quitting
1 month
1 year
5 years
10 years
15 years

Answer 15

improved cough, SOB

improved lung fxn, 50% decr

cardiac disease improved to never smokers

bladder, oral, cervical CA improved

lung CA 15 years decr

Question 16

MPOWER

Answer 16

1) Monitor tobacco use and prevention policies
2) Protect from second-hand smoke
3) Offer help in quiGng
4) Warn about dangers: product labels and mass media campaigns
5) Enforce bans on adver>sing and promo>on
6) Raise taxes

Question 17

factors that incr risk of teens starting to smoke

Answer 17

1) exposure to 2nd hand smoke or smoker in household

Question 18

Effect of taxes on tobacco use

Answer 18

1) young people and poor most price

Question 19

Why is quitting smoking so difficult?

Nicotine addiction

Answer 19

1) nicotine addictive = bind to CNS receptors, incr dopamine and norepeinephine –> euphoria and relaxation
2) Withdrawal symptoms = depression, anxiety intense for 72 hrs last 6-8 weeks
3) Social habit and craving hard to break

Question 20

Can we really make a difference?

Answer 20

75% smokers want to quit but only 30% received any counseling

never too late to quit

Question 21

5 A’s AHQR guidelines

Answer 21

1) Ask = every visit; screening
2) Advise = personalized, smoking is best thing on health
3) Assess willingness
4) Assist = if patient is willing to quit; counseling and pharmacotherapy
5) arrange =

Question 22

First line pharamcotherapy for smoking

Answer 22

1) nicotine replacement therapy
2) bupropion (Zyban, Wellbutrin)
3) Varenicline (Chantix)

Question 23

Nicotine replacement therapy forms

Answer 23

1) patch = long acting, slower onset, schedule
2) gum = long acting, slower, schedule
3) lozenge = shorter acting, PRN
4) inhaler = shorter acting, PRN
5) nasal spray = shorter acting, PRN

ALL SAME!!!!!

Question 24

Effects of nicotine replacement

Answer 24

1) alleviates symptoms of withdrawal (BEST TO COMBINE MULTIPLE FORMS)
2) long-term safe because no incr in death, MI, or arrhythmia

Question 25

What are E-cigarettes and vaping

Safety concerns

Answer 25

aerosolize nicotine and produce vapor

1) added toxins (carcinogens)
2) variation in nicotine dose
3) incr in accidental nicotine poisoning

CAN’T ASSUME SAFE

Question 26

Misperception about e-cigarettes

Answer 26

smoking cessation

- limited data but higher cessation rates compared to placebo and equivalent to NRT

Question 27

Targeting of E-cigarettes

Answer 27

no age restrictions

concern about gateway product to nicotine dependence

Question 28

Bupropion (Zyban or Wellbutrin SR)

Mechanism of smoking cessation

May prevent ____

Main contraindication

Answer 28

1) inhibit reuptake of dopamine and norepinephrine, decr craving and withdrawal
2) prevent weight gain and depression
3) contraindication = seizure disorder and mood disorder

Question 29

Chantix (Varenicline)

Mechanism

Answer 29

1) partial agonist at nicotine receptor, release dopamine (decr craving and withdrawal)
2) antagonist = block binding of exogenous nicotine (decr reward)

Question 30

Abstinence rate of Chantix

Common side effects of Chantix

Answer 30

1) 3x more likely to quit using Chantix

Side effects = nausea, nightmares, HA, insomnia

Question 31

Pharmacotherapy impact on mentally ill

Answer 31

1) smoking rates declined minimally with mentally ill

2) varenicline and bupropion are safe for mental ill (higher quit and better psych and no assoc with drug use)

Question 32

Is combining NRT and bupropion more effective?

Answer 32

More effective than patches alone

no evidence it improves abstinence (maybe heavy smokers)

Question 33

Using pharmacotherapy significantly incr ___

Are psychotherapy assoc with drugs better?

Answer 33

odds patient will be successful in smoking cessation

Yes, better to add psychotherapy to drugs -> no significant adverse events

Question 34

5A’s = arrange

Answer 34

1) Schedule f/u after quit day (phone within 2 weeks

2) review meds
3) troubleshoot

Question 35

Replapse in tobacco dependence

Answer 35

takes 4-5 attempts before long term success