Tobacco Use Flashcards
5 As for discussing smoking cessation
Ask - about current tobacco use and habits
Advise - to quit; let patient know risks to self, others, child (if pregnant); talking about how it can help current cough/COPD symptoms
Assess - willingness to quit; thoughts about quitting; if patient is ready
Assist - counseling, pharmacologic treatment; motivational interviewing
Arrange - for follow up and support
Strategy to enhance motivation
5 R’s
Relevance - to the patient of smoking cessation Risks of ongoing tobacco use Rewards of quitting Roadblocks to quitting Repetition; bring it up at each visit
symptoms of nicotine withdrawal
mood changes (irritability, anxiety, frustration), difficulty concentrating, increased hunger, restlessness
Two broad modalities of smoking cessation pharmacologic treatment
nicotine replacement or nonnicotine
Two FDA approved non-nicotine meds
buproprion and varenicline (Pregnancy Cat C)
must weight risks and benefits
Contraindications to buproprion
patients who used MAO in last two weeks, hx of seizure disorder, or eating disorder
be careful in patients with coronary heart disease
Cardiac side effects of buproprion
QRS widening and fatal arrythmias in high doses
Varenicline side effects
cardiac - possible increased cardiac events, neuropsychiatric symptoms
Options for nicotine treatment
gum, cartridge, inhaler, lozenge, patch,
Which nicotine treatment has highest dose of nicotine and subsequently highest dependency potential
inhaler
Which nicotine treatment is recommended for people who smoke first cig within 30 minutes of waking
lozenge
Pregnancy category for nicotine patch, spray, gum, inhaler
Cat D
must weigh risks and benefits
Strongest risk factor for smoking initation among children and adolescents
parental smoking
