Tobacco use disorder Flashcards
What are the DSM-5 diagnostic criteria for Tobacco Use Disorder (TUD)?
At least 2 out of 11 criteria must be met over a 12-month period. Criteria include: 1) Tobacco use in larger amounts/longer than intended, 2) Persistent desire/unsuccessful quit attempts, 3) Excessive time spent obtaining/using tobacco, 4) Strong cravings, 5) Interference with social/occupational life, 6) Continued use despite causing problems, 7) Giving up important activities due to use, 8) Use in risky situations, 9) Continued use despite physical/psychological problems, 10) Tolerance, 11) Withdrawal symptoms when discontinued.
What are the most common diseases linked to chronic tobacco use?
1) Cardiovascular: MI, stroke, peripheral artery disease, 2) Pulmonary: COPD, lung cancer, chronic bronchitis, 3) Cancer: Lung, bladder, esophageal, pancreatic, 4) Pregnancy: Preterm labor, fetal growth restriction, sudden infant death syndrome (SIDS).
What are the risks of smoking during pregnancy?
Increased risk of miscarriage, preterm birth, intrauterine growth restriction (IUGR), low birth weight, and sudden infant death syndrome (SIDS).
What are the key components of an effective motivational counseling strategy for smoking cessation?
Ask, Advise, Assess, Assist, Arrange. Ask about smoking, advise quitting, assess readiness, assist with support, arrange follow-ups.
What is the best first-line management for a patient who smokes occasionally but does not meet criteria for Tobacco Use Disorder?
Motivational smoking cessation counseling and routine follow-up. Even occasional smoking is associated with long-term risks.
What are the 5 R’s of Motivational Interviewing for smoking cessation?
1) Relevance – Make quitting personally relevant, 2) Risks – Explain health risks of smoking, 3) Rewards – Benefits of quitting (e.g., health, money), 4) Roadblocks – Identify barriers to quitting, 5) Repetition – Reinforce counseling at each visit.
What are the first-line pharmacologic therapies for Tobacco Use Disorder?
First-line options: 1) Nicotine replacement therapy (patch, gum, lozenge, inhaler), 2) Bupropion (reduces cravings, contraindicated in seizures), 3) Varenicline (partial nicotine receptor agonist, risk of neuropsychiatric effects).
How does smoking increase cardiovascular disease risk?
Nicotine increases sympathetic activity → increased heart rate and vasoconstriction. CO reduces oxygen delivery by binding to hemoglobin, increasing myocardial demand.
Why is no intervention incorrect in a patient who smokes occasionally?
Even occasional tobacco use increases long-term health risks. Motivational counseling is always beneficial.
Why is bupropion not the best option for occasional smokers?
Bupropion is used in patients with nicotine dependence and withdrawal symptoms. Occasional smokers benefit more from motivational counseling.
Which smoking cessation medications are contraindicated in pregnancy?
Bupropion and varenicline are not recommended in pregnancy. Nicotine replacement therapy may be used if benefits outweigh risks.
Why is nicotine replacement therapy not needed for occasional smokers?
Nicotine replacement is used for patients with established tobacco use disorder to manage cravings and withdrawal.
Why is cognitive behavioral therapy (CBT) not the first step in managing an occasional smoker?
CBT is useful for established tobacco dependence. Occasional smokers need motivational counseling and education first.
A 45-year-old man presents to the clinic for a follow-up appointment. After their last visit, the patient underwent pulmonary function testing due to progressive dyspnea on exertion and cough. The patient’s FEV1 is 78% and FEV1/FVC is 65%. The patient has smoked two packs of cigarettes per day since age 14. The patient has experienced significant anxiety, headaches, and insomnia when attempting to quit in the past. Today, the patient vocalizes a readiness to quit. In addition to nicotine replacement therapy, which of the following interventions is most likely to improve the patient’s chances of quitting?
This patient has developed COPD as a consequence of his tobacco use disorder. The patient is currently motivated to quit and would benefit from combination therapy with pharmacotherapy and behavioral therapy. Tobacco use disorder is a condition that develops with continued tobacco use, resulting from nicotine dependence. When assessing a patient, it is important to evaluate their readiness to quit. For those who are not ready, motivational smoking cessation counseling and close follow-up are important initial steps. Patients who are ready to quit benefit from motivational counseling and follow-up but will also be more open to additional measures. This includes a combination of cognitive behavioral therapy and pharmacotherapy, which has shown to be more effective than either used alone. Cognitive behavioral therapy can teach patients to recognize and avoid potential triggers and guide patients in the application of coping mechanisms and problem-solving skills to resist cravings. First-line medications for smoking cessation include nicotine replacement therapy (e.g. patch, gum), varenicline (a partial nicotine agonist), and bupropion (a dopamine/norepinephrine reuptake inhibitor). The choice of medications will depend on the patient’s history and preferences.
What is the preferred smoking cessation strategy in hospitalized patients?
Nicotine replacement therapy + behavioral counseling. Hospitalization is a teachable moment for smoking cessation.
