Treating Tobacco Dependence

Question 1

Deaths /year nationally caused by smoking? In WI?

Answer 1

More than 400,000 deaths/year nationally • More than 8,000 deaths/year in Wisconsin

Question 2

_ out of every __ deaths in America are directly caused by smoking

Answer 2

1 out of 5

Question 3

Four Populations in Particular Continue to Smoke at High Rates:

Answer 3

The Poor
– The least educated
– Those with co-morbid mental health or
addictive disorders – Certain/Specific racial and ethnic
minorities (e.g.: Native Americans)

Question 4

Tobacco directly causes…

≈ __% of all cancers, including ___% of all
lung cancers

≈ __% of all cardiovascular
diseases

≈ ___% of all Chronic obstructive pulmonary disease (COPD) – bronchitis and emphysema

Answer 4

30% of all cancers and 90% of lung cancers

30% of all cardiovascular disease

90% of all Chronic obstructive pulmonary disease (COPD) – bronchitis and emphysema

Question 5

__% of all oral cancer is

related to tobacco use

Answer 5

75

Question 6

SCC ___ times greater in
smokers

Higher prevalence of
leukoplakia

Cancer of cheek and
gingivae increase __-fold
in spit/chew tobacco users

Answer 6

4-7

50

Question 7

Impact on Dental Health

-Passive smoking (3)

Answer 7

Cardiovascular diseases, lung cancer, and

respiratory disease

Question 8

Smoking and the risk to children (4)

Answer 8

– Sudden Infant Death Syndrome (SIDS)
–Asthma and lung infections
– Increase in ear infections
– Increase in tooth decay

Question 9

how long does it take nicotine to reach the brain

Answer 9

7s

Question 10

Tobacco addiction exhibits classic characteristics of a drug addiction (3)

Answer 10

–Physical Dependence
–Psychological Dependence
–Chronic Nature/Relapse Cycle

Question 11

Nicotine withdrawal symptoms include (6)

Answer 11

Negative affect (sadness, anxiety, anger)
• Inability to concentrate 
• Hunger 
• Disrupted sleep 
• Drowsiness/fatigue 
• Headaches/dizziness 
• Cravings

Question 12

Who has nicotine receptors?

Answer 12

Everyone is born with them but those who smoke have many, many more

Question 13

Psychological Dependence Characterized by (3)

Answer 13

Using tobacco despite known negative
consequences

Relying on tobacco use for mood
enhancement or as a coping mechanism

Consistency: like relying on a good friend
that is always there for yo

Question 14

% of current smokers have made one attempt in their lifetime •

% of current smokers have made a quit
attempt in the past year

• Average number of quit attempts is __
over their lifetime

Answer 14

82

46

4-7

Question 15

Just some more facts, doubt these matter

Answer 15

• 70% of smokers report that they want to
quit • About 50% of smokers see a dentist
each year • About 80% see a clinician each year

Question 16

The 5 A’s for Patients Willing to Quit

**Know these!!!!!

Answer 16

• ASK all patients about their tobacco use
• ADVISE all smokers to quit
• ASSESS willingness to make a quit attempt
• ASSIST in quitting attempt (counseling &
meds)
• ARRANGE for follow-up

Question 17

Effective Tobacco Dependence Treatments Consist of:

~3

Answer 17

Brief clinician coaching/counseling

One of the 7 FDA Approved medications

Systems-level changes that institutionalize cessation treatment

Question 18

Oral Healthcare Professionals have the Skills to Intervene

Answer 18

MIEC

• Motivating - build trust and rapport
• Interviewing - assess and motivate
• Educating - relate tobacco use to dental
and medical condition
• Counseling - listen, encourage, support

Question 19

“Interventions lasting ___ minutes increase overall tobacco abstinence rates.”

Answer 19

3 minutes or less

Question 20

Seven FDA-approved medications for tobacco dependence:

Answer 20

 Bupropion SR (Zyban or
Wellbutrin)
 Nicotine nasal spray
 Nicotine inhaler
 Varenicline (Chantix)
 Nicotine patch
 Nicotine gum
 Nicotine lozenge

Question 21

How to assist someone to stop smoking

Do what? Review what? For first few weeks do what?

Answer 21

Set quit date
-have it be near (2 wks)

Review past quit attempts 
Review medications
Anticipate challenges
* Triggers
*  Weight gain
--5-10lbs
*  Other smokers in home
• Remove tobacco products 
-get cigarettes wet and throw away

For the first few weeks, avoid:
* Alcohol use
--50% of people who relapse are intoxicated
* Exposure to tobacco 
Refer to Quit Line for free, effective
coaching on how to quit * 1-800-QUIT-NOW

Question 22

Bupropion SR

Mechanism of action:

Answer 22

presumably
blocks neural reuptake of dopamine
and/or norepinephrine

Question 23

Bupropion SR availability

Answer 23

Available by prescription only

Question 24

Only non-nicotine medication approved
by the FDA as an aid to smoking
cessation treatment

Answer 24

Bupropion SR

Question 25

chance of being smoke free after 6 months going cold turkey

Answer 25

only 5%-call the line and increases to 1/4

Question 26

Combination therapy for smoking cessation effectiveness

Answer 26

The combination of
counseling and medication
is more effective than
either alone

Question 27

combine multiple drugs for smoking cessation?

Answer 27

Can combine two
medications for greater
effectiveness

Question 28

Bupropion SR

Contraindications (4)

Answer 28

Seizure disorder
MAO inhibitor within previous 2 weeks
History of anorexia nervosa or bulimia
Current use of Wellbutrin

Question 29

Side effects

of Bupropion SR(2)

Answer 29

Insomnia

Dry mouth

Question 30

Bupropion SR Dosing:

Answer 30

start 1-2 weeks before quit date
 150 mg orally once daily x 3 day
 150 mg orally twice daily x 7-12 weeks
 no taper necessary at end of treatment

Question 31

Maintenance of Bupropion SR:

Answer 31

efficacious as maintenance medication for

6 months

Question 32

Chantix-actual drug name???
Approved when?
Medication type????
Most common side effect?

Answer 32

Varenicline

• Approved by FDA in May, 2006
• Marketed as Chantix
• A non-nicotine medication
• A selective α4β2 Nicotinic
• Acetylcholine Receptor Partial Agonist
• Most common side effect - nausea

Question 33

How does Varenicline work? (2 mechanisms)

Answer 33

 Agonistic at the receptor sites (receptor sites
are activated just like when nicotine is there
so Acetylcholine is released and so is
dopamine so that withdrawal effects are
reduced). (The brain thinks its getting
nicotine.)

 Antagonistic to nicotine so when a person
smokes, there is no pleasure because all the
receptor sites are already occupied so that
smoking has no effect.

Question 34

When to start varenciline

Answer 34

Start varenicline one week before the quit date for
maximum effectiveness
 Recommended treatment is 12 weeks:
 Days 1-3………..1 pill (0.5 mg) per day
 Days 4-7………..1 pill (0.5 mg) twice a day (am &
pm)
 Day 8-end………1 pill (1 mg) twice a day (am &
pm)
 An additional course of 12 weeks for maintenance
can be considered

Question 35

Nicotine Replacement Therapy (NRT)

~5

Answer 35

Nicotine gum
Nicotine patch
Nicotine inhaler
Nicotine nasal spray
Nicotine lozenge

Question 36

Nicotine Replacement Therapy and NRT cardiovascular risk

Answer 36

No evidence of increased cardiovascular

risk with NRT

Question 37

Medical Contraindications:
 of NRT (3)

Answer 37

 serious arrhythmia
 serious or worsening angina pectoris
 accelerated hypertension
immediate myocardial infarction (< 2
weeks)

Question 38

Nicotine gum absorbed better in ____ environment

Answer 38

basic

Question 39

Most efficient NRT

Answer 39

Nasal Spray Nicotine

Question 40

recommended way to quit

Answer 40

Patch before start date… 2-3 wks

and then inhaler and lozenge (21mg patch)

Question 41

Patients not ready to make a quit attempt-use what to help

Answer 41

5 R’s

• RELEVANCE • RISKS • REWARDS • ROADBLOCKS • REPETITION

Question 42

Cost of smoking a pack a day

Answer 42

2500