Treating Tobacco Dependence Flashcards
Deaths /year nationally caused by smoking? In WI?
More than 400,000 deaths/year nationally • More than 8,000 deaths/year in Wisconsin
_ out of every __ deaths in America are directly caused by smoking
1 out of 5
Four Populations in Particular Continue to Smoke at High Rates:
The Poor – The least educated – Those with co-morbid mental health or addictive disorders – Certain/Specific racial and ethnic minorities (e.g.: Native Americans)
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
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
__% of all oral cancer is
related to tobacco use
75
SCC ___ times greater in
smokers
Higher prevalence of
leukoplakia
Cancer of cheek and
gingivae increase __-fold
in spit/chew tobacco users
4-7
50
Impact on Dental Health
-Passive smoking (3)
Cardiovascular diseases, lung cancer, and
respiratory disease
Smoking and the risk to children (4)
– Sudden Infant Death Syndrome (SIDS)
–Asthma and lung infections
– Increase in ear infections
– Increase in tooth decay
how long does it take nicotine to reach the brain
7s
Tobacco addiction exhibits classic characteristics of a drug addiction (3)
–Physical Dependence
–Psychological Dependence
–Chronic Nature/Relapse Cycle
Nicotine withdrawal symptoms include (6)
Negative affect (sadness, anxiety, anger) • Inability to concentrate • Hunger • Disrupted sleep • Drowsiness/fatigue • Headaches/dizziness • Cravings
Who has nicotine receptors?
Everyone is born with them but those who smoke have many, many more
Psychological Dependence Characterized by (3)
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
% 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
82
46
4-7
Just some more facts, doubt these matter
• 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
The 5 A’s for Patients Willing to Quit
**Know these!!!!!
• 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
Effective Tobacco Dependence Treatments Consist of:
~3
Brief clinician coaching/counseling
One of the 7 FDA Approved medications
Systems-level changes that institutionalize cessation treatment
Oral Healthcare Professionals have the Skills to Intervene
MIEC
• Motivating - build trust and rapport
• Interviewing - assess and motivate
• Educating - relate tobacco use to dental
and medical condition
• Counseling - listen, encourage, support
“Interventions lasting ___ minutes increase overall tobacco abstinence rates.”
3 minutes or less
Seven FDA-approved medications for tobacco dependence:
Bupropion SR (Zyban or Wellbutrin) Nicotine nasal spray Nicotine inhaler Varenicline (Chantix) Nicotine patch Nicotine gum Nicotine lozenge
How to assist someone to stop smoking
Do what? Review what? For first few weeks do what?
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
Bupropion SR
Mechanism of action:
presumably
blocks neural reuptake of dopamine
and/or norepinephrine
Bupropion SR availability
Available by prescription only
Only non-nicotine medication approved
by the FDA as an aid to smoking
cessation treatment
Bupropion SR
chance of being smoke free after 6 months going cold turkey
only 5%-call the line and increases to 1/4
Combination therapy for smoking cessation effectiveness
The combination of
counseling and medication
is more effective than
either alone
combine multiple drugs for smoking cessation?
Can combine two
medications for greater
effectiveness
Bupropion SR
Contraindications (4)
Seizure disorder
MAO inhibitor within previous 2 weeks
History of anorexia nervosa or bulimia
Current use of Wellbutrin
Side effects
of Bupropion SR(2)
Insomnia
Dry mouth
Bupropion SR Dosing:
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
Maintenance of Bupropion SR:
efficacious as maintenance medication for
6 months
Chantix-actual drug name???
Approved when?
Medication type????
Most common side effect?
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
How does Varenicline work? (2 mechanisms)
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.
When to start varenciline
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
Nicotine Replacement Therapy (NRT)
~5
Nicotine gum Nicotine patch Nicotine inhaler Nicotine nasal spray Nicotine lozenge
Nicotine Replacement Therapy and NRT cardiovascular risk
No evidence of increased cardiovascular
risk with NRT
Medical Contraindications: of NRT (3)
serious arrhythmia serious or worsening angina pectoris accelerated hypertension immediate myocardial infarction (< 2 weeks)
Nicotine gum absorbed better in ____ environment
basic
Most efficient NRT
Nasal Spray Nicotine
recommended way to quit
Patch before start date… 2-3 wks
and then inhaler and lozenge (21mg patch)
Patients not ready to make a quit attempt-use what to help
5 R’s
• RELEVANCE • RISKS • REWARDS • ROADBLOCKS • REPETITION
Cost of smoking a pack a day
2500
