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Patient Care III > Why Quitting is Difficult > Flashcards

Why Quitting is Difficult Flashcards

1
Q

What is nicotine?

A

An alkaloid that is contained in the leaves of plants

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2
Q

Nicotine is distributed quickly thorugh the bloodstream and crosses the…

A

blood-brain barrier

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3
Q

Nicotine reaches the brain within ____ seconds with inhalation

A

8-20

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4
Q

Elimination half-life of nicotine is around __ hours

A

2

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5
Q

Nicotine is metabolized in the…

A

liver

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6
Q

What is the effect of nicotine?

A
  • Stimulates adrenal glands
  • Increased heart rate, breathing activity, and blood pressure
  • Pancreas produces less insulin - causing increased blood sugar
  • Dopamine released
  • Acetylcholine and Norepinephrine released – concentration and memory
  • Increased levels of beta-endorphin – reducing anxiety
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7
Q

What does increased levels of beta-endorphin do?

A

reduces anxiety

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8
Q

The amount of nicotine absorbed by the body from smoking depends on:

A
  • type of tobacco
  • whether the smoke is inhaled
  • whether a filter is used
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9
Q

Amount released into the body tends to be much greater in ___________ tobacco

A

smokeless

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10
Q

Research indicates development of brain continues to occur until the age of ____

A

25

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11
Q

Nicotine changes the way ________ are formed

A

synapses

  • can harm the parts of the brain that control attention and learning
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12
Q

The nicotine in e-cigarettes and other tobacco products can also prime the adolescent brain for…

A

addiction to other drugs such as cocaine

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13
Q

How does nicotine impact youth/young adults?

A
  • Depression
  • Anxiety
  • Mood disorders
  • Addiction
  • Difficulty paying attention
  • Reduced impulse control
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14
Q

Why does the nicotine dependence cycle happen?

A

use of nicotine -> stimulates dopamine release -> causes pleasurable feeling -> repeated use of nicotine -> tolerance develops -> cycle starts over

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15
Q

Why does nicotine tolerance develop?

A

Body will create more nicotine receptor sites over time

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16
Q

What is the physiological part of tobacco dependence?

A

The addiction to nicotine

Use medications for cessation as the treatment

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17
Q

What is the behavioral part of tobacco dependence?

A

Start a behavior change program

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18
Q

_________ should address the physiological and the behavioral aspects of dependence

A

Treatment

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19
Q

What are the symptoms of withdrawal?

A
  • Dizziness; 1-2 days
  • Cravings for tobacco; first 2-3 days
  • Chest tightness; few days
  • Cough, dry throat; few days
  • Difficulty concentrating; few days
  • Insomnia; 1 week
  • Constipation, stomach pain; 1-2 weeks
  • Depressed mood, irritable; 1-4 weeks
  • Fatigue; 2-4 weeks
  • Hunger; several weeks
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20
Q

What are the benefits from quitting smoking for 20 minutes?

A

Blood pressure returns to normal

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21
Q

What are the benefits from quitting smoking for 8 hours?

A

Normal oxygen blood level

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22
Q

What are the benefits from quitting smoking for 24 hours?

A

Carbon monoxide eliminated from lungs – start to clear mucus

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23
Q

What are the benefits from quitting smoking for 48 hours?

A
  • Nicotine is eliminated
  • Smell and taste improve
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24
Q

What are the benefits from quitting smoking for 3 days?

A
  • Lung capacity begins to improve
  • Breathing become easier
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25
Q

What are the benefits from quitting smoking for 2-12 months?

A

Circulation improves

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26
Q

What are the benefits from quitting smoking for 5 years?

A

Risk of lung cancer decreases

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27
Q

What are the benefits from quitting smoking for 10-15 years?

A

Reduced risk of other cancers

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28
Q

Benefits of quitting smokeless tobacco…

A

Decreased risk for:
* oral, head and neck cancer
* tooth decay
* progression of gum recession
* high cholesterol
* high blood pressure
* heart attack or stroke

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29
Q

What are some of the assistance in cessation products?

A
  • nicotine transdermal patches (23%)
  • nicotine gum and lozenges (27%)
  • non-nicotine vareniciline (22-24%)
  • non-nicotine zyban (16%)
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30
Q

What do we ask someone who is smoking?

A
  • ASK about tobacco USE
  • ADVISE tobacco users to QUIT
  • ASSESS READINESS to make a quit attempt
  • ASSIST with the QUIT ATTEMPT
  • ARRANGE FOLLOW-UP care
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31
Q

What do you ask about tobacco use?

A

◼ “Do you ever smoke or use any type of tobacco?”
◼ “Do you use any form of e-cigarette or vaping device?”
◼ “Do you, or does someone in your household smoke?”

If yes to these quesions…ask about the amount per day and for how long they have been smoking (access risk for lung cancer)

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32
Q

What advice can you give to tobacco users to quit?

A

◼ “I realize that quitting is difficult. I am happy to work with you to design a specialized treatment plan for cessation when you are ready.”
◼ Best results if you can personalize this and be open, non-judgmental

clear, strong, personalized

33
Q

What are the options for assisting with the quit attempt?

A

◼ Not ready to quit: provide motivation
◼ Ready to quit: design a treatment plan
◼ Recently quit: relapse prevention

34
Q

What are the transtheoretical change model/stages of change?

A
35
Q

What is the estimated quit rate for 0-1 sessions of follow-up care?

A

12.4%

36
Q

What is the estimated quit rate for 2-3 sessions of follow-up care?

A

16.3%

37
Q

What is the estimated quit rate for 4-8 sessions of follow-up care?

A

20.9%

38
Q

What is the estimated quit rate for more than 8 sessions of follow-up care?

A

24.7%

39
Q

What is the pre-contemplation stage of the transtheoretical change method?

A

No intention to change

40
Q

What is the contemplation stage of the transtheoretical change method?

A

Aware problem exists but no commitment to action

41
Q

What is the preparation stage of the transtheoretical change method?

A

Intent on taking action to address the problem

42
Q

What is the action stage of the transtheoretical change method?

A

Active modification of behavior

43
Q

What is the maintenance stage of the transtheoretical change method?

A

Sustained change, new behavior replaces old

44
Q

What is the termination stage of the transtheoretical change method?

A

Not falling back into previous behavior

45
Q

What is the relapse stage of the transtheoretical change method?

A

Falling back into previous behavior patterns

46
Q

What are the cessation options?

A
  • Cold Turkey (no additional help)
  • Nicotine Replacement Therapy (NRT’s)*
  • Medications*
  • Behavioral Therapy
  • Combination Therapy
  • Hypnotherapy – Reveri app
  • Acupuncture
  • Yoga, meditation
  • Herbs
47
Q

T/F: all tobacco users can benefit from pharmacotherapy

A

Yes (check patient history)

48
Q

Check with a physician if the patient has… before starting pharmacotherapy

A
  • Hypothyroidism
  • Insulin-dependent diabetes
  • Active peptic ulcer
  • Anti-depressant medications
49
Q

Bupropion SR (zyban) has _____ mg sustained release tablet

A

150

50
Q

When should you begin taking bupropion SR (zyban)?

A
  • Begin taking 1 week prior to quitting
  • Double dose after 3 days
51
Q

What are the advantages of bupropion SR (zyban)?

A
  • Easy to use
  • Can be used with Nicotine Replacement Therapy (NRT)
52
Q

What are the adverse effects of bupropion SR (zyban)?

A
  • Insomnia
  • dry mouth
  • nervousness/difficulty concentrating
  • rash
  • constipation
  • seizures
53
Q

How do you write a zyban (bupropion SR) prescription?

A

Rx: Zyban Starter Pack
Disp: 1 (one) package
Sig: Take as directed
0 refills

Rx: Zyban Maintenance Pack
Disp: 1 (one) package
Sig: Take as directed
2 refills

54
Q

Varenicline comes in what mg tablets?

A

0.5 mg and 1.0 mg tablet

55
Q

How should your patient take the Varenicline?

A
  • Days 1-3: take one 0.5 mg tablet in the AM
  • Days 4-7: take 0.5 mg tablet twice daily
  • Weeks 2-12: take 1.0 mg tablet twice daily
56
Q

What are the advantages of Varenicline?

A

Easy to use and offers a new mechanism of action for patients who have failed with other agents

57
Q

What are the adverse effects of Varenicline?

A
  • Nausea, insomnia, vivid dreams, constipation, & vomiting
  • Neuropsychiatric symptoms
    — behavior changes
    — agitation
    — depressed mood
    — suicidal ideation or behavior
58
Q

Is varenicline approved for use with other Nicotine Replacement Therapy (NRT)?

A

NO

59
Q

How do you write a prescription for Varenicline?

A

Varenicline Starting Month/Pack
Disp: 1 (one) package
Sig: Take as Directed
0 Refills

Varenicline Continuing Month/Pack
Disp: 1 (one) package
Sig: Take as Directed
2 refills

60
Q

How many mg are the Gum (nicorette, zonnic)?

A

2 mg (smoke < 25 cig/day)
4 mg (smoke ≥ 25 cig/day)

61
Q

How should your patient take the Gum (nicorette, zonnic)?

A
  • Week 1-6: 1 piece every 1-2 hours
  • Week 7-9: 1 piece every 2-4 hours
  • Week 10-12: 1 piece every 4-8 hours
  • Max of 24 pieces per day. No food or beverage 15 min before or during use
62
Q

What are the advantages of Gum (nicorette, zonnic)?

A

May delay weight gain and satisfy oral cravings

63
Q

What are the adverse effects of Gum (nicorette, zonnic)?

A
  • Mouth/jaw soreness
  • hiccups
  • dyspepsia
64
Q

How many mg are the lozenge (nicorette, zonnic)?

A

2 mg (smoke > 30 min after waking)
4 mg (smoke ≤ 30 min after waking)

65
Q

How should your patient take the lozenge (nicorette, zonnic)?

A
  • Week 1-6: 1 lozenge every 1-2 hours
  • Week 7-9: 1 lozenge every 2-4 hours
  • Week 10-12: 1 lozenge every 4-8 hours
  • Max. of 20 lozenges/day. No food or beverage 15 min. before or during use. Do not chew or swallow lozenge
66
Q

What are the advantages of lozenge (nicorette, zonnic)?

A

May delay weight gain and satisfy oral cravings

67
Q

What are the adverse effects of lozenge (nicorette, zonnic)?

A
  • Nausea
  • hiccups
  • -cough
  • heartburn
  • headache
  • insomnia
68
Q

How many mg are the transdermal patch (nicoderm CQ)?

A

7 mg, 14 mg, 21 mg (24-hour release)**

less than 10 cigarettes/day
- 14 mg/day for 6 weeks
- 7 mg/day for 2 weeks

more than 10 cigarettes/day
- 21 mg/day for 6 weeks
- 14 mg/day for 2 weeks
- 7 mg/day for 2 weeks

69
Q

What are the advantages of the transdermal patch (nicoderm CQ)?

A

Provides consistent Nicotine for 24 hrs, easy to use

70
Q

What are the adverse effects of the transdermal patch (nicoderm CQ)?

A
  • Local skin reaction
  • headache
  • insomnia
  • vivid dreams
71
Q

How many mg are the nasal spray (nicotrol NS)?

A

0.5 mg metered spray per 50 mcL

72
Q

How should your patient use nasal spray (nicotrol NS)?

A
  • 1-2 doses per hour
    — 8-40 doses/day
    —Maximum 5 doses/hr
  • One dose = 2 sprays (1 per nostril)
73
Q

What are the advantages of nasal spray (nicotrol NS)?

A

Patients can titrate therapy to help with withdrawal

74
Q

What are the adverse effects of nasal spray (nicotrol NS)?

A
  • Nasal/throat irritation
  • rhinitis
  • tearing
  • sneezing
  • headache
  • cough
75
Q

How many mg are the oral inhaler (nicotrol)?

A

10 mg cartridge – delivers 4 mg inhaled nicotine vapor

76
Q

How should your patient use the oral inhaler (nicotrol)?

A
  • 6-16 cartridges/day
  • Begin with 1 cartridge every 1-2 hours
    — Best effects with continuous puffing for 20 min.
77
Q

What are the advantages of the oral inhaler (nicotrol)?

A

Patients can titrate amount to manage withdrawal and mimics hand-to-mouth ritual

78
Q

What are the adverse effects of the oral inhaler (nicotrol)?

A
  • Mouth/throat irritation
  • cough
  • headache
  • rhinitis
  • dyspepsia
79
Q

UMKC has a ___________ Program that is free for patients wanting to participate

A

Tobacco Cessation

Patient Care III (33 decks)

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