Module 13: Smoking Cessation (d) Flashcards
1
Q
5 A’s of Smoking Cessation
A
- Ask — every patient about tobacco use
- Advise —every tobacco user to quit
- Assess — pt’s willingness to make an attempt to quit
- Assist — those willing to quit by offering medication or referring for counseling
- Arrange — Follow-up contact w/in the first week after the quit date
2
Q
5 stages of change
A
- Stage 1: Pre-contemplation — No intention to quit
- Stage 2: Contemplation — Interested in quitting but NO plans
- Stage 3: Preparation — Planning to quit w/in the next few months and has made a failed attempt in previous year
- Stage 4: Action — Makes serious effort to quit by modifying behavior — Pt has abstained from 1 day to 6 months
- Stage 5: Maintenance - post 6 months of cessation
3
Q
Smoking Cessation
-Drug Therapy
A
- Most effective treatment of tobacco dependence requires the use of multiple modalities
4
Q
Nicotine Replacement Therapy
A
- MOST common first-line therapy
- Aims to control nicotine levels in bloodstream so withdrawal does not occur while pt adjusts to new lifestyle - MOA
- Maintain plasma nicotine levels to prevent withdrawal w/out peaks
- Once abstinence is achieved, pt can taper off the nicotine by gradual reduction
- Main benefit of NRT — not exposing pt to carcinogens and other toxins in smoke
5
Q
Nicotine Replacement Therapy
-Transdermal Patch
A
- Patch worn for 16-24 hrs — wear at night only if awakening w/ cravings
- OTC
A/Es
-Skin irritation, GI disturbance, dizziness, HA
6
Q
Nicotine Replacement Therapy
-Nicotine Gum
A
- Chew 1 piece of gum q1-2 hrs — chest at least 9 pieces per day during 1st 6 weeks to increase success - MAX 24 pieces per day
- Do not smoke while using gum
7
Q
Nicotine Replacement Therapy
-Nicotine Inhaler
A
- Thought to work by 2 different mechanisms
- Mimics hand-to-mouth ritual of cigarette smoking
- Produces sensation of inhaled smoke on back of throat
8
Q
Non-nicotine Products
-First and Second Line
A
- First Line
- Zyban (Bupropioin)
- Chantix (varenicline) - Second Line
- Clonidine
- Nortriptyline
9
Q
Non-nicotine Products
-Zyban SR (Bupropion SR)
A
- Also known as Wellbutrin SR
- First non-nicotine product approved for smoking cessation
—Good for coexisting depression, ADHD or both
MOA - Thought to affect dopaminergic or nor Adrenergic properties
- Pt needs to set “stop date” less than 2 weeks from date of starting medication.
- If patient has not made significant improvements by week 7, Medication is unlikely to work — Try different med
Contraindications
- SEIZURES & Eating disorders
- No not give to Pt’s who are taking Wellbutrin
10
Q
Non-nicotine Products
-Chantix (Varenicline)
A
- Binds nicotine acetylcholine receptor
- Blocks nicotines effects in the brain
- Alleviates withdrawal Sx’s
- 43% of pt’s quit using Chantix compared to 29% w/ Zyban
4. Prescribe starting pack then Maintenence pack — Start med 1 wk before quit date
A/E
- Suicidal ideation, nausea, constipation, ABNORMAL DREAMS
- Can cause neuropsychiatric Sx’s
Contraindications
- Preexisting psychiatric conditions
- Stop immediately if experience any changes in mood or behavior
11
Q
Non-nicotine Products
-Clonidine (2nd line agent)
A
- Not approved by FDA for smoking cessation
- Good at reducing withdrawal Sx’s
- TAPERING is very important to avoid rebound HTN
A/Es
-Drowsiness, dizziness, sedation
12
Q
Non-nicotine Products
- Nortriptyline (2nd line agent)
A
- Not FDA approved for smoking cessation — Treats depression and ADHD
- Must be titrate up to target dose of 75 to 100 mg for 12-24 wks
- May double chance of cessation compared to placebo
Contraindications
-Arrhythmia’s
A/E’s — Sedation and dry mouth
13
Q
E-Cigarettes - Vaporizers
A
- Can cause “Popcorn lung” (bronchiolitis obliterans) Damages the lungs alveoli
