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phm 516: self-care > smoking cessation > Flashcards

smoking cessation Flashcards

1
Q

how do withdrawal symptoms occur?

A
  • the number of nicotinic acetylcholine receptors increase once nicotine is removed, which results in withdrawal symptoms
  • withdrawal symptoms can last up to 4 weeks
  • agitation, trouble sleeping, anxiety, depression
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2
Q

what are the 5 A’s of smoking cessation?

A

ask, advise, assess, assist, arrange

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3
Q

ask

A
  • ask all patients about tobacco use: e-cigs, cigs
  • “do you ever smoke or use tobacco or nicotine, such as e-cigs?”
  • “condition (asthma, HTN, etc) is caused or worsened by exposure to tobacco smoke. do you, or someone in your household smoke?”
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4
Q

advise

A
  • advise patient to quit
  • “quitting is the most important thing you can do to protect your health now and in the future. i have training to help my patients quit, and when you are ready we can create a treatment plan”
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5
Q

assess

A
  • assess readiness to quit
  • what are your thoughts about quitting?
  • would you consider quitting in the next month?
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6
Q

2 questions to gauge patient’s readiness to quit

A
  1. would you like to be a non-tobacco user?

2. do you think you have a change of quitting successfully?

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7
Q

assist

A
  • assist with quitting
  • current use: type(s) tobacco, amount, time to first cigarette
  • past use: duration of tobacco use, changes in level of use recently
  • past quit attempts: what did or didn’t work? why or why not?
  • prior med administrations, dose, adherence, duration of treatment
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8
Q

some OTC meds may be limited due to the following medical conditions:

A
  • pulmonary conditions (asthma, COPD)
  • skin conditions (psoriasis, sensitive skin, eczema)
  • cardiac history (heart attack, atrial fibrillation)
  • nasal polyps
  • insomnia
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9
Q

assist (cont)

A
  • reasons/motivations for wanting to quit
  • triggers for tobacco use
  • discuss methods for quitting: pros and cons
  • adherence, proper use, with demonstration
  • discuss withdrawal
  • set a quit date: ideally 2 weeks away
  • determine occupation/lifestyle for ideal therapy*
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10
Q

assist: STAR

A
  • S: set a quit date ideally within 2 weeks
  • T: tell family, friends, co-workers about quitting and ask them for support
  • A: anticipate challenges to the upcoming quit attempt
  • R: remove tobacco products from the patient’s environment and make home smoke free
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11
Q

arrange

A
  • follow up contact should occur during the 1st week after quitting
  • 2nd follow up should be after the 1st month
  • these follow ups can be telephone, email, face/face etc
  • address the challenges, triggers, temptations
  • congratulate patients for success and reinforce need for continued support
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12
Q

is nicotine replacement therapy (NRT) available with or without an rx?

A

without

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13
Q

OTC NRT

A

gum, lozenge, patch

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14
Q

gum

A

nicorette, zonnic, generic

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15
Q

lozenge

A

nicorette mini lozenge, generic

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16
Q

patch

A

NicoDerm CQ, generic

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17
Q

prescription NTR

A
  • metered nasal spray: Nicotrol NS
  • oral inhaler: nicotrol inhaler
  • bupropion SR: Zyban
  • varenicline: Chantix
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18
Q

precautions that must be assessed prior to starting GUM

A
  • recent myocardial infarction <2 weeks
  • serious underlying arrhythmias
  • serious of worsening angina pectoris
  • TMJ disease
  • pregnancy and breastfeeding
  • adolescents
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19
Q

precautions that must be assessed prior to starting LOZENGE

A
  • recent MI <2 weeks
  • serious underlying arrhythmias
  • serious of worsening angina pectoris
  • adolescents
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20
Q

precautions that must be assessed prior to starting TRANSDERMAL PATCH

A
  • recent MI <2 weeks
  • serious underlying arrhythmias
  • serious of worsening angina pectoris
  • pregnancy and breastfeeding
  • adolescents
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21
Q

precautions that must be assessed prior to starting NASAL SPRAY

A
  • recent MI <2 weeks
  • serious underlying arrhythmias
  • serious of worsening angina pectoris
  • severe reactive airway disease (nasal polyps, rhinitis, allergy, sinusitis)
  • underlying chronic nasal disorders
  • pregnancy and breastfeeding
  • adolescents
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22
Q

precautions that must be assessed prior to starting ORAL INHALER

A
  • recent MI <2 weeks
  • serious underlying arrhythmias
  • serious of worsening angina pectoris
  • bronchospastic disease (asthma, COPD)
  • pregnancy and breastfeeding
  • adolescents
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23
Q

1st cigarette <30 minutes after waking

A

4 mg gum OR lozenge

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24
Q

1st cigarette >30 minutes after waking

A

2 mg gum OR lozenge

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25
Q

gum/lozenge week 1-6

A

1 piece every 1-2 hours

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26
Q

gum/lozenge weeks 7-9

A

1 piece every 2-4 hours

27
Q

gum/lozenge weeks 10-12

A

1 piece every 4-8 hours

28
Q

what is the maximum pieces per day for a GUM

A

24 pieces/day

29
Q

what is the maximum pieces per day for LOZENGE

A

20 pieces/day

30
Q

duration for gum/lozenge

A

duration up 12 weeks

31
Q

transdermal patch

A

-based on number of cigs/day

32
Q

patch: >10 cigs/day

A
  • 21 mg/day for 4-6 weeks
  • 14 mg/day for 2 weeks
  • 7 mg/day for 2 weeks
33
Q

patch: <10 cigs/day

A
  • 14 mg/day for 6 weeks

- 7 mg/day for 2 weeks

34
Q

transdermal patch duration

A

8-10 weeks

35
Q

transdermal patch duration

A

8-10 weeks

36
Q

nasal spray dosing

A

1-2 doses/hour (8-40 doses/day)

37
Q

what is one dose of nasal spray?

A
  • one dose = 2 sprays (1 in each nostril)

- each spray delivers 0.5 mg of nicotine

38
Q

what is the maximum dose of nasal spray?

A

-maximum is 5 doses/hour or 40 doses/day

39
Q

how many doses of nasal spray for best results?

A

-for best results initially use at least 8 doses/day

40
Q

nasal spray duration

A

3-6 months

41
Q

oral inhaler dosing

A

6-16 cartridges/day

initially use 1 cartridge every 1-2 hours

42
Q

oral inhaler duration

A

3-6 months

43
Q

gum: administration & counseling

A
  • use the chew and park method
  • chew each piece slowly
  • park between cheek and gum when peppery or tingling appears
  • rotate areas in mouth
  • resume chewing when tingling fades
  • repeat chew/park until no longer tingles (30 min)
  • no food or beverages 15 min before or during use
44
Q

lozenge administration & counseling

A
  • allow to dissolve slowly (about 10 minutes)
  • nicotine release may cause warm tingling sensation
  • DO NOT chew or swallow
  • rotate to different areas of the mouth
  • no food or beverages 15 minutes before or during use
45
Q

transdermal patch administration & counseling

A
  • rotate patch application site daily on clean, dry skin on upper body or upper arm
  • do not apply patch to the same skin site for at least 1 week
  • can wear patch 16-24 hours
  • can remove the patch at bedtime if having vivid dream/insomnia
  • do not cut patch
  • do not wear more than one patch
  • remove prior to MRI since it may contain metal
46
Q

nasal spray administration & counseling

A

-do not sniff, swallow, or inhale through the nose as the spray is being administered

47
Q

oral inhaler administration & counseling

A
  • nicotine in cartridges is depleted after 20 min of active puffing
  • best effects with continuous puffing for 20 min
  • inhale into back of throat or puff in short breaths
  • do NOT inhale into the lungs (like a cig) but “puff” as if lighting a pipe
  • open cartridge retains potency for 24 hours
48
Q

gum adverse effects

A
  • mouth/jaw soreness
  • mouth irritation
  • hiccups
  • dyspepsia
  • hyper salivation
49
Q

effects associated with incorrect chewing technique (gum)

A
  • lightheadedness
  • nausea/vomiting
  • throat and mouth irritation
50
Q

lozenge adverse effects

A
  • nausea
  • mouth irritation/jaw soreness
  • hiccups
  • cough
  • heartburn
  • headache
  • flatulence
  • insomnia
51
Q

transdermal patch adverse effects

A
  • local skin reactions
  • headache
  • sleep disturbances
52
Q

nasal spray adverse effects

A
  • nasal and/or throat irritation (hot, peppery, or burning sensation)
  • rhinitis (stuffy nose)
  • tearing
  • sneezing
  • cough
  • headache
53
Q

oral inhaler adverse effects

A
  • mouth and/or throat irritation
  • cough
  • headache
  • rhinitis
  • dyspepsia
  • hiccups
54
Q

advantages of GUM and LOZENGE

A
  • might serve as an oral substitute for tobacco
  • might delay weight gain
  • short-acting allows for flexible dosing
  • can be titrated to manage withdrawal symptoms
  • can be used in combo with other agents to manage situational urges
55
Q

lozenge: additional advantage

A

-may be easier than gum, especially patient with dental work or dentures

56
Q

transdermal patch advantages

A
  • once a day dosing
  • use is the least obvious NRT
  • can be used in combo with other agents
  • delivers consistent nicotine levels over 24 hours
  • can be removed at bedtime if having insomnia
57
Q

nasal spray & oral inhaler advantages

A
  • can be used in combo with other agents to manage situational urges
  • short-acting allows flexible dosing
  • can be titrated to manage withdrawal symptoms
58
Q

additional advantages of ORAL INHALER

A
  • mimics hand-to-mouth ritual of smoking

- might serve as an oral substitute for tobacco

59
Q

disadvantages of GUM

A
  • need for frequent dosing can affect adherence
  • might be problem for patients with significant dental work
  • proper chewing technique is necessary for effectiveness
  • gum chewing might not be acceptable for some patients
60
Q

disadvantages of LOZENGE

A
  • need for frequent dosing can affect adherence

- GI side effects (nausea, hiccups, heartburn) might be bothersome

61
Q

disadvantages of transdermal patch

A
  • when used as monotherapy cannot be titrated to acutely manage withdrawal symptoms
  • not recommended for use by patients with dermatologic conditions
  • may cause insomnia
  • insomnia & vivid dreams may lessen after three to four days
62
Q

disadvantages of nasal spray

A
  • need for frequent dosing can compromise adherence
  • nasal administration might not be acceptable or desirable for some patients; nasal irritation often problematic
  • not recommended for use by patients with chronic nasal disorders or severe reactive airway disease
63
Q

oral inhaler disadvantages

A
  • need for frequent dosing can compromise adherence

- cartridges might be less effective in cold environments (<60F)

phm 516: self-care (5 decks)

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