14 - Smoking Cessation Flashcards Preview

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Flashcards in 14 - Smoking Cessation Deck (33):
1

What enzymes does smoking induce?

1A1, 1A2, 2E1

2

What are the 5 A's?

-Ask
-Advise
-Assess
-Assist
-Arrange

3

What are the 5 evidence based steps required to successfully quit?

-Setting a target quit date
-Getting professional help
-Enlisting social support
-Using medication to quit smoking
-Using problem-solving methods of counselling to quit and remain smoke-free

4

What is first line?

NRTs (patch, gum, lozenge) - 1st line for many patients because it is so accessible

5

How long do you use NRTs for?

8-12 weeks (can go up to 24 weeks though)

6

What is varenicline?

alpha4beta2 nicotinic receptor partial agonist

7

How does bupropion work?

aminoketone that blocks reuptake of D, NE and S

8

What therapy has the highest quit rates?

varenicline

9

What kind of boxed warnings did varenicline have?

-boxed warnings for patients with thoughts of harm to self or others
-caution for those with past or current psych illness and those with CV concerns

10

Can you combine bupropion with NRT patch?

yes

11

What are two other options for smoking cessation?

-clonidine
-nortriptyline

12

points about clonidine?

good for those with HTN, must be tapered to prevent rebound HTN

13

points about nortriptyline?

used when 1st line therapies are either unaffordable or have not worked

14

What is the NHP that can be used for smoking cessation?

cytisine

15

Describe cytisine

NHP, partial nicotine agonist that demonstrated efficacy over placebo

16

Limitations of cytisine

-multiple daily doses (9mg/day in 6 doses then gradually tapered until 1.5mg is achieved)
-set quit date on day 5 after starting therapy

17

Describe smoking cessation in pregnancy

-non-pharms first
-then low-dose short acting NRT (ex. gum)
-bupropion may be used (use in pregnancy has not been associated w higher risk of congenital malformations)

Bottom Line: NRTs prob not safe in pregnancy but are safer than smoking

18

Can you use varenicline in pregnancy?

prob shouldn't - data about varenicline in pregnancy is limited

19

If pregnant ppl use the patch, remove at ______

night

20

How does smoking affect breastfeeding?

smoking reduces production and quality of milk, but amount of nicotine exposure to baby is minimal and overall benefits of breastfeeding outweigh risks of continued smoking

21

Can you use pharmacological therapies in breastfeeding?

NRT and bupropion may be used if benefits outweigh the risk

22

Can you use varenicline in breastfeeding?

no published safety data for varenicline and breastfeeding mothers

23

Key points for breastfeeding mothers who smoke

-non-pharms first
-try NRT and buproprion if needed
-try not to use NRT/smoke right before or during breastfeeding
-change clothes, frequent handwashing
-don't smoke around the baby or in the house

24

Avoid bupropion in severe _____ dysfunction

hepatic

25

Bupropion and Champix - start ____ weeks before quit date

1-2

26

Varenicline has a high incidence of ____ and _____

nausea and insomnia

*tell patients to take with food and a full glass of water for nausea
*take 2nd daily dose at suppertime if insomnia is bad

27

How long do you use varenicline for?

-for 12 weeks usually, but can be repeated for another 12 weeks if necessary

-can also combine with NRT

28

Some counselling points about NRTs?

-avoid coffee or acidic substances while in mouth and 15 mins before
-inhaler is absorbed buccally, not through the lungs (don't use for more than 6 months)
-Quick mist spray has to be primed
-Gum = bite bite park (Max 20 pieces/day for no more than 12 months

29

Normally the patch is started at 21mg/day. When would you start at 14mg/day?

if person has CV disease, weights < 45 kg or smokes < 1/2 pack/day

30

Can you use habitrol when exercising?

no, should avoid it

31

Which patch peaks faster than the other?

Nicoderm peaks faster than Habitrol

32

When do you start the patch?

on the quit date

33

What are the 5 R's of motivational interviewing?

-Relevance
-Risks
-Rewards
-Roadblocks
-Repetition

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