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PHAR253 > Smoking Cessation > Flashcards

Smoking Cessation Flashcards

1
Q

True or false: if you set the stage for a smoker to quit and they dont quit immediately, then it was a failure

A

false
if you dont get them to quit right now, but you set the stage to eventually quit, that is still a huge success

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2
Q

What is the best method to quit smoking?

A

there is no best method
simply trying something is likely close enough

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3
Q

What are patches often combined with?

A

a second form of NRT
-often a good move

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4
Q

True or false: with NRT cessation products we can be flexible with dosing

A

true

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5
Q

Where do the real issues lie with smoking?

A

behavioural aspects of smoking

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6
Q

What is the average number of cigarettes smoked per day among daily smokers in Saskatchewan?

A

13

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7
Q

What is the approximate age when people start smoking cigarettes in the USA and Europe?

A

15

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8
Q

List three points about the average smoker.

A

24 years old
smoke 14 cigs per day
lights up a cig within 30min of waking

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9
Q

How much are your chances of quitting smoking reduced if you light up after waking?

A

40%

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10
Q

What is a tendency that occurs with smokers trying to cut back on the number of cigs?

A

tend to take longer drags and hold the smoker longer

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11
Q

True or false: health warnings on the boxes of cigarettes have not been overly effective

A

true

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12
Q

Describe the physical aspects of addiction.

A

mood-altering effects
instant reinforcement
nicotine causes dopamine release

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13
Q

Describe the social aspects of addiction.

A

ritual of smoking
morning coffee
after meals
cigarette breaks
bar/friends

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13
Q

How many days into quitting tend to be the toughest?

A

2 days in
-irritability
-depressed
-anxiety
-difficulty concentrating

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13
Q

What is the average amount of weight gained during smoking cessation?

A

~5kg most within first 3 months)

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14
Q

What is the impact of nicotine on metabolism?

A

increases catecholamines
aromatic hydrocarbons impact metabolism
-enzyme induction: 1A1, 1A2, 2E1
-blood levels of certain drugs drop

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15
Q

What is the clinical implication of smoking on drug metabolism?

A

in general, minimal impact on drug therapy
-psychotropic agents
-methadone
-some oncology agents
can fax the MD regarding a change

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16
Q

What is the most common strategy that is done for quitting smoking?

A

cold turkey

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17
Q

What is the counseling service provided by Canadian Cancer Society to aid in quitting smoking?

A

Smokers Helpline

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18
Q

True or false: as pharmacists, we are well equipped to provide counseling on the behavioural aspects of smoking addiction

A

false

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19
Q

Are gimmicks an okay method of quitting smoking?

A

if they act as a crutch, great!

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20
Q

Are vapes a good method for quitting smoking?

A

not really
vapes provided fast release of nicotine which is not ideal a

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21
Q

Describe the two historical methods of quitting smoking.

A

lobelia plant:
-nicotine like substance
-was added to gums, lozenges, etc
silver acetate
-when you smoke it leads to bitter taste
-added to mouth wash and lozenges

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22
Q

True or false: if you dont have time to talk to a patient, you should tell them to keep and read the package inserts of nicotine products

A

true

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23
Q

What are the brands of nicotine gum?

A

Nicorette
Thrive

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24
Q

What are nicotine gums designed to do?

A

give enough nicotine to take the edge off
slow release process

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25
Q

How is nicotine gum absorbed?

A

buccal route (lag time)
-lag time makes it unideal for prn use

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26
Q

How is the release rate of nicotine gum controlled?

A

chewing
-chew a few moments until peppery taste
-then a cycle of bite, bite, park for up to 30min

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27
Q

What is the effect of coffee and acidic drinks on nicotine gum?

A

less nicotine absorbed
-not a huge worry, just adjust
-have gum before coffee break

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28
Q

What is the indication on the nicotine gum packages for the 2mg and 4mg strengths?

A

2mg: < than 25 cigs/day
4mg: > than 25 cigs/day

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29
Q

Is it a huge worry if you guess the wrong dose of a nicotine gum?

A

no, the smoker can adjust

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30
Q

What are the two approaches to the use of nicotine gum?

A

PRN use
-use whenever urge hits
-always playing catch up
scheduled
-defuses the next urge

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31
Q

What are the side effects of nicotine gum?

A

throat irritation
burping/hiccups
jaw fatigue
nausea (esp with faster chewing)

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32
Q

Can you smoke while using a nicotine gum?

A

you can but we would rather not

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33
Q

How much nicotine is delivered with a patch?

A

21mg over 24hrs

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34
Q

Do patches provide burst levels of nicotine or baseline levels of nicotine?

A

baseline levels

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35
Q

Describe proper application of nicotine patches.

A

apply to: upper body/outer upper arm/hip
clean, dry, non-hairy, healthy skin
can shower with it on (dont apply after shower)
change daily at the same time
dont re-use a site within 7 days

36
Q

What are the side effects of nicotine patches?

A

local reaction
headache, insomnia, nausea
-the patch or withdrawal symptoms?
dreams/nightmares
-take it off before bed, but might have a morning craving so use gum/lozenge/mist

37
Q

What is the step down order for nicotine patches?

A

21mg: weeks 1-6
14mg: weeks 7-8
7mg: weeks 9-10
different timelines are okay, its better than smoking

38
Q

Why do we need a weaning process for nicotine patches?

A

it takes time to:
-eliminate dependency
-allow for behaviour changes
-become aware of cessation benefits
-get over stress from trying to quit

39
Q

Do the packages say that you can combine NRTs?

A

no

40
Q

Differentiate between active forms of NRTs and passive forms of NRTs.

A

active forms:
-gum
-lozenge
-mist
-inhaler
passive form:
-patch

41
Q

Describe the inhaler as a method of quitting smoking.

A

puffing sensation stays intact (cig-like)
buccal absorption (not pulmonary)

42
Q

Explain how to use the inhaler.

A

the foil ends of the cartridge get poked by the device
inhale deeply
each cartridge lasts ~20min of frequent puffing

43
Q

How many cartridges of the inhaler can be used during the first phase of quitting smoking?

A

min: 6 per day
max: 12 per day

44
Q

True or false: like gum, coffee and acidic drinks can lower the amount of nicotine absorbed from the inhaler

A

true

45
Q

True or false: the original Nicorette lozenges are still sold

A

true
replaced by mini lozenges

46
Q

What strength do the Nicorette and Thrive lozenges come in?

A

Nicorette: 2mg or 4mg
Thrive: 1mg or 2mg
pack a day or less: 2mg (Nicorette) or 1mg
pack a day or more: 2mg (Thrive) or 4mg

47
Q

How should nicotine lozenges be used?

A

suck until the nicotine flavour is strong
rest the lozenge in your cheek until the taste fades
repeat the process for 30 min

48
Q

How long does a nicotine lozenge last?

A

30 min

49
Q

How much nicotine is in one cigarette?

A

1mg

50
Q

Describe the mini-lozenges.

A

dissolve 3x faster
lasts about 10 min
move from side-to-side prn

51
Q

Describe the quick-mist method for quitting smoking.

A

sprayed into mouth (not towards back of throat)
effect within 60 seconds (fastest method)
hold spray in mouth for a few seconds and dont inhale
dont eat or drink for about 15 min

52
Q

How many sprays of the quick mist can be used at once? How many can be used per day?

A

2 sprays at a time
64 sprays per day

53
Q

Which antidepressant can be used for smoking cessation? What is its mechanism?

A

bupropion (Zyban SR)
increases noradrenaline and dopamine via uptake blockage
still need willpower

54
Q

What would be a scenario where bupropion would likely be the drug of choice for smoking cessation?

A

depression
-quitting is difficult until depression is dealt with
-works in the non-depressed

55
Q

What is the typical regimen of bupropion for smoking?

A

150mg OD for first 3 days
then 150mg BID (8hr separation and not near bedtime)
keep smoking days 1-7, then quit smoking (can add NRT from this point on)

56
Q

What are the side effects of bupropion?

A

dry mouth
insomnia
less weight gain when quitting smoking
derm
seizure disorders (dont see it at smoking dose)

57
Q

Aside from bupropion, are there other antidepressants that can be used for smoking cessation?

A

nortriptyline
SSRIs (not that helpful)

58
Q

What is the mechanism of varenicline?

A

partial nicotine agonist and also blocks nicotine (smoking is less enjoyable)

59
Q

What is the dosing of varenicline?

A

days 1-3: 0.5mg OD
days 4-7: 0.5mg BID
day 8 and on: 1mg BID
titration to help decrease nausea
*stop smoking around day 7-14&

60
Q

What are the side effects of varenicline?

A

nausea
abnormal dreams
constipation
drowsiness

61
Q

Which formulation of bupropion is used for smoking cessation?

A

SR

62
Q

True or false: the adverse effects of varenicline outweigh the benefits

A

false

63
Q

Describe cytisine as a method of smoking cessation.

A

plant-derived (almost varenicline like)
oral capsule
OTC status
considered useful

64
Q

What are the main steps in selecting an agent for a patient?

A

ask about their smoking habit
-# of cigs/day, how early, after meals, etc
number of quit attempts
-tried what to date? what helped?
pick a method
give them quitting tips

65
Q

Asking about the number of cigs per day is an important aspect in selecting an agent, why?

A

reflects on how tough it might be to quit
needed for NRT dosing

66
Q

Why is it important to ask about how early in the day a smoker lights up?

A

earlier smokers will have a tougher time quitting

67
Q

Why is it important you ask a smoker what they have tried so far in terms of quitting?

A

helps decide what is next
what to avoid
can help explain what went “wrong”

68
Q

What are the factors that can be used when selecting an agent?

A

health status
-derm, TMJ, heartburn, cardio, depressed
quit history
dependency
-early morning cravings, hand-mouth ritual
product use history
patient preference
-picking easiest way? control over nic intake? weight gain an issue?
cost

69
Q

How many calories are burned from one cigarette?

A

10 calories

70
Q

Which smokers have a greater chance of quitting cold turkey?

A

light smokers

71
Q

True or false: lots of smokers eventually succeed cold turkey

A

true
using a crutch is a good idea

72
Q

Which form of NRT is the best?

A

none, simply pick one
its patient preference
find the sweet spot between withdrawal symptoms and nicotine side effects

73
Q

True or false: NRT cannot be used alongside bupropion

A

false
they can be used together

74
Q

Are varenicline and NRT used together?

A

pharmacologically, it does not make any sense

75
Q

Can patients with cardiovascular disease use an NRT?

A

it is not suggested however it is more dangerous to continue smoking than use NRT
-would be wise to be monitored by an MD

76
Q

Can pregnant women use an NRT?

A

there is no safe dose of nicotine in pregnancy, although NRT is safer than smoking
IR>patch (only bursts compared to 24/7)

77
Q

Can NRTs be used beyond 3 months?

A

continue with NRT as long as need be
-treatment should be flexible
-smoker should vary their approach according to their needs

78
Q

What is the maximum amount of nicotine that a person should be receiving from a patch per day?

A

84mg

79
Q

What proportion of smokers succeed in quitting on their first try?

A

1/10

80
Q

What are the stages of change?

A

precontemplation
contemplation
preparation
action
maintenance

81
Q

What is the biggest aspect of quitting smoking?

A

motivation

82
Q

What is often the first choice of therapy for smoking?

A

varenicline or a combination of 2 NRT methods (patch+gum/lozenge/etc)

83
Q

True or false: bupropion appears to be less effective than combo NRT or varenicline

A

true

84
Q

How long is therapy generally slated for?

A

3 months but varenicline and bupropion can be extended up to a year
-an extra 12wks of varenicline may prevent relapse
NRT can be used indefinitely

85
Q

What is the Rule of 3?

A

a nicotine craving lasts 3 minutes
a nicotine addiction lasts 3 days
the psychological addiction lasts 3 weeks+

86
Q

Are quit dates helpful?

A

yes, gives the smoker time to think
-try develop new habits two weeks before (things that take the fun out of smoking)

87
Q

Describe smokers cough.

A

often worse in morning
minimal sputum at first, becomes productive
~40% of smokers have one
can get worse when quitting
starts to decline after ~3 months

88
Q

True or false: there is a product for smokers cough

A

false

PHAR253 (16 decks)

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