Tobacco Cessation - Hudmon

Question 1

Electronic Nicotine Delivery Systems (ENDS)

Answer 1

• devices similar in appearance to cigarettes, cigars, pipes, or pens
• battery operated devices that create a vapor for inhalation
• simulates smoking but does not involve combustion of tobacco

Question 2

E-joice Constituents

Answer 2

Propylene Glycol
Vegetable glycerin
Flavorings (> 7000)
Nicotine (0-36 mg/mL)

Question 3

Nicotine POD Systems

Answer 3

• do not resemble cigarettes
• nicotine liquid that is stored in small plastic cartridges
• produce much less vapor compared to tank models

ex) juul, sourin, PHIX

Question 4

Plasma Nicotine Concentrations

Answer 4

• JUUL is just as addictive as cigarettes
• faster onset to peak nicotine concentrations than regular cigarette

1 JUUL pod = 1 pack of cigarettes

Question 5

ENDS for Cessation

Answer 5

• actively discourage use the ENDS with current non-smokers
• ENDS should not be promoted as a SAFE alternative to smoking however it may be less harmful
• ENDS is largely unregulated; most contain lower toxic constituents compared to tobacco smoke

Question 6

Cessation Techniques for Patients on ENDS

Answer 6

1. Behavioral Counseling
2. Pharmacotherapy: NRT
   - if patient has switched from smoking to vaping, start with pre vaping # of cigarettes/day to guide initial dosing
   - if patient is only on ENDS, estimate nicotine intake
   - > 20 mg/day: 21 mg patch
   - < 20 mg/day: 14 mg patch
   - may use buproprion SR or varinecline as well

Question 7

Most effective NRT

Answer 7

1. Varinecline
2. Combination NRT (Patch + Gum/Lozenge)

Question 8

Indiana Protocol for Tobacco Cessation

Answer 8

• Active Indiana Pharmacist License
• received education/training in tobacco use disorder and tobacco cessation
• complete continuing education on tobacco cessation counseling every 2 years
• be acting in good faith

Question 9

Indiana Protocol: Medications Covered

Answer 9

All medications with an FDA indication are included

Question 10

Indiana Protocol: Procedures

Answer 10

• assess readiness to quit (set a quit date within 30 days or 1 week prior with certain medications)
• apply 5 A’s (ask, advise, assess, assist, arrange)
• health screening (patient history, family history, living environment, illnesses, allergies, med history)

Question 11

Indiana Protocol: Referral for High-Risk Patients

Answer 11

pregnant or planning to become pregnant in next 6 months

cardiovascular disease with:
- MI in last 2 weeks
- history of arrhythmias or irregular heartbeat
- unstable angina or chest pain with strenuous activity

history of mental health disorder AND is not stable

Question 12

Dispensing and Counseling

Answer 12

Name and description of medication
dosage form, dosage, route of admin, duration
special directions and precautions
common adverse effects/interactions and actions if occurred
techniques for self-monitoring
proper storage
what to do if dose is missed
prescription refill info

PROVIDE BEHAVIORAL COUNSELING AND/OR REFER TO QUITLINE

Question 13

Follow-Up

Answer 13

1. within 2 weeks of initiating therapy
2. at the end of therapy

Question 14

Notification and Documentation

Answer 14

• provide patient with record of medication dispensed
• advise patient to follow up with PCP
• pharmacist must notify PCP of prescription record and follow up care plan within 3 business days
• maintain records for 7 years