3.1.1 Smoking Cessation

Question 1

Children exposed to second hand smoke are at greater risk for what?

Answer 1

SIDS, bronchitis, asthma exacerbations, middle ear infections, cough, phlegm, wheezing

Question 2

What are some of the perceived benefits of nicotine?

Answer 2

Dopamine leading to calmness and pleasure

Suppression of appetite

Temporary improvement of cognitive and motor function

Soothe cognitive symptoms including depression, schizophrenia, ADHD

Question 3

If someone isn’t successful quitting, what should be done next?

Answer 3

Try, try, try again

More counseling, alternative pharmacotherapy, if she is willing to try YOU are willing to help

Question 4

How does snus compare to smoking?

Answer 4

For an individual, it is a safer alternative.

However, promoting snus as a public health policy would be counterproductive, as many people who may have never used snus would begin to dabble in a world full of evil and empty pleasures.

Question 5

What are the two components to assisting the patient in cessation?

Answer 5

Pharmacotherapy

Counseling

Question 6

What system is responsible for releasing dopamine after stimulation by nicotine?

Answer 6

Mesolimbic system

Question 7

What are two markers of heavy nicotine addiction?

Answer 7

Smoking the 1st cig within 30 min of waking

Smokes 20 or more cig per day

Question 8

What are the 5 A’s of smoking cessation?

Answer 8

Ask, Advice, Assess, Assist, Arrange follow-up

Question 9

What is the MOA of bupropion SR?

Answer 9

WE DON’T REALLY KNOW. WE ASSUME IT HAS SOMETHING TO DO WITH THE NORADRENERGIC/DOPAMINERGIC PATHWAY

Question 10

What are some of the efforts to alter the current course of the projected mortality pattern?

Answer 10

Prevention effect Prevention and treatment effect

Question 11

What is the half-life of nicotine?

Answer 11

2 hours

Question 12

Why is nicotine from cigarettes absorbed so well?

Answer 12

Lung alveolar epithelium - provides large area for nicotine absorption (tennis court)

Alkalinized to enhance absorption

Question 13

What type of absorption is utilized with nicotine gum and lozenges?

Answer 13

Buccal absorption

Question 14

What are the four stages of change?

Answer 14

1. Precontemplation
2. Contemplation
3. Preparation
4. Action

Question 15

What is the contraindication for buproprion SR?

Answer 15

increased risk of seizure

Question 16

If a patient is willing to quit, what are the two ways to assist in quitting?

Answer 16

1. Pharmacotherapy
2. Counseling

Question 17

What is the MOA of varencline?

Answer 17

Binds to the same receptor as nicotine in the ventral tegmental area (VTA) leading to an agonist-antagonistic effect

Question 18

What are the nicotine doses possible with patches? How do this therapy alter quit rates? How long for the onset of action?

Answer 18

7, 14, 21 mg/24 hrs

Doubles quit rates

Onset: 2-4 hrs

Question 19

Smoking is a chronic disease. What dependence is associated with smoking?

Answer 19

Nicotine dependence

Question 20

What are some of the symptoms of nicotine withdrawal?

Answer 20

Headache, lightheadedness, hunger cramps, sleep disturbance, stress, anxiety, cravings, irritability, poor concentration, depression

Question 21

Which therapy can increase the quit rate by a factor of 3.6 (2.5-5.2)?

Answer 21

Combination of patch with gum or spray

Question 22

What is something that the whole family can enjoy?

Answer 22

Smoking

Question 23

What is suggested to increase how often physicians ask about smoking?

Answer 23

Treat smoking as a vital sign (current, former, never)

Question 24

What are some of the mortalities related to second hand smoke

Answer 24

Heart dz, lung cancer, SIDS

Question 25

What is the estimated smoking-related mortality between 2001-2100?

Answer 25

1 billion (w/ a b)

Question 26

What are four pharmacotherapies to assist in cessation?

Answer 26

Nicotine replacement (short acting, long acting) Bupropion Varenicline

Question 27

What type of problem is smoking?

Answer 27

Global

Question 28

What are some counseling resources available for smokers?

Answer 28

1-800-QUITNOW smokefree.gov

Question 29

If a patient is not willing to quit, what are two ways to motivate them to quit?

Answer 29

Motivational interviewing The 5 R's (Relevance, Risks, Rewards, Roadblocks, Repetition)

Question 30

What is the appropriate chewing method for nicotine gum?

Answer 30

Chew 15 times, note flavor, stop chewing, put gum b/t cheek and gums, chew again when tingling is gone

Question 31

What are some of the effective public policies that have reduced smoking?

Answer 31

Tobacco taxation, restrictions on smoking (ie no indoor smoking/increased age), bans on advertising and promotion, smoking cessation interviews

Question 32

What is an undesired consequence of smoking?

Answer 32

Impotence

Question 33

What are the smoking rates amongst males? females

Answer 33

Males: 50% Females: 10%

Question 34

What are some of the smoking related morbidities that contribute to the mortality rate?

Answer 34

Lung cancer, Ischemic heart dz, COPD, stroke, other cancers

Question 35

How does varencline affect the quit rate?

Answer 35

Triples the quit rate

Question 36

How would you treat Mary? Withhold treatment until she has had counseling and is ready for treatment 4 mg nicotine gum 21 mg nicotine patch 21 mg nicotine patch plus 2 mg nicotine gum Varenicline

Answer 36

21 mg nicotine patch plus 2 mg nicotine gum or Varenicline

Question 37

What type of relationship does counseling have with quit rates?

Answer 37

Dose-response relationship

Question 38

What are the four MOA of nicotine replacement?

Answer 38

Stimulate nicotine receptors, reduce symptoms of withdrawal, decrease frequency of urges, reduce reinforcement of tobacco-delivered nicotine

Question 39

If a patient responds that they're a smoker, what would be the next step in promoting smoking cessation

Answer 39

Advise all smokers to stop!

Question 40

What are the two factors to elucidate when assessing a smoker?

Answer 40

1. Willingness to quit 2. Nicotine dependence

Question 41

What is the STAR approach to counseling?

Answer 41

**S**et a quit date **T**ell family and friends **A**nticipate challenges and plan for them **R**emove tobacco products

Question 42

About how much nicotine does each cigarette deliver?

Answer 42

~2 mg/cig