Smoking Cessation Flashcards

1
Q

What’s the best approach to quitting, if no CI?

A

Use a combo of 2 nicotine pdts

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2
Q

Which pdt shouldn’t be used with Nicotine products? Why?

A

Varenicline (shouldn’t be used with nicotine pdts)

Due to increased SE

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3
Q

What’s the “5 A’S” model for treating tobacco use & dependence?

A

Ask about tobacco use

Advise to quit

Assess

Assist

Arrange

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4
Q

Smoking and CYP 450 system? Effect once smoker quits?

A

Smoking causes an induction of some isoforms of CYP450 system.

T/4, smokers who quit can experience SEs from SUPRAtherpeutic drugs levels of caffeine, estrogens (oral), theophylline, Fluvoxamine, Olanzapine and clozapine

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5
Q

List drugs that a recently quit smoker may experience SEs from?

A

Caffeine

Estrogen (oral)

Theophylline

Fluvoxamine

Olanzapine

Quetiapine

Clozapine

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6
Q

Vaccinations req for smokers?

A

Pneumococcal (Pneumovax 23)
If >= 65 yrs + > 5 yrs since last vaccine, a 2nd dose is needed

Annual flu vaccine

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7
Q

Which nicotine pdts are preg cat C? Other non-nicotine?

A

Gum and lozenge

Bupropion - cat. C

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8
Q

List nicotine replacement therapies (NRT)

A
OTC
Nicotine gum (Nicorette, Nicorelief, Thrive)

Nicotine patch (NicoDerm CQ)

Nicotine Lozenge (Commit, Nicorelief, Nicorette)

Rx
Nicotine inhaler (Nicotrol inhaler)

Nicotine nasal spray (Nicotrol NS)

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9
Q

MOA of Bupropion?

A

Blocks neural re-uptake of dopamine and/or NE and blocks acetylcholinergic receptors

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10
Q

Moa of Varenicline?

A

Partial neuronal alpha4-beta2 nicotinic receptor agonist

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11
Q

Brand name of Bupropion SR?

A

Zyban

Buproban

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12
Q

CI to Bupropion SR (Zyban, Buproban)?

A

Seizure disorder

Pts receiving other dosage forms of bupropion

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13
Q

Warnings associated with Bupropion SR (Zyban, Buproban) use?

A

Caution in pts with underlying psychiatric disorders

Accidents have occurred while driving or operating machinery

Avoid use in pilots, air traffic controllers, commercial truckers, bus drivers

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14
Q

SEs of Bupropion SR (Zyban, Buproban)?

A

Dry mouth

Insomnia

Tremors/seizures (dose-related)

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15
Q

Bupropion SR (Zyban, Buproban) and sexual dysfunction?

A

No effects on 5HT (serotonin) => NO sexual dysfunction

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16
Q

Max daily dose of Bupropion SR (Zyban, Buproban)? Why?

A

Don’t exceed 450 mg/d

Dut to seizure risk

17
Q

Whats req when dispensing Bupropion SR (Zyban, Buproban) & Varenicline (Chantix)?

A

MedGuide

18
Q

Brand name of Varenicline?

A

Chantix

19
Q

How do u start Bupropion SR (Zyban, Buproban) and Varenicline (Chantix)?

A

Start taking them 1 week B4 quit date

20
Q

Warnings associated with Varenicline (Chantix)?

A

Angioedema

Serious skin rxn

Caution in pts with underlying psychiatric disorders

Avoid in pilots, air traffic controllers, commercial truckers, bus drivers

21
Q

SEs of Varenicline (Chantix)?

A

Nausea (~30% and dose dependent)

Insomnia

Abnormal dreams

Constipation

Flatulence

Vomiting

22
Q

How do u reduce nausea from Varenicline (Chantix)?

A

Can lower dosage and/or take with food + a full glass of water

23
Q

How do u reduce insomnia from Varenicline (Chantix)?

A

Take 2nd dose at dinner rather than bedtime

24
Q

How do u use nicotine gum?

A

Chew gum slowly, until a “peppery” or “flavored” taste emerges

Then park gum btw cheek to facilitate nicotine absorption thru oral mucosa

Cont to slowly and intermittently chewed and parked for about 30 mins or until taste dissipates

25
Q

Nicotine gum; nicotine lozenge and acidic beverages?

A

Avoid acidic beverages (coffee, juices, soft drinks) and eating for 15 mins B4 or during chewing

Bcuz they interfere with buccal absorption of nicotine

26
Q

What’s the dose of nicotine gum and lozenge?

A

At least 1 piece Q1-2hrs

27
Q

How do u use Nicotine inhaler (Nicotrol inhaler) - rx only?

A

Freq, continuous puffing for 20 mins is advised with each cartridge

28
Q

How long is Nicotine inhaler (Nicotrol inhaler) good for once opened?

A

1 day only

29
Q

Storage of Nicotine inhaler (Nicotrol inhaler)?

A

Store above 40 degrees F

Delivery of nicotine from inhaler declines significantly below
40 degrees F

Keep in inside pocket or other warm area in cold weather

30
Q

How do u use nicotine lozenge?

A

Should be allowed to dissolve in mouth

Don’t chew or swallow it

31
Q

Howz Nicotine nasal spray (Nicotrol NS) used?

A

Best delivered with head tilted slightly back

32
Q

How long does it take for Bupropion SR (Zyban, Buproban) and Varenicline (Chantix) to start working?

A

About 1 wk

33
Q

When do u dose adjust Chantix (Varencline)?

A

Renal dysfunction (CrCl < 30ml/min)

34
Q

What age is NRT approved for?

A

> = 18 yrs

35
Q

What strength of gum is recommended for use if < 25 cigarettes/day is used? > 25 cigs/day?

A

< 25 cigs/day = 2 mg

> 25 cigs/day = 4 mg

36
Q

There’s a strong correlation btw counseling intensity and quitting success?

A

T

Counseling sessions should be > 10 mins in length
+
number of sessions should be >= 4