Pulmonary Conditions & Tobacco cessation: Tobacco Cessation

Question 1

pack-year smoking history calculation

Answer 1

cigarette packs per day X number of years smoked

Question 2

Who is recommended behavioral counseling over medication to quit smoking?

Answer 2

pregnant women
adolescents
smokeless tobacco users
light smokers = < 10 cigs/day

Question 3

which enzyme does nicotine induce?

Answer 3

CYP450 1A2

will have supra therapeutic lvls of caffeine if intake stays same and reduce smoking

Question 4

Women > 35yrs old who smoke should not take what type of birth control?

Answer 4

estrogen-containing oral contraceptives

Question 5

Which NRT therapy is more effective than mono therapy

Answer 5

using long acting such as patch with short acting like hum or lozenge

Question 6

NRT warnings

Answer 6

avoid immediate post MI period, life threatening arrhythmia, severe or worsening angina and pregnancy

Question 7

NRT side effects

Answer 7

insomnia
Vivid dreams = patch
mouth/throat irritation = inhaler
nasal irritation = nasal spray

Question 8

NRT patch notes

Answer 8

remove before MRI, highest adherence rate

Question 9

NRT Gum/Lozenge notes

Answer 9

4mg ca reduce or delay weight gain
acidic food/bev decrease absorption, dont eat/drink 15min before or during use

Question 10

Nicotine inhaler dosing

Answer 10

6-12 cartridges.day for 12 weeks, then taper frequency over 6-12 wks
use up to 6 months

Question 11

Nicotine patch dosing schedule if > 10 cig/day

Answer 11

21mg X 6 wk
14mg X 2wk
7mg X 2 wk

Question 12

Nicotine patch dosing schedule if < 10 cig/day

Answer 12

14mg X 6 wk
7mg X 2 wk

Question 13

Nicotine gum/lozenge schedule if 1st cig < 30min after waking

Answer 13

4mg Q1-2h X 6wk
4mg Q2-4h X 3wk
4mg Q4-8h X 3wk

Question 14

Nicotine gum/lozenge schedule if 1st cig > 30min after waking

Answer 14

2mg Q1-2H X 6wk
2mg Q2-4H X 3wk
2mg Q4-8H X 3wk

Question 15

Bupropion should be started before

Answer 15

1 week before quit date

Question 16

Bupropion for smoking dosing

Answer 16

150mg QAM X 3 days, then 150mg BID
MAx Dose: 300mg/day
use up to 6 months

Question 17

Bupropion boxed warning

Answer 17

inc risk of suicidal thinking and behavior in children, adolescents, and young adults on antidepressants

Question 18

Bupropion CI

Answer 18

seizure disorder
hx of anorexia/bulimia
concurrent use of MAOi, Linezolid or IV methylene blue

Question 19

Bupropion Warnings

Answer 19

serious neuropsychiatric events

Question 20

Bupropion Side effects

Answer 20

Dry mouth
insomnia
tremors
weight loss

Question 21

How to delay weight gain with bupropion

Answer 21

take 1st dose when wake up, 2nd dose 8hrs after

Question 22

Varenicline should be started…

Answer 22

1 week before quit date

Question 23

Varenicline warnings

Answer 23

serious neuropsychiatric events, seizures

Question 24

Varenicline side effects

Answer 24

nausea, insomnia, abnormal dreams, headaches

Question 25

Varenicline notes

Answer 25

to dec nausea, take after eating with full glass of water to dec insomnia, take 2nd dose before bedtime if cant quit smoking on day 8, dec smoking by 50% in 1st 4 weeks, then 50% in weeks 5-8, then complete stop 12 wks

Question 26

Varenicline dosing

Answer 26

Day 1-3 = 0.5mg QD Day 4-7 = 0.5mg BID Day 8+ = 1mg BID If CrCl < 30, then 0.5mg BID max doseW

Question 27

which meds should be avoided in seizures?

Answer 27

Bupropion and Varenicline

Question 28

Which med should be used in depression

Answer 28

Bupropion

Question 29

If weight gain, which med should be used

Answer 29

gum, lozenge, and bupropion = all delay weight gain

Question 30

If getting vivid dreams from patch then it should be removed....

Answer 30

remove before bed time, put new one on in the morning so wear ~ 16yrs/day

Question 31

Nicotine patch notes

Answer 31

dont cut patch never wear more than 1 rotate sites, try to not use same site until 1 week after