Smoking

Question 1

What are the top three most preventable deaths caused by smoking a year

Answer 1

Heart disease, lung cancer, and COPD

Question 2

What nicotine alter to cause dependence?

Answer 2

Dopamine and serotonin
Releases adrenaline

Question 3

What is the half like of nicotine?

Answer 3

2 hours

Question 4

What are the withdrawal symptoms of nicotine?

Answer 4

Irritability, anxiety, difficulty concentrating, and increased appetite

Question 5

How does smoking cessation affect women?

Answer 5

It reduces the risk if infertility and the chances of low birth weight

Question 6

What are the five As of smoking cessation

Answer 6

Ask if they smoke
Advise to quit
Assess motivation for change
Assist if willing to change
Arrange for follow up

Question 7

How many mg of nicotine are delivered with one cigarette

Answer 7

1.2-2.9
20-40 per pack

Question 8

What are first line agents used for smoking cessation?

Answer 8

Nicotene replacement therapy, bupropion, varenicline

Question 9

What are the second line agents used in smoking cessation

Answer 9

Clonidine, notriptyline

Question 10

What are special considerations when prescribing smoking cessation?

Answer 10

Medical considerations, those who smoke less 10 cigarettes a day, pregnant, and adolescent smokers

Question 11

What are the forms that NRT comes in?

Answer 11

Patch, gun, lozenge, nasal spray, oral inhaler

Question 12

Which forms of NRT require a script?

Answer 12

Nasal spray and inhaler

Question 13

What is the most adherent form of NRT

Answer 13

Tablets, lozenges and gum

Question 14

What is the most affective routine for NRT

Answer 14

Patch + gum

Question 15

Who is NRT contraindicated in?

Answer 15

Unstable cardiac patients and patients with arrhythmias.
Patients with unstable ischemic disease.

Question 16

What does NRT bind to?

Answer 16

CNS and peripheral nicotinic choleric receptors

Question 17

What is the half life of the patch vs the others

Answer 17

Patch 3-4 hours
Others 1-2 hours

Question 18

How are NRT patches dosed?

Answer 18

7, 14, 21 mg
One patch a day in between the waist and neck
Rotate patch site

Question 19

How is dosing of the NRT patch determined?

Answer 19

Parents that smoke > 10 cigarettes a day start at 21mg and taper down to 7 over the course of 8-12 weeks

< 10 starts at 14mg

Question 20

What are the adverse reactions to the NRT patch

Answer 20

Local skin reactions
Insomnia
Vivid dreams, headache, palpitations, nausea

Question 21

How do you tear skin reactions to the NRT patch?

Answer 21

Hydrocortisone or triancinolone cream

Question 22

How should NRT gum be dosed

Answer 22

2-4mg t
<25 cigarettes a day = 2mg
>25 cigarettes a day = 4mg

1 piece every 1-2 hours
Chew and park
Max 24 pieces a day
Do not eat or drink 15 min before or after
Use for 12 weeks

Question 23

How are lozenges NRT dosed

Answer 23

Given over 3-6 months
Max 20 a day
2mg dose if you smoke > 30 min after waking up
4mg if you smoke < 30 min after waking up
Taper over 10-12 weeks

Question 24

What are the side effects of lozenges

Answer 24

Sore mouth, hiccups, dyspepsia, insomnia, headache

Question 25

How can you avoid GI upset with oral NRT

Answer 25

Instruct patients not to swallow excess saliva and use the chew and park method

Question 26

How is nicotine spray dosed

Answer 26

.5 each nostril 1-2 times an hour Max 5 doses an hour 3-6 month taper

Question 27

Why is nicotine nasal spray more preferred for some people?

Answer 27

They get a nicotine “hit” faster than other forms. Making it lead to dependence at times.

Question 28

If you are concerned for addiction to NRT nasal spray what should you transition patients to?

Answer 28

Gum patch or bupropion

Question 29

What are the comment effects of nasal spray

Answer 29

Nasal irritation, nasal congestion, changes in smell, throat irritation, headache

Question 30

Who should you avoid giving nasal spray to?

Answer 30

Reactive airway diseases and high dependence risk

Question 31

How is the inhaler dosed?

Answer 31

4mg cartilage 6-16 cartridges a day Do not inhale in lungs Do not eat or drink within 15 min Use up to 6 months and taper down

Question 32

What are the side effects of the inhaler

Answer 32

Mouth and throat irritation, cough, rhinitis, sneezing, headache, taste changes, and withdrawal side effects from improper use of

Question 33

How does bupropion affect smoking cessation

Answer 33

Inhibits neuronal uptake or norepinephrine and dopamine

Question 34

When is bupropion contraindicated?

Answer 34

In patients with a history of seizures Anorexia/ bulimia Withdrawal from alcohol or psych drugs MOA inhibitor within 14 days

Question 35

How is bupropion dosed?

Answer 35

150 ER tabs daily for once daily x 3 days then BID Separate doses at least 8 hours and don’t take later than 6 pm Initiate one week before target quit date

Question 36

What are adverse effects of bupropion?

Answer 36

Depression, agitation, headache, nausea, abnormal dreams, dry mouth, insomnia

Question 37

What drugs should you avoid with bupropion

Answer 37

Linezolid MAOI pimozide Promethazine Codiene Alcohol SSRI

Question 38

What is the MOA of varenicline

Answer 38

A agonist and antagonist of alpha 4 beta 2 nicotinic acetylcholine receptors

Question 39

How is varenicline dosed

Answer 39

Started while still smoking Days 1-3 .5 mg daily 4-7 .5. BID Day 8 and on 1mg BID Attempt to stop smoking around day 8 Duration 12 weeks

Question 40

Who is varenicline contraindicated in

Answer 40

Renal impairment, psych disorder, cardiovascular disease, pregnancy

Question 41

What are the AE of varenicline

Answer 41

Nausea, headache, insomnia, abdnormal dreams, agitation