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PHARM 253 Exam 1 > Smoking Cessation > Flashcards

Smoking Cessation Flashcards

(80 cards)

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1
Q

What we hope to do as pharmacists?

A

If you help a person quit smoking, way to go, you just added years to their life
If you don’t get them to quit right now, but you set the stage to eventually quit, that is still a huge success
Don’t get bogged down trying to get the ‘best’ method; simply trying something is likely close enough

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2
Q

What is a good move? What is hard about quitting?

A

You will see that combining a patch with a second form of NRT is often agood move
Pharmacists are sticklers for following the rules. But in the case of NRT cessation products, we can be flexible with dosing
Starting them on a product is just a small part of the equation. The behavioral aspects of smoking (and quitting) is where the real issues lie

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3
Q

Does smoking impact other meds?

A

Starting to smoke, or quitting, generally has little impact other medicines the person may be using (a few exceptions)

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4
Q

Is cultural tobacco connecected with addiction?

A

NO, tobacco use today, including inhaling has no connection with First Nations.

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5
Q

Aveerage SMoker Stats

A
  • 24 years old, 14 cigs per day, lights up within 30 mins of waking
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6
Q

Why is lighting up 30 mins before wakening bad?

A
  • Reduce the chances of quitting by 40%
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7
Q

Can one smoke on the patch?

A

People can smoke on the patch, if drop them down from 15 cigs to 7 cigs

SUCCESS (would rather have them not smoke on the patch)

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8
Q

Smokers trying to cut back tend to…..

A

Smokers trying to cut back on the number of cigs tend to take longer drags and hold the smoke longer

Squeeze the filter, more smoke gets in

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9
Q

Are smoking warnings effective?

A

No - Only one that had traction “look 30 at 16”

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10
Q

What are the aspects of an addiction?

A

Physical:
Mood altering
Instant reinforcement
Nicotine –> Dopamine

Behvaioural/Social:
Ritual of smoking
Morning coffeee
After meals
Cigarette breaks
Bar/friends

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11
Q

What days are the toughest to quit smoking?

A
  • First. 2 days

Irritability, anxiety, depressed, diffuclty concentrating

  • Weight gain - Approx. 5 kg (most within first 3 months)
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12
Q

What is the rule of 3”s?

A

3 minutes ‘nic fit’
3 days nic addiction
3 weeks psych addiction

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13
Q

Nicotines impact on Drug Metabolism

A
  • Increase catecholamines –> Increase metabolic rate
  • Aromatic hydrocrabones –> Increase metabolism through enzyme induction
  • One of the effects may be a drop in blood level, however, re-establishes new blood level
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14
Q

If someone starts smoking, blood levels may

A

Drop

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15
Q

If someone stops smoking, blood levels may…

A
  • levels rise as enzyme induction now normal (slower metabolism)
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16
Q

If a smoker continues to smoke while on a medication blood levels

A

No effect

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17
Q

Is there a big worry about drug levels? Which agents? What to do if worried?

A
  • In general, minimal impact of drug tx
  • Psychotropic agents, methadone, some oncology agents
  • FAX MD re the chnage
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18
Q

What is a word we should avoid?

A

“FAILURE”

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19
Q

What is th emain method of cessation?

A

Cold turkey -nNeed willpower here

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20
Q

In regards to counselling, an important distinction is……

A

Addictions counselling vs Pharmacist counselling
Big difference!

Psychiatry –> Different
Pharmacist –> More of an advisor; cannot provide behvaioural changes

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21
Q

Should we be worried about scams?

A

Scams vs. legitimate

  • If they act as. a crutch, great
  • Device to fiddle with
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22
Q

Should e-cigs be used to quit?

A

No - Fast hit of nicotine, want slow delievery

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23
Q

Lobeila Plant

A

nicotine-like substance
- Historical –> pre-champix

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24
Q

Silver Acetate

A

Silver acetate + smoke –> Bitter taste

  • Historical

Deterrent –> Tastes terrible

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25
To quit one must have ________. If we are busy, we need to inform the pt of what?
Still need motivation Product + “program” IF you have NO time for the patient .... READ THE FINE PACKAGE INSERT
26
Nicotine Gum Brands
Nicorette and Thrive - 2 or 4 mg in gum resin
27
Nicotine Gum release. How long does it take to work?
- Just enough to take the edge off - DO not chew fast, slow release prep 9controlled by chewing) - BUCCAL DELIEVERY: want nicotine to hit mouth, absorbed (little lag), to the brain - Gum takes 5-8 mins to work --> Morning smokers that lag time is important
28
Nicotine Gum Technique
BITE BITE --> PARK --> repeat for up to 30 min - if smoker needs more, can go faster - If smoker needs less, can go slower - Chew until pepper taste
29
Nicotine GUm Interactions
-Coffee and acidic drinks slow abdorption - SMoke with coffee, have gum before coffee - Chew a bit more
30
Is 2 or 4 mg a big mistake if switched?
NO --> Chew what you need - Under-dosing is a major issue
31
NRT Heart Attack
If have heart attack, 2 weeks after then NRT --> Second heart attack is common anyways - What if they smoke in those 2 weeks --> Easy call for JT to use Nicorette
32
Two approaches to Gum: One should have what for how long?
PRN - Use whenever urge hits but always playing ctach up Scheduled: Defuses the next urge Emergency supply likely needed for months Wean Off: Follow package insert; hyowever, can be on for a long time
33
Nicotine Gum Side Effects
Throat Irritation Burping/hiccups Jaw fatigue Nauseau
34
Can one become addicted to the gum?
Very hard, slow release prep - Preferably do not want the smoking during gum use but if smoke less cigaretets than ok
35
Transdermal Nicotine Patch Design
- 114 mg of Nicotine, 21 mg over 24 hours to the - 7 mg, 14 mg, 21 mg
36
Nicotine levels via smoking vs patch
Smoking fluctuates Patch is constant
37
Patch SIte Application, switching sites?
upper body / outer upper arm / hip clean / dry / non-hairy / healthy skin showering is fine with it on Don't re-use a site within 7 days
38
Patch S/e
Local rxn --> redness, move it around "How are you with band aids?" Headache, insomnia, nauseai (or just withdrawal sx) Nightmares/dreams --> Take 24 hour patch off at night vs 16 hour patch (hard to find) --> less impact on those who smoke upon wakening
39
Step Down Tx
- Not worried --> Follow pt - If not ready, maybe behavioural change shave not occured - FLexible algorithm
40
A person is ready to drop wean off the patch when:
eliminate dependency allow for behavior changes become aware of cessation benefits get over stress from trying to quit
41
What is the suces srate of all NRT's?
- 1/10 will succeed (10%), NRT increases it to 20%
42
What are the active forms of nRT? They are also refrred to as....
"Rescue methods" --> PRN use with patch to cover emergencies Gum, lozenge, inhaler, mist
43
Passive form (baseline level) NRT
PATCH
44
Inahler Effectiveness and Absorption
puffing sensation stays intact (cig-like) buccal absorption again (not pulmonary)
45
Inhaler Directions
6 min, max 12 carts/day - Low level directions, get in ball park
46
Lozenges Choosing a Strength:
Nicorette: 2, 4 mg Thrive: 1,2 mg - Does not matter, suck on it more or less
47
Lozenge technique
Suck --> Until nicotine flavour is strong Rest --> Cheek until taste fades Repeat --> 30 mins
48
Mini-Lozenges Difference from lozenges. Strength?
Dissolves 3x faster Lasts about 10 min Move from side-to-side prn 2 / 4 mg
49
Quick Mist Directions
sprayed into mouth (but not towards back of throat)some effect within 60 seconds ‘hold’ spray in mouth few seconds + don’t inhale don’t eat or drink for about 15 min
50
Fastest delivery system
Quick-mist
51
Bupropion:
- Two strengths: SR and XL
52
Does bupropion only work for depressed people:
Depression more common in smokers Quitting is difficult until depression is dealt with It works in the non-depressed too
53
How does bupropion work?
Antidepressants seem to reduce cravings ↑ NA and ↑ DA via uptake blockage (noradrenaline, doapmuine) STILL NEED WILLPOWER
54
Bupropion Does and Schedule
- 150 mg bid SR (max) (switch to bid on day 4) - Keep on smoking for first week, day 7 go cold turkey, can add on nRT at any point
55
Bupropion s/e, di
S/e: Dry mouth, insomnia, decraesed weight, derm DI: MAOI's, seizure disorders
56
DOsing interval Bupropion
Sr: Want > 8 hour seperation, and last dose not near bedtime
57
Bupropion Effectiveness:
Bupropion: 20% With NRT: 30%
58
Other anti-depressants
Notriptylline SSRI's
59
Varencilline (CHampix) MOA:
- Partial nicotine agonist - Some hit of nicotine, get enough dopamine to wave off withdrawal - Also blocks nicoitne from smoke from binding
60
Dosing of CHampix
0.5 mg OD (1-3), 0.5 mg BID(4-7), 1 mg BID (8) - Titration helps decrease nausaeu - STop smoking for day 7 to 14
61
Does champix with NRT make sense?
NO
62
Champix S/e
Nauseau, abnormal dreams, constipation, drowsiness - Increase sucicide risk?????
63
Cytistine
- OTC cap - Plant-derived Considered useful - Varencilline-like
64
Slecting an agent: Ask about:
Ask about their smoking habit (# cigs overall, how early in day, after meals, etc) Number of quit attempts tried what to date? what seemed to help (however small)?
65
In regards to slecting an agent one should consider:
Pt's expectations and bring them to reality
66
Weight gain Smoking Cessation
1 cigarette burns about 10 calories If a quitter does not change any eating habits, they will likely gain - about 3-4 kg
67
Can one use NRT while on zyban (bupropion)? Champix?
YES Champix No --> Does not makes ense
68
Champix and Zyban Combo?
Makes people a bit more nervous - A possibility --> More s/e - Shown some value for sure and sometimes no value - evidence lacking
69
Preganncy and NRT
There is NO safe dose of nicotine during pregnancy.NRT, although potentially harmful to the fetus, is safer than smoking GO WITH QUICK RELEASE OVER PATCH
70
Treatment with NRT DUration:
Withdrawal symptoms vary minute by minute, hour byhour, day by day. Treatment should be flexible enough to put more control in the hands of the smoker. Smokers should vary their approach according to their needs. Continue with NRT as long as need be
71
What is the patch maximum per day?
- 84 mg
72
What is the main thing needed for peopl to quit?
BEHAVIOUR CHANGES --> MOTIVATION Make behaviour harder to do --> Make new behaviour easier to do
73
Steps of Behaviour CHange:
Pre-contemplation (I love to smoke, see not benefits of quitting) Contemplation Preparartion (turning point) Action Maintenance (now se ebenefits, what was i thinking?"
74
Smoking is how many addictions:
3 Behavioural, Physical, Social
75
need time to:
eliminate your dependency on nicotine replace smoking with other activities become aware of the benefits
76
Pharmacists need to know:
WHY PEOPLE SMOKE - Plan for cravings
77
Cravings last how long? what to do?
Last 3 mins The 4 D's - DO something else - Delay Deep breathing Drink water
78
Tips for cravings
- Tell family about attempt remove ashtrays Reward yourself
79
Quit Day Technique
brush your teeth, then smoke right away (GROSS) change brands use your other hand change seating in the house try cutting down; smoke only half the cig postpone lighting for a few minutes emptying ashtrays (or put butts in a jar) put cigs in a different spot (house, car, etc) - 2 WEEKS
80
Smokers Cough
often worse in morning minimal sputum at first, becomes productive ~40% of smokers have one arts to decline after ~3 months

PHARM 253 Exam 1 (8 decks)

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