smoking cessation Flashcards

Question

abuse liability of NRT

Answer 1

-Prevalence of abuse and dependence with current NRT products is almost zero (patch) or very low (<10% gum, nasal spray, inhaler) -Likely to be greatest with products that deliver nicotine rapidly, but less than that of cigarettes -Even if dependence develops, there is likely to be overall health benefit if individual no longer smokes

Answer 2

-First line agents -MOA: Antidepressant – Weak inhibitor of neuronal uptake of serotonin, NE and dopamine. Does not inhibit MAO. -Precautions: Seizure risk. (Higher risk w/ doses > 450mg per day or individual dose > 150mg) -ADRs – insomnia, dry mouth, HTN ( risk w/ nicotine patch) -Dose: Start 2 weeks before quit date. 150 mg PO qam x 3days then 150mg PO bid for 7-12 weeks. May use for up to 6 months

Answer 3

-first line agent -MOA – Partial nicotinic ACH receptor agonist. Reduces craving and withdrawal symptoms -Precautions – Nausea. Take w/ full glass of water to decrease nausea symptoms -Common ADRs – GI effects, (nausea, vomiting, dysgeusia) sleep disturbances, headaches, abnormal dreams, anxiety, irritability.

Answer 4

-first line -Behavioral & Psychiatric side effects: anxiety, depression, emotional disturbances, irritability, restlessness, vivid dreams, angry outbursts, irrational behavior, suicidal ideation -Report from ISMP: -Accidents/injuries -Visual disturbances -Dysrhythmias -Seizures -Dermatological reactions -Diabetes

Answer 5

-Dosing: Start one week before quit date and continue for 12 weeks. If patient successfully quits – then may continue treatment for additional 12 weeks to maintain success -Titrate dose as follow: -Day 1-3: 0.5 mg PO QD -Day 4-: 0.5 mg PO BID -Day 8 – end of treatment: 1 mg PO BID

Answer 6

-FDA-approval based on combined data from 5 clinical trials (3659 patients total) -Smoked at least 10 cigarettes per day (Average 21 cigarettes per day for an average of 25 years) -Compared to placebo: More effective in reducing urge to smoke, less withdrawal and more likely to maintain abstinence during follow-up -Compared to bupropion: Similar efficacy rates with less adverse effects and precautions

Answer 7

-not FDA approved for smoking cessation -Reduce the craving. MOA unknown -Nortriptyline (Pamelor) (antidepressant) -Dose: 75mg-100mg/day for up to 12 weeks -ADRs – risk of arrhythmia, sedation, dry mouth

Answer 8

-limited efficacy -Clonidine (Catapres) (alpha2 agonist) -Dose: 0.15-0.75 mg/day for 3-10 weeks -Can use PO or patch -ADRs – rebound HTN, dry mouth, CNS effects

Answer 9

-MOA: Induce antibodies which bind to nicotine → Nicotine cant cross blood brain barrier → Reduces reinforcing action of nicotine in the brain -Efficacy: Phase 2 trial. Showed improved abstinence rates in vaccine group at two months (47% vs. 35%), but differences in continued abstinence at 6 months was not statistically significant. Subgroup analysis did show that vaccine patients with higher antibody levels did have higher abstinence rates between 2-6 months. -Further research with immunotherapy needed

Answer 10

-Should be utilized in combination w/ pharmacological therapy -Includes: -practical counseling (problem solving and skills training) -social support -person to person contact

Answer 11

-appetite suppressants -benzodiazepines -beta-blockers -buspirone -caffeine/ephedrine -cimetidine -dextrose tablets (food supplement) -lobeline --moclobemide (monoamine oxidase inhibitor) -SSRIs

Answer 12

-Clinic screening systems such as expanding the vital signs to include tobacco use status, or the use of other reminder systems such as chart stickers or computer prompts are essential for the consistent assessment, documentation and intervention with tobacco use -All patients should be screened for tobacco use and assessed for their interest in quitting. -All physicians and clinicians should strongly advise every patient who smokes to quit -All healthcare personnel and clinicians should repeatedly and consistently deliver smoking cessation interventions to their patients. -Patients should be encouraged to use nicotine replacement therapy or bupropion/varenicline for smoking cessation -To be most effective, interventions should include either individual, group or telephone counselling/contact

Answer 13

-The elements of behavioural interventions that enhance effectiveness -Effectiveness of combining: -different NRT formulations -NRT and non-nicotine pharmacotherapies -Long-term use of NRT or other pharmacotherapies to prevent relapse or reduce harm -Interventions for adolescent smokers -Improving access to effective interventions -Organization of healthcare systems for delivery of appropriate interventions -Optimal sequence of treatment combinations for repeated attempts to quit -Treatment of smokers with co-morbidities

Answer 14

-Toxins in tobacco smoke cause most adverse health effects -Nicotine is addicting therefore it sustains tobacco use -Smoking Cessation Therapy may include aversion therapy, substitution therapy or abrupt withdrawal -Tobacco Cessation Guidelines have identified 3 types of patients for smoking cessation -Nicotine Replacement Therapy is first-line per guidelines. It is available in various dosage forms and essentially helps reduce the withdrawal symptoms associated with quitting -NRT can be combined with bupropion (also first-line) to reduce craving -Varenicline (Chantix) is a partial nicotinic receptor agonist used to reduce craving and withdrawal. It is considered first-line but not yet part of official guidelines. Chantix is associated with potential behavioral and psychiatric side effects -The success rate for quitting is increased when pharmacological agents are combined with counseling and behavioral therapies

smoking cessation Flashcards

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