Smoking Cessation Flashcards Preview

Fall2014 - Pharm ID/Pulm > Smoking Cessation > Flashcards

Flashcards in Smoking Cessation Deck (23):
1

How many adults in the US smoke?

1 in 5

2

What percent of smokers want to quit? What % succeed?

70% want to quit
5% succeed

3

What are the 5 steps in treating tobacco use and dependence?

1. Ask (smoking status)
2. Advise (to quit)
3. Assess (willingness to quit)
4. Assist
5. Arrange

4

What are the 5 Rs of motivational intervention with smokers who do not want to quit?

-Relevance
-Risks
-Rewards
-Roadblocks
-Repetition

5

What test is used to evaluate tobacco use?

Fagerstrom test

6

What are the treatment options (general) for smoking cessation?

-behavioral therapy
-nicotine replacement therapy (gum, lozenge, patch)
-Bupropion SR (Zyban)
-Varenicline (Chantix)
-2nd line: clonidine and nortriptyline

7

What is the quit rate associated with behavior modification programs?

30%

8

How does nicotine replacement therapy work?

-supplies body w/ low levels of nicotine to help diminish withdrawal sxs
-doubles quit rate when used w/ behavioral counseling
-not recommended for active smokers, active PUD, pregnancy, lactation

9

How is transdermal NRT used?

-apply to non-hairy, clean, dry site on upper body
-rotate daily
-AE: erythema, burning, pruritis

10

How is nicotine gum used?

-proper chewing technique to promote slow buccal absorption of nicotine
-30 minutes
-park gum

11

Nicotine Nasal Spray

-delivers nicotine more rapidly than gum or patch
-AE: nasal and throat irritation, rhinitis, sneezing, coughing, watering eyes

12

Nicotine Inhaler

-plastic rod with a nicotine plug that provides a nicotine vapor when puffed
-each cartridge has 4 mg nicotine, similar to gum

13

Nicotine Lozenge

-full dose released gradually by placing lozenge in mouth and sucking until completely dissolved
-dosing based on time to 1st cigarette (< or > 30 minutes in AM)
-avoid eating or drinking acidic products 15 minutes before/after

14

CIs of Bupropion

-hx of seizure disorder
-coadministration with MAOI
-current or prior dx of bulimia or anorexia nervosa
-do not use with Wellbutrin

15

Drug Interactions of Bupropion

-carbamazepine decreases [bupropion]
-cimetidine increase [bupropion]
-MAOIs: increase toxicity of bupropion

16

AEs of Bupropion

-seizures w/ high doses
-insomnia, irritability
-dry mouth, HA
-weight gain/loss

17

When is therapy initiated with bupropion?

while patient is still smoking and establish target quit date for 7 days after starting Zyban

18

Who requires adjusted Zyban dosing and how should it be adjusted?

-pts with renal or hepatic insufficiency
-decrease dose by 50%

19

MOA of Chantix/Varenicline

-selectively blocks nicotine binding to alpha4 beta2 nicotinic ACh receptors
-partially stimulates the nicotinic receptor to decrease cravings and withdrawal sxs

20

Precautions for Chantix

-coadministration w/ NR patch resulted in increased risk of nausea, HA, vomiting, dizziness, fatigue
-safety and efficacy of administering w/ other NRTs has not been established

21

AEs of Chantix

-most common: nausea, sleep disturbance, HA, abnormal dreams, constipation, flatulence, vomiting
-several reports of violent or bizarre behavior, suicidal thoughts, suicide
-may be linked to MI, DM, seizure, confusion

22

Who requires adjusted dosing of Chantix?

renal dysfuncton (if CrCl < 30 mL/min)

23

Usage of Chantix is banned in which groups?

-airline pilots and air traffic controllers