Flashcards in Smoking Cessation Deck (23):
How many adults in the US smoke?
1 in 5
What percent of smokers want to quit? What % succeed?
70% want to quit
What are the 5 steps in treating tobacco use and dependence?
1. Ask (smoking status)
2. Advise (to quit)
3. Assess (willingness to quit)
What are the 5 Rs of motivational intervention with smokers who do not want to quit?
What test is used to evaluate tobacco use?
What are the treatment options (general) for smoking cessation?
-nicotine replacement therapy (gum, lozenge, patch)
-Bupropion SR (Zyban)
-2nd line: clonidine and nortriptyline
What is the quit rate associated with behavior modification programs?
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
How is transdermal NRT used?
-apply to non-hairy, clean, dry site on upper body
-AE: erythema, burning, pruritis
How is nicotine gum used?
-proper chewing technique to promote slow buccal absorption of nicotine
Nicotine Nasal Spray
-delivers nicotine more rapidly than gum or patch
-AE: nasal and throat irritation, rhinitis, sneezing, coughing, watering eyes
-plastic rod with a nicotine plug that provides a nicotine vapor when puffed
-each cartridge has 4 mg nicotine, similar to gum
-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
CIs of Bupropion
-hx of seizure disorder
-coadministration with MAOI
-current or prior dx of bulimia or anorexia nervosa
-do not use with Wellbutrin
Drug Interactions of Bupropion
-carbamazepine decreases [bupropion]
-cimetidine increase [bupropion]
-MAOIs: increase toxicity of bupropion
AEs of Bupropion
-seizures w/ high doses
-dry mouth, HA
When is therapy initiated with bupropion?
while patient is still smoking and establish target quit date for 7 days after starting Zyban
Who requires adjusted Zyban dosing and how should it be adjusted?
-pts with renal or hepatic insufficiency
-decrease dose by 50%
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
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
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
Who requires adjusted dosing of Chantix?
renal dysfuncton (if CrCl < 30 mL/min)