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AmCare Exam 3 > Smoking Cessation > Flashcards

Smoking Cessation Flashcards

1
Q

Health Benefits

A

~30 minutes: BP and HR decrease
8-12 hours: carbon monoxide levels in lungs return to level of non-smoker
1 yr: CV risk decreases by 50%
5-10 years stroke risk decreased to non-smoker level and cancer risk decreased by 50%

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2
Q

Withdrawal Symptoms

A 
	Peak in 24-48 hours and can last weeks to months
	Cravings
	Headache
	Restlessness
	Impaired concentration
	Irritability, impatient, frustration
	Insomnia
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3
Q

Stages of Change

A 
Precomtemplation
Contemplation
Preparation
Action
Maintenance
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4
Q

Precontemplation

A

Patient is NOT planning on changin in the next 6 months

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5
Q

Contemplation

A

Patient is CONSIDERING a behavior change within the next 6 months

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6
Q

Prepartion

A

Patient is PLANNING to make a behavior change within the next 30 days

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7
Q

Action

A

Patient is ACTIVELY ENGAGED in the desired behavior for less than 6 months

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8
Q

Maintenance

A

Patient has been ENGAGED in the desire behavior for >/= 6 months

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9
Q

1 pack of cigarettes =

A

20 cigarettes

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10
Q

Patient’s WILLING to Quit =

A 
ASK about quitting
ADVISE patient to quit
ASSESS readiness to quit
ASSIST with quit plan
ARRANGE appropriate follow up
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11
Q

Patient’s UNWILLING to Quit =

A 
RELEVANCE to values/goals
RISKS to health/money
REWARDS if patients were to quit
ROADBLOCKS ID and addressed
REPETITION
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12
Q

Fagerstrom Nicotine Dependence Scoring

A 
0-2: Very low dependence
3-4: Low
5: Medium
6-7: High 
8-10: Very high
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13
Q

Exclusions for Self-Treatment

A

o Severe heart disease ( recent MI, irregular beat, severe angina)
o High blood pressure that isn’t controlled
o Pregnancy/breast feeding
o

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14
Q

Patch MOA

A

Stimulate nicotine receptors, replace nicotine from cigarettes while tapering to reduce severity of withdrawal and cravings

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15
Q

Nicotine Patches: If >10 cigs/day

A

Start 21 mg patch applied daily for 4-6 weeks
Then 14 mg patch/day for 2 weeks
Then 7 mg patch/day for 2 weeks

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16
Q

Nicotine Patch Counseling

A
  • Place patch on hairless area between neck and waist, rotate site with each application
  • Wash hands before and after applying or removing
  • Do NOT cut patches
  • Due to not wanting to wear the patch overnight due to vivid dreams, leads to cravings in the morning
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17
Q

Lozenge and Gum Counseling

A
  • Avoid eating or drinking for 15 minutes before and during lozenge use
  • Provides PRN nicotine replacement or could be scheduled
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18
Q

Gum Dosing: If first cigarette is within 30 minutes of waking

A

1 piece of 4 mg gum every 1-2 hr for weeks 1-6
1 piece of 4 mg gum every 2-4 hr for weeks 7-9
1 piece of 4 mg gum every 4-8 hr for weeks 10-12

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19
Q

Gum Dosing: If first cigarette is greater than 30 minutes of waking

A

1 piece of 2 mg gum every 1-2 hr for weeks 1-6
1 piece of 2 mg gum every 2-4 hr for weeks 7-9
1 piece of 2 mg gum every 4-8 hr for weeks 10-12

20
Q

Gum Chewing:

A

Chew and park: chew until peppery taste then park the gum between check and gums for about 30 minutes or taste dissipates

21
Q

Max Dose for Gum

A

No more than 24 pieces//day

22
Q

Lozenges Dosing: If first cigarette is within 30 minutes of waking

A

One 4 mg lozenges every 1-2 hr for weeks 1-6
One 4 mg lozenges every 2-4 hr for weeks 7-9
One 4 mg lozenges every 4-8 hr for weeks 10-12

23
Q

Lozenges Dosing: If first cigarette is greater than 30 minutes of waking

A

One 2 mg lozenges every 1-2 hr for weeks 1-6
One 2 mg lozenges every 2-4 hr for weeks 7-9
One 2 mg lozenges every 4-8 hr for weeks 10-12

24
Q

Max Lozenge Dose

A

20 lozenges/day

25
Q

Lozenge Counseling

A

Do not chew or swallow

Allow to dissolve slowly

26
Q

Nasal Spray Dosing

A

1 dose = 1 spray in each nostril = 1 mg nicotine

1-2 doses per hour X 6-8 weeks (3-6 months)

27
Q

Nasal Spray MAX Dosing

A

No more than 40 doses/day

28
Q

Nasal Spray Counseling

A

Do not sniff

Fastest and most addictive nicotine source

29
Q

Nasal Spray CI

A

Chronic nasal disorder

Severe reactive airways disease

30
Q

Nicotine Inhaler Dosing

A

6-16 cartridges/day for 12 weeks and gradually d/c over 6-12 weeks

31
Q

Inhaler Counseling

A

Continuous puffing for 20 minutes
Puff into mouth and hold for a few seconds
DO NOT INHALE
Avoid eating/drinking 15 minutes before and during
Mimics hand to mouth motions

32
Q

Inhaler CI

A

Reactive airwary disease

33
Q

NRT Symptoms of too much nicotine

A

N/V/D, tachycardia, cold sweats, blurred vision, dizziness and headache

34
Q

Buproprion MOA

A

Inhibits reuptake and potentiates effects of NE and DA

May relieve nicotine withdrawal symptoms

35
Q

Buproprion Dosing

A

150 mg AM for 3 days
Then increase to 150 mg BID for 7-12 weeks
Start 1 week before quit day and can be used fo rup to 6 months

36
Q

Buproprion CI

A 
o	Alcohol abuse
o	Could be beneficial in pts with depression/anxiety
o	Bulimia/anorexia
o	Seizure
o	Head trauma
o	MAOI
37
Q

Varenicline Dosing

A

0.5 mg once daily for day 1-3, then 0.5 mg BID for days 4-7, then 1 mg BID thereafter
Last for 12 weeks and can be used for another 12 weeks if needed
Start 1 week before quit date

38
Q

Varenicline MOA

A

Block nicotine binding to receptor

39
Q

Varenicline Renal Dosing

A

CrCl less than 30 mL/min: max of 0.5 mg BID

40
Q

Buproprion and Varenicline Boxed Warning

A

Neuropsychiatric events!!

41
Q

Varenicline SE

A

Dream disturbances

42
Q

Buproprion SE

A

Insomnia, dry mouth

43
Q

Pregnancy + Smoking

A

NRT and buproprion are okay

NOT varenicline

44
Q

Adolescents + Smoking

A

NRT is save via Rx

45
Q

Mental Illness or Other Addiction + Smoking

A

Should not delay smoking cessation

46
Q

Relapse typically occurs:

A

3-7 days

So followup in 1 week, 2 weeks and then every month after

AmCare Exam 3 (7 decks)

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