Therapeutics - Smoking Cessation Flashcards by amanda kastel

3 things that smokers are more likely to get than non

heart disease
stroke
lung cancer

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explain how tobacco dependence is a 2 part problem

physiological addiction to nicotine

behavioral - habit of using tobacco

thus, there are meds for cessation that address the physiological addiction and behavioral change programs to address the other part

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treatment for smoking cessation should address what 2 things

physiological AND behavioral aspects of dependence

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according to the surgeon general, ___ and ___ are more effective in combination than alone

behavioral counseling AND smoking cessation meds

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true or false

it has been shown that text messages are ineffective for smoking cessation

false - effective

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true or false

evidence has shown that starting cessation medication before the patient quits - like gum/patch is 100% helpful in quitting

false - MAY be helpful. not really sure

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the 5 A’s for smoking cessation

ask
advise
assess
assist
arrange

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true or false

we should be asking patients about tobacco use once a week

FALSE

at every encounter

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many drugs interact with cigarettes
why

NOT bc of the nicotine - it’s from the combusion of tobacco smoke

the polycyclic aromatic hydrocarbons may ENHANCE THE METABOLISM of other drugs

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true or false

using cigarettes may decrease the metabolism of other drugs

FALSE

increase the metabolism if anything

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smoking cigarettes induces what enzyme

CYP1A2

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name 4 drugs that are substrates of CYP1A2 and thus their metabolism is increased when cigarettes are used

caffeine
fluvoxamine
propranolol
warfarin

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smoking increases the CLEARANCE of ___ and ____
(NOT metabolism related)

clozapine and olanzapine

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explain how nicotine withdrawal symptoms are enhanced

bc smoking increases the metabolism of caffeine, when a patient stops smoking, the caffeine levels increase over 50%!!!!

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hormonal contraceptive + smoking concern
-efficacy concern?
-safety concern?

increased risk for stroke, MI, thromboembolism (particular for pts over 35 and smoke 15 cig/day)

NO EFFECT on the efficacy of birth control

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what are you doing in the “assess” portion of tobacco cessation counseling

see how ready they are to quit and see why they wanna quit

should set a quit date within 30 dyas

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“STAR” to do when the patient is ready to quit

S - Set a quit date (preferably within 30 days)

T - Tell fam/friends that you’re quitting

A- anticpate challenges (withdrawal)

R - Remove tobacco products

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according to the guidelines, ALL PATIENTS, unless contraindicated, should be encouraged to quit smoking, with the use of effective medications

this EXCLUDES what 4 patients

-smokeless tobacco users

-lighter smokers (less than 10 a day)

-pregnant patients

-adolescents

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name all 3 FIRST LINE THERAPIES for smoking cessation

bupropion SR

NRT (patch/gum/lozenge/inhaler/ nasal spray)

varenicline

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partial nicotinic receptor agonist

varenicline

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what are the 2 second line options for smoking

clonidine
nortriptyline

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true or false

in NY, pharmacists are permitted to prescribe NRT

FALSE - nothing at all.. can’t even prescribe OTC NRT

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true or false

dentures are a consideration for treatment selection

true

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What are the options that have the EASIEST ACCESS for patients who want to quit smoking

NRT

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explain the dosing for nicotine gum/lozenge

if smoke first cig LESS THAN 30 mins after waking up - use 4mg if more than 30 mins - use 2mg weeks 1-6 - 1 piece every 1-2 hours weeks 7-9 - 1 piece every 2-4 hours weeks 10-12 - 1 piece every 4-8 hours NO MORE THAN 24 PIECES OF GUM A DAY AND NO MORE THAN 20 LOZENGES/DAY)

TRUE OR FALSE if a particular nicotine product is really helping a patient, they can use it forever

TRUE still better than inhaling all of the chemicals that are in cigs

explain the counseling for nicotine gum

"chew and park" chew each piece SLOWLY. when you feel a tingling - park the gum somewhere in the mouth for it to be absorbed when the tingle fades - chew slowly again and repeat until most of the nicotine is gone (around 30 mins. the taste/tingle won't come back when you chew)

what to tell a patient to avoid when using nicotine gum

dont drink/eat for 15 mins before (or during chewing) - ESPECIALLY acidic things like coffee or juices. will reduce effect

true or false nicotine gum is best used PRN

FALSE - chewing gum on an initial fixed schedule has higher rate of success after that tho - may be able to use PRN

true or false the gum provides the same rapid satisfaction as cigs

FALSE - not the same

why can a patient not chew the gum too rapidly

too much nicotine release - can get lightheaded, nausous, throat/mouth irritation, hiccups, indigestion

true or false a disadvantage of nicotine gum is that it enhances the weight gain that occurs when you stop smoking

FALSE - delays weight gain. this is an advantage

true or false the gum can be used in combo with other agents

true

name some disadvantages of the gum

-frequent dosing - issue w adherence -issue w dental work -need specific chewing technique

when patients are using the lozenge, they should use at least ______ for the 1st ____ weeks

at least 9/day for the first 6 weeks

true or false an advantage of the lozenge is that it gives the same rapid satisfaction of cigs

FALSE does not

4 things that REDUCE THE EFFECTIVENESS of the lozenge

coffee wine juices soft drink

can patients eat/drink before using the lozenge

NO - only water. for 15 mins before OR while using the lozenge

true or false a SE of the lozenge is flatulence and insomina

true

true or false like the gum, the lozenge may also delay weight gan

true

what particular side effects of the lozenge may be undesirable

GI - nausea, hiccups, heartburn

true or false nicotine is well absorbed across the skin

true

explain dosing for the patch

if over 10 cigs a day - start at step 1 if 10 or less/day - start at step 2 step 1 - 21mg (week 1-6) step 2 - 14 mg (7-8) step 3 - 7mg (9-10)

for the patch _______ weeks or less may be just as effective as using it for longer

8 weeks

counseling for patch

shoose skin between the head and waist - upper body apply to a DIFFERENT AREA every day and don't apply to that area again for at least a week

when a pt uses the patch, it should not be left on for more than...

24 hours may cause irritation if you leave on for longer than that

if a patient removes the patch and they have some residual adhesive on their skin, what can they do

remove with rubbing alcohol or acetone

how do patients dispose of the patch

fold inward

true or false patients can bathe/swim, etc while wearing the patch

true - water doesn't affect

can a patient cut the nicotine patch to change the dose

if a pt is using the patch, it should be removed before...

MRI

3 side effects in the 1st hour after applying patch 3 additional possible side effects

itching/burning/tingling vivid dreams, sleep issues, headache

after the patch is removed it is normal for the skin to appear red however, when does it become a concern

if it's red for more than 4 days or if it swells or a rash appears

true or false an advantage of the patch is that it is once daily dosing

TRUE

which NRT product is the LEAST OBVIOUS to others

patch

the patch is NOT RECOMMENDED for what pts

with skin conditions - psoriasis, eczema, atopic derm

dosing of the nasal spray

start with 1-2 doses/hr increases as needed to MAX of 5 doses/hour or 40mg daily for best results - use at least 8 doses daily for 1st 6-8 weeks

how is the nicotine spray d/c'ed

gradual taper over 4-6 weeks

recommended duration of therapy for the nasal spray

3-6 months

common AE in 1st week of using spray

sneezing, coughing, water eyes hot feeling in back of throat nasal irritation

big issue with the nasal spray

DEPENDENCY - highest nicotine levels out of all NRT some pts may use longer than recommended bc of this

for who is the nasal spray NOT recommended

chronic nasal disorders severe reactive airway disease

which NRT has been discontinued

the inhaler

the cartridges for the inhaler may be less effective in what scenario

in cold environments

Therapeutics - Smoking Cessation Flashcards

(65 cards)