Tobacco Cessation Flashcards by sophie rosen

NICOTINE

 An alkaloid that is contained in the leaves of plants

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Distributed quickly through the — and
crosses the —

bloodstream
blood–brain barrier

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Distributed quickly through the bloodstream and
crosses the blood–brain barrier
 Reaches the brain within— with inhalation
 Elimination half-life of nicotine is around —

8–20 seconds
two hours

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Nicotine is metabolized in the —

liver

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NICOTINE EFFECT
* Stimulates

adrenal glands
* Releases adrenaline – surge causes immediate release of glucose

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NICOTINE EFFECT
* Increased (3)

heart rate, breathing activity, and blood pressure

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NICOTINE EFFECT
Pancreas produces less

insulin – causing increased blood sugar or glucose

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NICOTINE EFFECT
Dopamine released –
Acetylcholine and Norepinephrine released –

feeling of contentment is higher
concentration and memory

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NICOTINE EFFECT
Increased levels of

beta-endorphin – reducing anxiety

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The amount of nicotine absorbed by the body
from smoking depends on:
(3)

 type of tobacco
 whether the smoke is inhaled
 whether a filter is used

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Amount released into the body tends to be much
greater in

smokeless tobacco

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Research indicates development of brain continues to
occur until the age of —

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Nicotine changes the way — are formed

synapses
 can harm the parts of the brain that control attention and
learning

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The nicotine in e-cigarettes and other tobacco products
can also prime the adolescent brain for

addiction to other
drugs such as cocaine.
 Surgeon General

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HOW IMPACTS YOUTH/YOUNG ADULTS
(6)

 Depression
 Anxiety
 Mood disorders
 Addiction
 Difficulty paying attention
 Reduced impulse control

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NICOTINE ADDICTION
-MORE THAN A “BAD HABIT”
cycle (5)

Use of
Nicotine

Stimulates
Dopamine
Release

Causes
Pleasurable
Feelings

Repeated use
of Nicotine

Tolerance
Develops

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Body will
create more
—
over time

nicotine
receptor sites

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TOBACCO DEPENDENCE:
A 2-PART PROBLEM

Physiological
Behavioral

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Physiological
The addiction to nicotine
tx

Medications for cessation

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Behavioral
The habit of using tobacco
tx

Behavior change program

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Treatment should address the (2) aspects of dependence.

physiological
and the behavioral

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WITHDRAWAL SYMPTOMS
(10)

Chest tightness A few days
Constipation, stomach pain 1-2 weeks
Cough, dry throat A few days
Cravings for tobacco Frequent in first 2-3 days
Depressed mood, irritable 1-4 weeks
Dizziness 1-2 days
Difficulty concentrating A few days
Fatigue 2-4 weeks
Hunger Up to several Weeks
Insomnia 1 week

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BENEFITS OF QUITTING SMOKING
20 minutes
8 hours
24 hours
48 hours
3 days
2-12 months
5 years
10-15 years

Blood pressure returns to normal
Normal oxygen blood level
Carbon monoxide eliminated from lungs –
start to clear mucus
Nicotine is eliminated, Smell and taste improve
Lung capacity begins to improve, Breathing become easier
Circulation improves
Risk of lung cancer decreases
Reduced risk of other cancers

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BENEFITS OF QUITTING SMOKELESS TOBACCO
 Decreased risk for:
(6)

 oral, head and neck cancer
 tooth decay
 progression of gum recession
 high cholesterol
 high blood pressure
 heart attack or stroke

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1 year post cessation Nicotine Transdermal patches --% Nicotine Gum and Lozenges --% Non Nicotine Chantix --% Non Nicotine Zyban --%

23 27 22-24 16

THE 5 A’S

ASK about tobacco USE ADVISE tobacco users to QUIT ASSESS READINESS to make a quit attempt ASSIST with the QUIT ATTEMPT ARRANGE FOLLOW-UP care

Ask about tobacco use (3)

◼ “Do you ever smoke or use any type of tobacco?” ◼ “Do you use any form of e-cigarette or vaping device?” ◼ “Do you, or does someone in your household smoke?”

Figure up pack year:

Number of cigs per day/20 x number of years of smoking = number of pack years

Advise tobacco users to quit (clear, strong, personalized)

◼ “I realize that quitting is difficult. It is the most important thing you can do to protect your health now and in the future. I have training to help my patients quit, and when you are ready, I will work with you to design a specialized treatment plan.” ◼ Best results if you can personalize this and be open, non-judgmental

◼ Assess readiness to make

a quit attempt

Assist with the quit attempt ◼ Not ready to quit: ◼ Ready to quit: ◼ Recently quit:

provide motivation design a treatment plan relapse prevention

ARRANGE THE 5 A’S (CONT’D) Number of sessions: Estimated quit rate* 0 to 1: 2 to 3: 4 to 8: More than 8:

12.4% 16.3% 20.9% 24.7%

Transtheoretical Change Model (Stages of Change) (7)

Relapse Pre-contemplation Contemplation Preparation Action Maintenance Termination

Relapse: Pre-contemplation: Contemplation: Preparation: Action: Maintenance: Termination:

Falling back into previous behavior patterns No intention to change Aware problem exists but no commitment to action Intent on taking action to address the problem Active modification of behavior Sustained change, new behavior replaces old Not falling back into previous behavior

Quit-line

available 24 hours a day, 7 days a week. FREE service that is available in multiple languages.

Confidential, personalized support is available from

Trained Quit Coaches.

CESSATION OPTIONS (9)

 Cold Turkey (no additional help)  Nicotine Replacement Therapy (NRT’s)*  Medications*  Behavioral Therapy  Combination Therapy  Hypnotherapy – Reveri app  Acupuncture  Yoga, meditation  Herbs

 Behavioral Therapy (2)

 Counselor/Coach, app/tech use, telephone counseling (1-800-QUITNOW)  Apps – QuitNow!, KWIT, Smoke Free, Quitters Circle, Quick Tracker

 Combination Therapy

 Multiple uses of NRTs, NRTs and medications

GUIDELINES FOR PHARMACOTHERAPY All tobacco users can benefit  Check with physician if pt has: (4)

Hypothyroidism Insulin-dependent diabetes Active peptic ulcer Anti-depressant medications

BUPROPION SR (ZYBAN)  --- mg sustained release tablet  Begin taking --- week prior to quitting  Double dose after --- days

150 1 3

BUPROPION SR (ZYBAN) Advantages: (2)

 Easy to use  Can be used with Nicotine Replacement Therapy

BUPROPION SR (ZYBAN)  Adverse Effect: (6)

 Insomnia, dry mouth, nervousness/difficulty concentrating, rash, constipation, seizures

VARENICLINE (CHANTIX®)  --- mg tablet  Days 1-3:  Days 4-7:  Weeks 2-12:

0.5 mg and 1.0 mg take one 0.5 mg tablet in the AM take 0.5 mg tablet twice daily take 1.0 mg tablet twice daily

VARENICLINE (CHANTIX®)  Advantages:

 Easy to use and offers a new mechanism of action for patients who have failed with other agents

VARENICLINE (CHANTIX®) Adverse Effects: (6)

 Nausea, insomnia, vivid dreams, constipation, vomiting, Neuropsychiatric Symptoms (behavior changes, agitation, depressed mood, suicidal ideation or behavior)

NICOTINE REPLACEMENT THERAPY OPTIONS (GUM – NICORETTE, ZONNIC)  --- mg (smoke < 25 cig/day or --- mg (smoke ≥ 25 cig/day)  Week 1-6:  Week 7-9:  Week 10-12:  Max of --- pieces per day. No food or beverage -- min before or during use

2, 4 1 piece every 1-2 hours 1 piece every 2-4 hours 1 piece every 4-8 hours 24, 15

NICOTINE REPLACEMENT THERAPY OPTIONS (GUM – NICORETTE, ZONNIC)  Advantages:

 May delay weight gain and satisfy oral cravings

NICOTINE REPLACEMENT THERAPY OPTIONS (GUM – NICORETTE, ZONNIC)  Adverse Effects: (3)

 Mouth/jaw soreness, hiccups, dyspepsia

NICOTINE REPLACEMENT THERAPY OPTIONS (LOZENGE – COMMIT, ZONNIC)  -- mg (smoke > 30 min after waking) and -- mg (smoke ≤ 30 min after waking)  Week 1-6:  Week 7-9:  Week 10-12:  Max. of -- lozenges/day. No food or beverage -- min. before or during use. Do not chew or swallow lozenge

2, 4 1 lozenge every 1-2 hours 1 lozenge every 2-4 hours 1 lozenge every 4-8 hours 20, 15

NICOTINE REPLACEMENT THERAPY OPTIONS (LOZENGE – COMMIT, ZONNIC)  Advantages:

 May delay weight gain and satisfy oral cravings

NICOTINE REPLACEMENT THERAPY OPTIONS (LOZENGE – COMMIT, ZONNIC)  Adverse Effects: (6)

 Nausea, hiccups, cough, heartburn, headache, insomnia

NICOTINE REPLACEMENT THERAPY OPTIONS (TRANSDERMAL PATCH - NICODERM CQ)  -- mg, -- mg, mg (24-hour release) ≤ 10 cigarettes/day -- mg/day for 6 weeks -- mg/day for 2 weeks > 10 cigarettes/day -- mg/day for 6 weeks -- mg/day for 2 weeks -- mg/day for 2 weeks

7, 14, 21 14 7 21 14 7

NICOTINE REPLACEMENT THERAPY OPTIONS (TRANSDERMAL PATCH - NICODERM CQ)  Advantages:

 Provides consistent Nicotine for 24 hrs, easy to use.

NICOTINE REPLACEMENT THERAPY OPTIONS (TRANSDERMAL PATCH - NICODERM CQ)  Adverse Effects: (4)

 Local skin reaction, headache, insomnia, vivid dreams

NICOTINE REPLACEMENT THERAPY OPTIONS (NASAL SPRAY – NICOTROL NS)  --- mg metered spray per 50 mcL  --- doses per hour  --- doses/day  Maximum -- doses/hr  One dose = -- sprays

0.5 1-2 8-40 5 2 (1 per nostril)

NICOTINE REPLACEMENT THERAPY OPTIONS (NASAL SPRAY – NICOTROL NS)  Advantages:

 Patients can titrate therapy to help with withdrawal

NICOTINE REPLACEMENT THERAPY OPTIONS (NASAL SPRAY – NICOTROL NS)  Adverse Effects: (6)

 Nasal/throat irritation, rhinitis, tearing, sneezing, headache, cough

NICOTINE REPLACEMENT THERAPY OPTIONS (ORAL INHALER – NICOTROL)  -- mg cartridge – delivers -- mg inhaled nicotine vapor  --- cartridges/day  Begin with 1 cartridge every ---  Best effects with continuous puffing for ---

10, 4 6-16 1-2 hours 20 min.

NICOTINE REPLACEMENT THERAPY OPTIONS (ORAL INHALER – NICOTROL)  Advantages:

 Patients can titrate amount to manage withdrawal and mimics hand-to-mouth ritual

NICOTINE REPLACEMENT THERAPY OPTIONS (ORAL INHALER – NICOTROL)  Adverse Effects: (5)

 Mouth/throat irritation, cough, headache, rhinitis, dyspepsia

 UMKC has a Tobacco Cessation Program that is free for patients wanting to participate  Program consists of: (3)

 Prep-work by the student  Initial Visit Appointment  Follow-Up Visit Appointment(s)

Tobacco Cessation Flashcards

(62 cards)