Tobacco Cessation

Question 1

What are the A’s associated with smoking cessation?

Answer 1

Ask about tobacco use
Advice to quit
Assess readiness to quit
Assist in quit attempt
Arrange follow up

Question 2

How do you calculate pack-year smoking history?

Answer 2

Pack-year smoking history = cigarette packs/day x number of years smoked

Question 3

What is the most essential component of quitting

Answer 3

Counseling

Question 4

What are the first line agents for quitting?

Answer 4

NRTS: patch, gum, lozenge, inhaler, nasal spray
Bupropion and varenicline

Question 5

What is the most effective regimen

Answer 5

Combo of 2 drugs

Question 6

What populations should receive behavioral counseling over drugs?

Answer 6

Pregnancy, adolescent, light smokers, smokeless tobacco

Question 7

Drug interactions from smoking

Answer 7

Induces CYP1A2

Those who quit with gave higher levels of caffeine, warfarin, theophylline

Women ≥35YO should not take estrogen-containing PO contraceptives → CV events

Question 8

Vaccinations recommended for smokers?

Answer 8

12-64 YO: pneumococcal and flu

Question 9

Nicotine Patch

Answer 9

NicoDerm CQ

Question 10

Nicotine Gum

Answer 10

Nicorette

Question 11

Nicotine inhaler

Answer 11

Nicotrol

Question 12

How do you determine the starting dose of the patch?

Answer 12

> 10 cigs: 21 mg/day x 6 wk → 14 mg/day x 2 wks → 7 mg/day x 2 wks

≤10 cigs: 14 mg/day x 6 wks → 7 mg/day x 2 wks

Question 13

How do you determine the starting dose of gum and lozenges?

Answer 13

≤30 min: 4 mg Q1-2H x 6 wks → 4 mg Q2-4H x 3 wks → 4 mg Q4-8H x 3 wks

> 30 min: 2 mg Q1-2H x 6 wks → 2 mg Q2-4H x 3 wks → 2 mg Q4-8H x 3 wks

Question 14

Warnings associated with NRTs

Answer 14

Avoid in post-MI, arrhythmias, angina, pregnancy

Inhalers: asthma and COPD

Question 15

ADR of NRTs

Answer 15

Insomnia

Patch: vivid dreams
Inhaler: mouth and throat irritation
Nasal spray: nasal irritation

Question 16

Counseling of patch

Answer 16

1. Remove before an MRI
2. Press firmly for 10 sec
3. Wear 24 hrs: remove prior to bed if experiencing 16 hrs
4. Fold patch to discard
5. Wash hands after application
6. Rotate site (topical hydrocortisone for irritation)
7. Don’t cut patch

Question 17

Counseling for gum

Answer 17

1. Chew slowly till tingly and park between cheek and gum
2. Rechew once tingling is gone
3. Do not eat or drink 15 min before or during chewing
4. acidic food and beverages can reduce buccal absorption

Question 18

Counseling for lozenge

Answer 18

1. Do not eat or drink 15 min before or during chewing
2. Don’t swallow or chew. Move from cheek to cheek until fully dissolved
3. One lozenge at a time
4. Acidic food and beverages can reduce buccal absorption

Question 19

Counseling of inhaler

Answer 19

1. Each cartridge provides 20 min of active puffing and good for 1 day
2. Soap and water the mouth piece
3. Inhale deeply into the back of throat or puff in short breaths

Question 20

NRTs that are Rx

Answer 20

Nicotine inhaler and nasal spray

Question 21

MOA of buproprian

Answer 21

Inhibits the reuptake of dopamine and norepinephrine to reduce cravings and withdrawal symptoms

Question 22

Bupropion formulations for quitting

Answer 22

Bupropion SR (Zyban)

Question 23

Dosing of Buproprion

Answer 23

Start 1-2 wks before quit date

150 mg QAM for 3 days → 150 mg BID for up to 6 months
(Max: 300 mg/day)

Question 24

BBW and warning of Buproprion

Answer 24

Suicidal ideations in children and young adults taking antidepressants

Serious neuropsychiatric events

Question 25

CI of Zyban

Answer 25

Seizure disorder, anorexia/bulemina MOA inhibitors, linezolid, IV methylene blue

Question 26

ADR of bupropion

Answer 26

Dry mouth, insomnia, weight loss, tremors

Question 27

How do you reduce insomnia in bupropion?

Answer 27

1st dose waking up and 2nd dose 8 hrs after 1st

Question 28

MOA of varenicline

Answer 28

Partial neuronal alpha-4 beta-2 nicotinic receptor agonist to reduce cravings and blocks nicotine from binding

Question 29

Dosing of varenicline

Answer 29

Start 1 wk before quitting for 12 wks

Question 30

Warning of varenicline

Answer 30

Serious reuropsychiatirc events

Question 31

ADR of Chantix

Answer 31

Nausea, insomnia, vivid dreams, HA Inability to drive or operate machinery ↑ the effect of alcohol

Question 32

How to reduce nausea with Chantix

Answer 32

Take after eating with a full glass of water

Question 33

Which drugs is more effective?

Answer 33

Varenicline > buproprion Combo is the best

Question 34

Drug selection if weight gain is an issue

Answer 34

Gum, lozenge, bupropion sr

Question 35

Drug selection if depression is an issue

Answer 35

Bupropion SR

Question 36

Drug selection if dentures is an issue

Answer 36

Avoid gum

Question 37

Drug selection if COPD and asthma is an issue

Answer 37

Avoid inhaler and nasal spray

Question 38

Drug selection if skin condition is an issue

Answer 38

Avoid Patch

Question 39

Drug selection if seizures is an issue

Answer 39

Avoid bupropion sr, varenicline