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Flashcards in Tobacco cessation Deck (61):

Tobacco use causes what percent of all lung cancer deaths in men and women?

- 90%


What is the pathophys of nicotine addiction?

-nicotine is a highly addictive drug in tobacco
- the cravings can begin within days of the first use
- nicotine stimulates brain nicotinic cholinergic receptors releasing dopamine and other neurotransmitters in the brain's reward center
- nicotine activates the brain's reward system during pleasurable activities similar to that of addictive drugs


Acute effects of tobacco use?

- increases HR, BP, and RR
- increases energy
- increased ability to concentrate
- ability to overcome fatigue


What are the chronic effects of tobacco use?

- yellow stains of teeth and fingers
- skin is drier and more wrinkled
- hair is thinner


Withdrawals from tobacco use?

- anxiety
- difficulty concentrating
- sleep disruption


What are the medical conditions related to tobacco?

- smoking causes a large range of health conditions:
COPD: emphysema, chronic bronchitis
pregnancy (low birth weight)
bone and tissue health
affects teeth and gums
delayed wound healing


Why is tobacco use a RF for CVD and stroke?

- raises TGs
- lowers HDL
- damage cells that line blood vessels
- causes thickening and narrowing of blood vessels
- causes clots to form


How does tobacco use lead to COPD?

- poisons in cigarette smoke can weaken lungs' defense against infections, narrow air passages, causes swelling in air tubes and destroys air sacs


What effects does tobacco use have on pregnancy?

- damage sperm and ED
- premature birth
- birth defects: cleft palate
- SIDs


What effects does tobacco use have on bone and tissues?

- osteoporosis
- delayed bone healing after fracture
- gum disease


Why are different types of cancers related to tobacco use?

- smoking itself can cause cancer and it also blocks your body from fighting it
- poisons in tobacco smoke weaken the body's immune system to fight off the cancer cells
- poisons in tobacco smoke can damage a cell's DNA causing the cell to begin to grow out of control and create a cancerous tumor


What cancers are related to smoking?

- almost all cancers in the body
- mouth, nose, throat
- larynx
- trachea
- esophagus
- lungs
- stomach
- pancreas
- liver
- kidneys and ureters
- bladder
- colon and rectum
- cervix
- bone marrow and blood (leukemia)


What cancers are linked to smokeless tobacco?

- esophagus
- mouth and throat
- pancreas


What are the 3 types of smokeless tobacco?

- chewing tobacco: loose leaf or plug tobacco, nicotine is absorbed through the mouth tissue
- snuff: finely ground tobacco in cans or pouches, nicotine is absorbed through the mouth tissue, dry snuff in powder form is used by sniffing or inhaling the powder up the nose
- snus: from Sweden and Norway. commonly packaged in small pouches. Has fewer tobacco specific nitrosamines (TSNAs) that are known to cause cancer


Who usually uses smokeless tobacco?

- about 3.5% of people 12 and older
- more high school students use compared to young adults
- the route is different, but the nicotine addiction is the same


What are the harmful health effects of smokeless tobacco?

- mouth, tongue, cheek, gum and throat cancer
- esophageal, stomach, and pancreatic cancer
- increased risk of heart disease and stroke
- leukoplakia


Who uses e-cigs?

- increase use in adults, high school and middle school kids since 2010
- most are current smokers
- most report purpose of use is for smoking cessation


How does an e-cig work?

- contains a battery that activates a heating device, atomizing liquid nicotine inside a cartridge and producing a vapor that is inhaled


First gen ECs?

- cigalikes
- disposable
- re-chargeable with pre filled cartridges


Second gen ECs?

-refillable with liquids


3rd gen ECs?

- mods
- able to adjust atomizer - burn liquid hotter - get more nicotine out


What are the components of an E-cig?

- liquid components:
nicotine (Not followed by FDA)
propylene glycol/glycerol
other components
- vapor: little is known about health effect


What are the public health concerns about E-cigs?

- appeal to youth
- reverse changing social norms about acceptability of cigarette smoking


How should you counsel a pt on use of ECs?

- not approved by FDA
- probably less harmful than conventional cigs
- if smokers want to use E cigs to quit, up to provider to support use


Second hand smoke exposure rates?

- 88 million nonsmokers exposed 07-08
- today: half of children b/t ages 3-18 are exposed regularly
- body begins to metabolize nicotine from the smoke, producing a byproduct called cottoning, which can be measured by testing saliva, urine or blood for cotinine


What are the effects of secondhand smoke on children?

- ear infections
- asthma attacks
- respiratory sxs
- resp. infections
- SIDs


What are the effects of secondhand smoke on adults?

- CVD: increases risk 25-30%
- causes around 34000 heart disease death annually
- lung cancer: increases risk 20-30% - causes more than 7300 lung cancer deaths annually


What are the goals of nicotine replacement therapies? (NRT)

- goal is to provide nicotine to a smoker w/o using tobacco while a smoker tries to break the habit
- the use of long acting NRT in combo with a short acting NRT is preferred
- initial dosing is based on the number of cigarettes smoked daily
- NRT is recommended for 2-3 months after smoking cessation
- NRT products can be used while the smoker is still smoking


What NRT products are available?

- 3 OTC products:
patch, gum and lozenge
- 2 Rx:
nasal spray, and oral inhaler


Describe the transdermal nicotine patch?

- provides the most continuous nicotine delivery
- patch provides a 16 and 24 hour release
16 hr: usually helps for light average smoker
24 hr: helps with morning cravings
- doses available: 21, 14, and 7
- light smokers: less than 10 cigs/day - should start on quit day and start with 14 mg/day strength for 6 weeks, followed by 7 mg/day for 2 weeks
- heavy smokers: more than 10 cigs a day - should start on quit day with 21 mg/day for 6 weeks followed by 14 for 2 weeks and then 7 mg/day for 2 weeks


What are the SEs of the transdermal nicotine patch?

- skin irritation (most common)
- dizziness
- nausea
- sleep problems and unusual dream
- HA
- muscle aches and stiffness
- SE if patch is too strong:
tachycardia, nausea and overstimulated


What are the short acting NRT agents?

- nicotine gum
- lozenge
- nasal spray
- inhaler
- these should be used in combo with the patch to help control nicotine cravings and withdrawal sxs


Describe the nicotine gume (OTC)?

- most common short acting NRT used
- chewing the gum releases nicotine that is absorbed through the oral mucosa
- doses available: 2 mg for light smokers
and 4 mg: for those that smoke more than 25 cigs a day
- chew one piece of gum every 1-2 hours for 6 weeks with gradual reduction over the next 6 weeks for a total duration of 3 months
- chew and park method and then repeat for 30 minutes


What are the SEs of nicotine gum?

- Nausea
- vomiting
- abdominal pain
- constipation
- hiccups (air in the stomach)


Describe the nicotine lozenge (OTC)?

- place in mouth and it dissolves over 30 minutes
- doses:
2 mg for most smokers
4 mg for smokers who smoke within 30 min after waking
- use one lozenge q 1-2 hours for 6 weeks with gradual reduction over the next 6 weeks
- max dose is 5 lozenges every 6 hours or 20 lozenges per day
- good for pts that cant chew gum (bad jaw, or dentition)


SEs of lozenges?

- mouth irritation
- hiccups
- N/V


Describe the nasal spray (Rx)?

- delivers nicotine directly to the nasal mucosa where it is absorbed
- 1 or 2 sprays/hr for about 3 months with a max dose of 10 sprays/hr for 80 sprays a day
- each spray contains about 0.5 mg of nicotine


SEs of nasal spray?

- nasal irritation
- runny nose
- watery eyes
- b/c of SEs limits use (caution use in asthma, nasal polyps, any sensitivity in Upper respiratory tract)


Describe oral inhalers (Rx)?

- consist of nicotine cartridge and a thin plastic tube that mimics a cigarette
- smoker inhales puffs on the tube and produces a vapor of nicotine that is absorbed in the mucosa of the mouth so it gives the sensation of the cigarette
- downfall: easier to get e-cig, most expensive of NRTs, vapor rarely reaches the lungs


SEs of oral inhalers?

- coughing
- mouth or throat irritation
- upset stomach


What 2 medical therapies are available for tobacco cessation?

- varenicline (chantix)
- Bupropion (wellbutrin, zyban)


MOA of Varenicline?

- agonizes and blocks alpha-4-beta-2 nicotine acetylcholine receptors
- works in 2 ways:
1. binds to and produces partial stimulation of alpha-4 beta 2 nicotine receptor, thereby reducing nicotine withdrawal
- since the drug binds to alpha 4 beta 2 it blocks nicotine from binding to the receptor reducing the pleasure reward


SEs of varenicline?

- Nausea (low dose and titrating up will reduce nausea)
- constipation
- sleep disturbance
- unusual dreams


What are the 2 main concerns of Varenicline?

- neuropsychiatric SEs:
risk of suicide (BBW) so monitor smokers with depression
- Cardiovascular SEs:
may have higher risk of MI or stroke


Administration of varenicline?

- start 0.5 mg daily for 3 days
- 0.5 mg 2x for 4 days
- 1 mg 2x daily for rest of 12 week therapy


MOA of Bupropion?

- unknown, thought to act by enhancing CNS noradrenergic and dopaminergic release
- may benefit smokers who are concerned about post cessation wt gain
- considered 1st line therapy for smokers with schizophrenia
- CI for smokers with seizure disorder


SEs of bupropion?

- insomnia
- dry mouth
- HAs


Administration of Bupropion?

- start 1-2 weeks prior to stop date
- 150 mg/day for 3 days
- then 150 mg 2x a day for 12 weeks


How much more likely are smokers going to quit when they see a provider that advises on cessation?

- 1.6x more likely to quit
- providers must ask about smoking history
- advise smokers to quit
- assist smoker with plan to stop
- determine smokers desire: 5 stages of change and 5 As for assessing tobacco use and quitting


What are the 5 stages of change?

- step 1: pre-contemplation
- step 2: contemplation (thinking about quitting but not quite ready)
- step 3: preparation (set a quit date)
- stage 4: action
- stage 5: maintenance


What are the 5 As?

- ask
- advise
- assess
- assist
- arrange


What are some useful strategies for cessation?

- get rid of ashtrays
- drink a lot of water
- avoid smoke filled places
- track money saved
- exercise
- eat healthy, avoid alcohol
- reflect on why you want to quit
- call a friend or support line
- think of yourself as a non-smoker


What are alternative cessation therapies?

- hypnosis
- acupuncture
- behavioral therapy
- motivational therapy


What is nicotine withdrawal? sxs?

- usually begins 30 minutes after the last use of tobacco
- sxs will usually peak in 2-3 days
- sxs will usually subside over the next 3-4 weeks, however some smokers it may take a couple of months
sxs: intense craving for nicotine, tingling in the hands and feet, sweating, nausea, HAs, and feeling irritable


What are the health benefits of smoking cessation?

- within 20 minutes: BP, HR and peripheral circulation improve
- in 24 hrs CO levels drop
- within 48 hrs nicotine is eliminated and taste and smell improve
- 2-12 weeks lung fxn can improve 30%
- 3-9 months: SOB and coughing decrease
- 1 year: risk of MI reduced 50%
- 10 years: risk of lung cancer: reduced by 50%


How do you calculate pack years?

- packs smoked per day x years smoked
- or (number of cigs a day/20)x number of years smoked


What groups have highest rates of tobacco use?

- american indians and alaska natives


Health conditions linked to tobacco use?

- CV
- COPD/cancer
- pregnancy complications


smokeless tobacco is most prevalent in which age group?

- kids


Second hand smoke effects on children?

- infections
- asthma


What is first line medical therapy for tobacco cessation?

Varenicline (Chantix) - **suicide risk