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Pharm III > Tobacco Cessation > Flashcards

Tobacco Cessation Flashcards

(52 cards)

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1
Q

USPHS and USPSTF recommendations

A

Identify ever tobacco user
Provide advice to quit and practical counseling no matter how brief (behavioral therapy)
Motivate health behavior change (MI)
Combine brief behavioral tx with effective and approved pharmacotherapy for everyone making a quit attempt
-Exceptions include contraindications and special populations where evidence is poor

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2
Q

The 5 A’s about tobacco cessation

A

Ask about smoking
-ID and document tobacco use status for every pt at every visit
Advise to quit
Assess willingness to quit
Assist in quitting
Arrange f/u
-Preferably within the first week after the quit date

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3
Q

Ways of prepping for quit day

A

Emotional
Physical
Therapeutic
Medical preparation

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4
Q

Motivational interviewing

A

Pt-centered to elicit behavioral change
Goal: help pt resolve ambivalence without evoking resistance
Use of open-ended questions
Affirm positive behaviors and strengths
Paraphrase their comments
Emphasize personal choice through summaries

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5
Q

Affirmation

A

Helps individuals acknowledge positive behaviors and strengths

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6
Q

Reflective listening

A

Paraphrasing individuals’ comments lets them know you heard what they said

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7
Q

Summary statements

A

Pull together allowing for transitions; emphasize personal choice

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8
Q

What are the five principals of motivational interviewing?

A 
Develop discrepancy
Express empathy
Amplify ambivalence
Roll with resistance
Support self-efficacy
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9
Q

Developing discrepancy

A

Create a gap between where the person is and where they want to be
Pt can realize that their current behavior is not leading them towards goals

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10
Q

Expressing empathy

A

Listen to put yourself in their shoes

Critical to minimize resistance

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11
Q

Amplifying ambivalence

A

Ambivalence is nl

Verbalizing can help pts explore both sides they are dealing with

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12
Q

Rolling with resistance

A

Resistance is also nl
Do not argue- seek clarification to encourage pts to determine solutions they think will work
Emphasize personal choice and control

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13
Q

Supporting self-efficacy

A

Pt must believe that change is possible AND attainable

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14
Q

Non-pharmacologic cessation methods

A

Counseling and behavioral therapies
Two types of counseling and behavioral therapies result in higher abstinence rates
-Practical counseling (problem-solving skills)
-Support and encouragement

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15
Q

Practical counseling

A

Recognize danger situations
-Alcohol, stress, triggers, other users
Develop coping skills
-Avoid triggers, lifestyle change, distract from urge

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16
Q

Support

A

Encouragement
-Options to help, belief in ability to be successful
Caring
-How pt feels, willingness to help
Talk it out
-Why pt wants to quit, pt concerns, discuss successes the pt has, anticipated difficulties

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17
Q

Who benefits from tx?

A

Psychological disorders
Low SES
Limited formal education

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18
Q

No recommendation for tx due to data

A 
Children and adolescent smokers (inconclusive)
Light smokers (excluded from studies)
Non-cigarette tobacco users (excluded from studies)
Pregnant smokers (safety)
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19
Q

1st line monotherapy

A

NRT
Bupropion
Varenicline

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20
Q

Forms of NRT

A 
Gum
Patch
Lozenges
Inhalers
Nasal sprays
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21
Q

1st line combos

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A

Long-term (>14 wks) nicotine patch + other NRT (gum, lozenge, or spray)
Nicotine patch + nicotine inhaler
Nicotine patch + bupropion SR

22
Q

Who needs long-term meds?

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A

Smokers who report persistent withdrawal sx
Smokers who have had relapse after stopping medication
Smokers at higher risk for relapse
-More dependent (>20 CPD; smokes within 30 mins of waking)
-Other smokers in household
-Psychiatric comorbidity (include substance abuse hx)
Smokers who desire long-term therapy

23
Q

MOA of bupropion SR

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A

Norepinephrine/dopamine reuptake inhibitor and nicotine antagonist

24
Q

Dose of Bupropion SR

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A

Begin 1-2 wks before quit date
150 mg daily x 3 days, then 150 mg BID
Duration: 12 wks- 6 mos

25
CIs of bupropion SR
Hx seizures | Eating disorder
26
SE of bupropion SR
``` Appetite decrease Vivid dreams Increase BP Insomnia Dry mouth ```
27
Counseling for bupropion SR
Early second dose Monitor BP Keep smoking until the actual quit day Can continue after quit period for comorbid depression, anxiety
28
MOA of varenicline (Chantix)
Nicotinic receptor partial agonist
29
Dose of varenicline (Chantix)
Begin 7 days before quit date | 0.5 mg daily x 3 days, then 0.5 mg BID x 4 days, then 1 mg BID (quit date) x 3-6 mos
30
Precautions for varenicline (Chantix)
CrCl <30- reduce dose 0.5 mg BID max ESRD 0.5 mg daily max
31
SEs of varenicline (Chantix)
Nausea Insomnia Vivid/strange dreams
32
Counseling for varenicline (Chantix)
Take with food to decrease nausea
33
Patch dose
7 mg, 14 mg, 21 mg based on smoking; step down every 2-6 wks
34
SEs of patch
Local skin reaction Insomnia Vivid dreams
35
Counseling for patch
Less than 1/2 ppd, try lozenge or gum instead of patch If side effects at nigh, put on patch in morning instead If patch falls off, don't replace, get a new one
36
Gum dose
``` 2 mg (1 PPD) 4 mg (> 1 PPD) q1-2 h ```
37
Precautions of gum
CV pts within 2 wks of MI Serious arrhythmias, or unstable angina No more than 24 pieces per day
38
SEs of gum
Mouth soreness Hiccups Dyspepsia
39
Counseling for gum
Chewing technique | No drinking except water for 15 mins before or during
40
Lozenge dose
2 mg if > 30 mins | 4 mg if < 30 mins
41
Precautions of lozenge
No more than 20 lozenges per day
42
SEs of lozenge
Nausea Hiccups Heartburn
43
Counseling for lozenge
Rotate around in the mouth near cheek, don't bite it
44
Inhaler dose
4 mg per cartridge
45
Precautions of inhaler
Mouth/throat irritation
46
SEs of inhaler
Cough | Rhinitis
47
Counseling for inhaler
Schedule use | May use cartridge for 24 hrs after opening
48
Nasal spray dose
0.5 mg spray per nostril q1-2 hr (max 40 per day)
49
Precautions of nasal spray
Severe reactive airway dz | Highest peak and thus highest risk of dependence
50
SE of nasal spray
Nasal irritation Smell and taste changes Nasal congestion
51
Counseling for nasal spray
Spraying technique (prime, tilt head back; no sniff, swallow, or inhale)
52
Populations to use 6 mo tx plan
``` Past substance abuse Unable to quit on quit date Comorbid illness Persistent urges to smoke Higher dependence ```

Pharm III (8 decks)

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