Tobacco Cessation Flashcards Preview

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Flashcards in Tobacco Cessation Deck (52):
1

USPHS and USPSTF recommendations

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

2

The 5 A's about tobacco cessation

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

3

Ways of prepping for quit day

Emotional
Physical
Therapeutic
Medical preparation

4

Motivational interviewing

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

5

Affirmation

Helps individuals acknowledge positive behaviors and strengths

6

Reflective listening

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

7

Summary statements

Pull together allowing for transitions; emphasize personal choice

8

What are the five principals of motivational interviewing?

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

9

Developing discrepancy

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

10

Expressing empathy

Listen to put yourself in their shoes
Critical to minimize resistance

11

Amplifying ambivalence

Ambivalence is nl
Verbalizing can help pts explore both sides they are dealing with

12

Rolling with resistance

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

13

Supporting self-efficacy

Pt must believe that change is possible AND attainable

14

Non-pharmacologic cessation methods

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

15

Practical counseling

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

16

Support

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

17

Who benefits from tx?

Psychological disorders
Low SES
Limited formal education

18

No recommendation for tx due to data

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

19

1st line monotherapy

NRT
Bupropion
Varenicline

20

Forms of NRT

Gum
Patch
Lozenges
Inhalers
Nasal sprays

21

1st line combos

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

22

Who needs long-term meds?

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

MOA of bupropion SR

Norepinephrine/dopamine reuptake inhibitor and nicotine antagonist

24

Dose of Bupropion SR

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