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Tobacco Cessation Flashcards

(105 cards)

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1
Q

Tobacco is the leading cause of…

A

known preventable death

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2
Q

Smoking causes more deaths per year than all of the following combined:

A
  • HIV
  • Illegal drug use
  • alcohol use
  • motor vehicle accidents
  • firearm-related incidents
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3
Q

Smoking increases the risk of…

A
  • coronary heart disease x2-4
  • stroke x2-4
  • lung cancer in men x25 and women x25.7
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4
Q

Smoking can cause cancer in…

A

almost anywhere in the body

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5
Q

Smoking during pregnancy can lead to…

A
  • preterm delivery
  • stillbirth
  • LBW
  • SIDS
  • ectopic pregnancy
  • orofacial clefts in infants
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6
Q

Correlated factors for smoking:

A
  • 25-44 YO
  • non-hispanic american Indians/Alaskan natives
  • lower education levels
  • < federal poverty level
  • differs by state (WV has highest and UT has lowest)
  • mental illness
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7
Q

Second-hand smoke increases the risk of…

A
  • SIDS
  • respiratory infections
  • ear infections
  • severe asthma
  • slowed lung growth
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8
Q

Marketing regulation of 1965:

A

federal cigarette labeling and advertising act

- surgeon general’s warning on cigarette packaging

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9
Q

Marketing regulation of 1971:

A

broadcast advertising banned

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10
Q

Marketing regulation of 1990:

A

cigarette ban on flights and interstate busses

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11
Q

What happened in 1994?

A

Mississippi filed lawsuit

  • big tobacco for Medicaid costs
  • first of 22 states to file suit
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12
Q

Marketing regulation of 1995:

A

President Clinton announced FDA to regulate sales and advertising to minors

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13
Q

T/F: cigarettes are the only marketed consumable product, that when used persistently, will kill half or more of its users

A

T

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14
Q

On June 18, 2021, the US will…

A

change packaging

- warnings prominently on packaging

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15
Q

In 2021, warning labels in the US will…

A
  • occupy top 50% of package area on the front and back

- at least 20% of advertisements

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16
Q

How can nicotine can induce and sustain chemical dependence?

A
  • psychoactive effects
  • used in highly controlled or compulsive manner
  • reinforce behavioral patterns
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17
Q

Pharmacologic process of smoking is similar to…

A
  • heroin

- cocaine

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18
Q

Pathophysiology of smoking:

A

stimulates mesolimbic dopaminergic system in midbrain

  • dopamine reward pathway
  • induces pleasant or rewarding effects
  • promotes continued use
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19
Q

Cigarette smoke has an EPA of…

A 
class A carcinogen
- no safe level of exposure for humans
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20
Q

Cigarette smoke has a complex mixture of…

A
  • nitrogen
  • CO
  • ammonia
  • hydrogen cyanide
  • benzene
  • nicotine
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21
Q

Nicotine:

A
  • distilled when burned
  • carried in tar droplets to small airways
  • absorbed into arterial circulation
  • readily penetrates CNS
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22
Q

Effects of nicotine on brain:

A
  • decreased appetite
  • decreased anxiety and tension
  • increased mood
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23
Q

Effects of nicotine on heart:

A
  • increases heart rate

- increases blood pressure

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24
Q

Nicotine will affect:

A
  • brain
  • heart
  • endocrine
  • nervous
  • metabolic
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25
Chronic users of smoking:
- develop tolerance to nicotine | - abrupt cessation triggers withdrawal
26
Withdrawal symptoms:
- irritability, frustration, anger - anxiety, depression - loss of concentration - insomnia, restlessness - cravings - impaired performance - constipation - dizziness
27
Timeline of withdrawal symptoms:
- manifest 1-2 days - peak in 1 week - dissipates 2-4 weeks - appetite and weight gain may persist for > 6 months
28
Drug interactions:
- increased toxicity of some drugs - CYPP450 enzyme inducer - caffeine exposure increased 56%
29
Significant drug interactions w/...
combination hormonal contraceptives - increased clotting risk - increased risk of CV effects - greater risk if > 35 YO/ > 15 cigs a day
30
Primary treatment goal for smoking:
complete, long term abstinence from all nicotine products
31
Treatment goals for smoking:
- help patients quit tobacco - prevent relapse - utilize appropriate pharmacotherapy and counseling
32
General approach to quitting:
- no treatment (cold turkey) - tobacco cessation counseling - pharmacotherapy
33
What percentage of quitters fail by going cold turkey?
95%
34
Tobacco cessation counseling helps...
- increases odds of quitting | - longer and more frequent beneficial
35
Pharmacotherapy will help...
increases odds of quitting
36
What is the best approach for quitting smoking?
counseling and pharmacotherapy
37
Exclusions for self treatment:
- serious heart disease - irregular heartbeat - uncontrolled HTN - pregnancy - breastfeeding - < 18 - active PUD
38
Comprehensive counseling has the 5A's. What are they?
- ask patients if they use tobacco - advise users to quit - assess readiness to quit - assist patients to quit - arrange follow up care
39
Info about asking patients about tobacco use:
- routine component of care - consider asking about secondhand smoke - "do you ever smoke or use any type of tobacco?"
40
Info about advising patients about tobacco use:
- clear, strong, and personalized - sensitive and convey concern - "strongly encourage you to quit"
41
Info about assessing patients for tobacco use:
- not all patients are ready to quit when approached - "what are your thoughts about quitting?" - "something you are willing to do in the next month?
42
Classifications for assessing patients for quitting:
1. not ready to quit in next month 2. ready to quit in next month 3. recent quitter in past 6 months 4. former user > 6 months ago
43
Info about assisting patients with quitting:
- be empathetic - acknowledge quitting is challenge - goal is to maximize success - encourage counseling and medication
44
Info about arranging follow up with patients who are quitting:
- multiple counseling interactions are preferred | - follow up is crucial
45
Intervals of following up with recent quitter:
- week 1 - month 1 - periodically after
46
Better quitting success comes from...
more and longer contacts
47
Precontemplation counseling:
- always ask permission first - use open-ended questions - motivational interviewing
48
Counseling:
- group and individual is effective | - self-help material alone is not effective
49
Most successful tips for quitting:
- social support - problem-solving training - stress management - relapse prevention - > 4 sessions - > 10 minute sessions
50
Motivational interviewing techniques:
- develop discrepancy - express empathy - amplify ambivalence - roll w/ resistance - support self-efficacy
51
Motivational interviewing:
- always ask permission first | - use open-ending questions
52
Info about developing discrepancy:
- patient is smoking and knows it's harmful - can't acknowledge that quitting is important - will tend not to want to talk about it, so try to have honest discussion
53
Techniques of how to develop discrepancy:
- readiness ruler | - decisional matrix
54
How to express empathy:
- understand patient's POV - people want to feel understood - no judgement zone
55
How to amplify ambivalence:
- explore two sides of thought to amplify ambivalence | - help bring quitting to forefront of patient's mind
56
Rolling w/ resistance:
- avoid "righting reflex" | - humans resist change
57
Techniques for rolling with resistance:
- ask permission - offer advice - emphasize choice - elicit response - voice confidence
58
How to support efficacy:
- many lack confidence to change (want to increase it) | - maintain positive tones b/c patients will lean toward negative
59
Reminders for helping people quit:
- stay positive - don't be judgmental - utilize motivational interviewing - remember how difficult it is for patients
60
T/F: some pharmacological agents double quit rates
F, all agents double quit rates
61
What are the 7 FDA approved first-line agents?
- NRT gum - NRT lozenge - NRT patches - NRT nasal spray - sustained release buproprion - varenicline
62
Nicotine replacement therapy (NRT) is...
FDA approved for cigarette cessation
63
MOA of NRT:
stimulates release of dopamine in the central NS - non-tobacco source of nicotine - reduces physiologic symptoms of withdrawal - allows focus on behavior change - no exposure to carcinogens
64
NRT has...
lower, slower, and less-variable plasma levels
65
General counseling for NRT:
- don't use tobacco products w/ it
66
Adverse effects of nicotine:
- nausea - vomiting - hyper-salivation - perspiring - abdominal pain - dizziness - weakness - palpitations
67
Adverse effects of NRT:
- headache - insomnia - abnormal dreams
68
Dosage of NRT gum/lozenge:
- 2mg - 4mg - buffering agent helps absorption in buccal mucosa - time to first cigarette (TTFC)
69
Peak effectiveness of NRT gum/lozenge:
30 minutes
70
Duration of NRT gum/lozenge:
2-3 hours
71
Strength selection for NRT gum/lozenge during 1st cigarette < 30 minutes after waking:
4 mg
72
Strength selection for NRT gum/lozenge during 1st cigarette > 30 minutes after waking:
2 mg
73
How to taper gum/lozenge:
- weeks 1-6: 1 piece Q 1-2 H - weeks 7-9: 1 piece Q 2-4 H - weeks 10-12: 1 piece Q 4-8 H
74
Adverse effects of gum/lozenge:
- general NRT adverse effects - unpleasant taste - mouth irritation - jaw soreness/fatigue - hiccups - dyspepsia
75
How to use the NRT gums:
- chew and park method - gum lasts about 30 minutes - don't excess 24 pieces a day
76
What is the chew and park method:
- chew slowly several times - stop chewing when you feel "peppery" sensation (around 15 chews) - park gum between cheek and gum - when tingling goes away, resume chewing - rotate "parking" locations
77
Why do you rotate parking locations?
it reduces mouth irritation
78
NRT lozenge use:
- place in mouth and allow to dissolve - warm, tingling sensation is normal - don't chew or swallow - occasionally rotate in mouth to reduce irritation - don't excess 20 lozenges/day
79
Standard lozenges dissolve within...
20-30 minutes
80
Mini lozenges dissolve within...
10 minutes
81
NRT patch dosages:
7 mg, 14 mg, 21 mg | - based on # of cigarettes/day
82
NRT patches deliver...
continuous, low levels or nicotine
83
Each NRT patch lasts...
about 24 H
84
Composition of NRT patch:
- waterproof surface layer - nicotine reservoir - adhesive layer - disposable protective liner
85
NRT patch dosing if one smokes > 10 cigarettes per day:
- 21 mg/day for 4 weeks - 14 mg/day for 2 weeks - 7 mg/day for 2 weeks
86
NRT patch dosing if one smokes < 10 cigarettes per day:
- 14 mg/day for 6 weeks | - 7 mg/day for 2 weeks
87
Adverse effects of NRT patch:
- local skin reactions at application site - rotate application site - change brands - nonrx hydrocortisone cream - sleep disturbances, so can remove patch at night
88
How to use NRT patch:
- apply to clean, dry, hairless area same time every day with firm pressure for about 10 seconds - rotate application site - apply for no more than 24 H - don't cut - can shower and swim with it
89
How to choose therapy based on patient factors:
- comorbidities - smoking habits - gum difficult w/ dental work/dentures
90
How to choose therapy based on patient preferences:
- frequent vs infrequent dosing | - perceptions from past attempts
91
E-cigarettes are the most common...
teen "tobacco" product in the US b/c of availability, alluring ads, e-liquid flavor, and belief of safety over cigarettes
92
E-cigarettes risks:
- nicotine addiction - mood disorders - aerosol related lung damage - affects attention and learning in teens - affects decision making and impulse control in teens
93
US e-cigarettes regulations:
- 2016 FDA center for tobacco products (CTP), which is similar to tobacco regulations
94
In 2018, US surgeon general declared...
vaping is a youth epidemic
95
In 2020, FDA encourages...
smokers to switch to less harmful products such as e-cigarettes - made it illegal to market to youth populations
96
People with CVD should...
- use NRT w/ caution because it can increase b.p. and h.r. | - use NRT w/ MD/DO supervision
97
Pregnant people should...
- look at risk/benefit - NRT has a category D: fetal harm - use NRT w/ MD/DO supervision
98
No FDA approved products for...
adolescents
99
Elderly people:
- same recommendations as adult population | - pharmacologic therapy and counseling
100
Stages of behavioral change:
- precontemplation - contemplation - preparation - action - maintenance
101
Precontemplation stage of behavioral change:
unaware of problem
102
Contemplation stage of behavioral change:
aware of problem and of desired behavioral change
103
Preparation stage of behavioral change:
intends to take action
104
Action stage of behavioral change:
practices desired behavior
105
Maintenance stage of behavioral change:
works to sustain behavioral change

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