Patient Care III (PR) > Why Quitting is Difficult > Flashcards

Why Quitting is Difficult Flashcards

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1
Q

What is nicotine?

A

An alkaloid that is contained in the leaves of plants

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2
Q

Nicotine is distributed quickly thorugh the bloodstream and crosses the…

A

blood-brain barrier

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3
Q

Nicotine reaches the brain within ____ seconds with inhalation

A

8-20

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4
Q

Elimination half-life of nicotine is around __ hours

A

2

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5
Q

Nicotine is metabolized in the…

A

liver

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6
Q

What is the effect of nicotine?

A
  • Stimulates adrenal glands
  • Increased heart rate, breathing activity, and blood pressure
  • Pancreas produces less insulin - causing increased blood sugar
  • Dopamine released
  • Acetylcholine and Norepinephrine released – concentration and memory
  • Increased levels of beta-endorphin – reducing anxiety
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7
Q

What does increased levels of beta-endorphin do?

A

reduces anxiety

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8
Q

The amount of nicotine absorbed by the body from smoking depends on:

A
  • type of tobacco
  • whether the smoke is inhaled
  • whether a filter is used
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9
Q

Amount released into the body tends to be much greater in ___________ tobacco

A

smokeless

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10
Q

Research indicates development of brain continues to occur until the age of ____

A

25

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11
Q

Nicotine changes the way ________ are formed

A

synapses

  • can harm the parts of the brain that control attention and learning
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12
Q

The nicotine in e-cigarettes and other tobacco products can also prime the adolescent brain for…

A

addiction to other drugs such as cocaine

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13
Q

How does nicotine impact youth/young adults?

A
  • Depression
  • Anxiety
  • Mood disorders
  • Addiction
  • Difficulty paying attention
  • Reduced impulse control
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14
Q

Why does the nicotine dependence cycle happen?

A

use of nicotine -> stimulates dopamine release -> causes pleasurable feeling -> repeated use of nicotine -> tolerance develops -> cycle starts over

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15
Q

Why does nicotine tolerance develop?

A

Body will create more nicotine receptor sites over time

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16
Q

What is the physiological part of tobacco dependence?

A

The addiction to nicotine

Use medications for cessation as the treatment

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17
Q

What is the behavioral part of tobacco dependence?

A

Start a behavior change program

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18
Q

_________ should address the physiological and the behavioral aspects of dependence

A

Treatment

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19
Q

What are the symptoms of withdrawal?

A
  • Dizziness; 1-2 days
  • Cravings for tobacco; first 2-3 days
  • Chest tightness; few days
  • Cough, dry throat; few days
  • Difficulty concentrating; few days
  • Insomnia; 1 week
  • Constipation, stomach pain; 1-2 weeks
  • Depressed mood, irritable; 1-4 weeks
  • Fatigue; 2-4 weeks
  • Hunger; several weeks
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20
Q

What are the benefits from quitting smoking for 20 minutes?

A

Blood pressure returns to normal

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21
Q

What are the benefits from quitting smoking for 8 hours?

A

Normal oxygen blood level

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22
Q

What are the benefits from quitting smoking for 24 hours?

A

Carbon monoxide eliminated from lungs – start to clear mucus

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23
Q

What are the benefits from quitting smoking for 48 hours?

A
  • Nicotine is eliminated
  • Smell and taste improve
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24
Q

What are the benefits from quitting smoking for 3 days?

A
  • Lung capacity begins to improve
  • Breathing become easier
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25
What are the benefits from quitting smoking for 2-12 months?
Circulation improves
26
What are the benefits from quitting smoking for 5 years?
Risk of lung cancer decreases
27
What are the benefits from quitting smoking for 10-15 years?
Reduced risk of other cancers
28
Benefits of quitting smokeless tobacco...
Decreased risk for: * oral, head and neck cancer * tooth decay * progression of gum recession * high cholesterol * high blood pressure * heart attack or stroke
29
What are some of the assistance in cessation products?
- nicotine transdermal patches (23%) - nicotine gum and lozenges (27%) - non-nicotine vareniciline (22-24%) - non-nicotine zyban (16%)
30
What do we ask someone who is smoking?
- ASK about tobacco USE - ADVISE tobacco users to QUIT - ASSESS READINESS to make a quit attempt - ASSIST with the QUIT ATTEMPT - ARRANGE FOLLOW-UP care
31
What do you ask about tobacco use?
◼ “Do you ever smoke or use any type of tobacco?” ◼ “Do you use any form of e-cigarette or vaping device?” ◼ “Do you, or does someone in your household smoke?” If yes to these quesions...ask about the amount per day and for how long they have been smoking (access risk for lung cancer)
32
What advice can you give to tobacco users to quit?
◼ “I realize that quitting is difficult. I am happy to work with you to design a specialized treatment plan for cessation when you are ready.” ◼ Best results if you can personalize this and be open, non-judgmental clear, strong, personalized
33
What are the options for assisting with the quit attempt?
◼ Not ready to quit: provide motivation ◼ Ready to quit: design a treatment plan ◼ Recently quit: relapse prevention
34
What are the transtheoretical change model/stages of change?
35
What is the estimated quit rate for 0-1 sessions of follow-up care?
12.4%
36
What is the estimated quit rate for 2-3 sessions of follow-up care?
16.3%
37
What is the estimated quit rate for 4-8 sessions of follow-up care?
20.9%
38
What is the estimated quit rate for more than 8 sessions of follow-up care?
24.7%
39
What is the pre-contemplation stage of the transtheoretical change method?
No intention to change
40
What is the contemplation stage of the transtheoretical change method?
Aware problem exists but no commitment to action
41
What is the preparation stage of the transtheoretical change method?
Intent on taking action to address the problem
42
What is the action stage of the transtheoretical change method?
Active modification of behavior
43
What is the maintenance stage of the transtheoretical change method?
Sustained change, new behavior replaces old
44
What is the termination stage of the transtheoretical change method?
Not falling back into previous behavior
45
What is the relapse stage of the transtheoretical change method?
Falling back into previous behavior patterns
46
What are the cessation options?
- Cold Turkey (no additional help) - Nicotine Replacement Therapy (NRT’s)* - Medications* - Behavioral Therapy - Combination Therapy - Hypnotherapy – Reveri app - Acupuncture - Yoga, meditation - Herbs
47
T/F: all tobacco users can benefit from pharmacotherapy
Yes (check patient history)
48
Check with a physician if the patient has... before starting pharmacotherapy
* Hypothyroidism * Insulin-dependent diabetes * Active peptic ulcer * Anti-depressant medications
49
Bupropion SR (zyban) has _____ mg sustained release tablet
150
50
When should you begin taking bupropion SR (zyban)?
* Begin taking 1 week prior to quitting * Double dose after 3 days
51
What are the advantages of bupropion SR (zyban)?
* Easy to use * Can be used with Nicotine Replacement Therapy (NRT)
52
What are the adverse effects of bupropion SR (zyban)?
- Insomnia - dry mouth - nervousness/difficulty concentrating - rash - constipation - seizures
53
How do you write a zyban (bupropion SR) prescription?
Rx: Zyban Starter Pack Disp: 1 (one) package Sig: Take as directed 0 refills Rx: Zyban Maintenance Pack Disp: 1 (one) package Sig: Take as directed 2 refills
54
Varenicline comes in what mg tablets?
0.5 mg and 1.0 mg tablet
55
How should your patient take the Varenicline?
* Days 1-3: take one 0.5 mg tablet in the AM * Days 4-7: take 0.5 mg tablet twice daily * Weeks 2-12: take 1.0 mg tablet twice daily
56
What are the advantages of Varenicline?
Easy to use and offers a new mechanism of action for patients who have failed with other agents
57
What are the adverse effects of Varenicline?
* Nausea, insomnia, vivid dreams, constipation, & vomiting * Neuropsychiatric symptoms --- behavior changes --- agitation --- depressed mood --- suicidal ideation or behavior
58
Is varenicline approved for use with other Nicotine Replacement Therapy (NRT)?
NO
59
How do you write a prescription for Varenicline?
Varenicline Starting Month/Pack Disp: 1 (one) package Sig: Take as Directed 0 Refills Varenicline Continuing Month/Pack Disp: 1 (one) package Sig: Take as Directed 2 refills
60
How many mg are the Gum (nicorette, zonnic)?
2 mg (smoke < 25 cig/day) 4 mg (smoke ≥ 25 cig/day)
61
How should your patient take the Gum (nicorette, zonnic)?
* Week 1-6: 1 piece every 1-2 hours * Week 7-9: 1 piece every 2-4 hours * Week 10-12: 1 piece every 4-8 hours * Max of 24 pieces per day. No food or beverage 15 min before or during use
62
What are the advantages of Gum (nicorette, zonnic)?
May delay weight gain and satisfy oral cravings
63
What are the adverse effects of Gum (nicorette, zonnic)?
- Mouth/jaw soreness - hiccups - dyspepsia
64
How many mg are the lozenge (nicorette, zonnic)?
2 mg (smoke > 30 min after waking) 4 mg (smoke ≤ 30 min after waking)
65
How should your patient take the lozenge (nicorette, zonnic)?
* Week 1-6: 1 lozenge every 1-2 hours * Week 7-9: 1 lozenge every 2-4 hours * Week 10-12: 1 lozenge every 4-8 hours * Max. of 20 lozenges/day. No food or beverage 15 min. before or during use. Do not chew or swallow lozenge
66
What are the advantages of lozenge (nicorette, zonnic)?
May delay weight gain and satisfy oral cravings
67
What are the adverse effects of lozenge (nicorette, zonnic)?
- Nausea - hiccups - -cough - heartburn - headache - insomnia
68
How many mg are the transdermal patch (nicoderm CQ)?
7 mg, 14 mg, 21 mg (24-hour release)** less than 10 cigarettes/day - 14 mg/day for 6 weeks - 7 mg/day for 2 weeks more than 10 cigarettes/day - 21 mg/day for 6 weeks - 14 mg/day for 2 weeks - 7 mg/day for 2 weeks
69
What are the advantages of the transdermal patch (nicoderm CQ)?
Provides consistent Nicotine for 24 hrs, easy to use
70
What are the adverse effects of the transdermal patch (nicoderm CQ)?
- Local skin reaction - headache - insomnia - vivid dreams
71
How many mg are the nasal spray (nicotrol NS)?
0.5 mg metered spray per 50 mcL
72
How should your patient use nasal spray (nicotrol NS)?
* 1-2 doses per hour --- 8-40 doses/day ---Maximum 5 doses/hr * One dose = 2 sprays (1 per nostril)
73
What are the advantages of nasal spray (nicotrol NS)?
Patients can titrate therapy to help with withdrawal
74
What are the adverse effects of nasal spray (nicotrol NS)?
- Nasal/throat irritation - rhinitis - tearing - sneezing - headache - cough
75
How many mg are the oral inhaler (nicotrol)?
10 mg cartridge – delivers 4 mg inhaled nicotine vapor
76
How should your patient use the oral inhaler (nicotrol)?
* 6-16 cartridges/day * Begin with 1 cartridge every 1-2 hours --- Best effects with continuous puffing for 20 min.
77
What are the advantages of the oral inhaler (nicotrol)?
Patients can titrate amount to manage withdrawal and mimics hand-to-mouth ritual
78
What are the adverse effects of the oral inhaler (nicotrol)?
- Mouth/throat irritation - cough - headache - rhinitis - dyspepsia
79
UMKC has a ___________ Program that is free for patients wanting to participate
Tobacco Cessation
Patient Care III (PR)
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