Term
| 5 Health Consequences of Smoking |
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Definition
| emphysema, cancers, heart attack, stroke, aneurysms |
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Term
| Health Benefits of Quitting after 2 weeks to 3 months |
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Definition
| increased circulation, walking is easier, lung function is increased |
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Term
| Health Benefits of Quitting after 1 to 9 months |
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Definition
| cilia regain function; can clear lung mucus better; decreased shortness of breath, cough, & fatigue |
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Term
| Health Benefits of Quitting after 1 year |
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Definition
| excess CHD risk decreases to 1/2 of a smoker |
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Term
| Health Benefits of Quitting after 5 years |
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Definition
| stroke risk decreases to that of a non-smoker |
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Term
| Health Benefits of Quitting after 10 years |
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Definition
| lung cancer death rate decreases to 1/2 of smokers; decrease in other cancer risk |
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Term
| Health Benefits of Quitting after 15 years |
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Definition
| CHD risk is similar to people who have never smoked |
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Term
| # of cigarrettes in a pack |
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Definition
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Term
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Definition
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Term
| Pharmacokinetics & Pharmacodynamics in Nicotine |
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Definition
| a weak base that is absorbed optimally in alkaline media; reaches brain in 11 seconds; very short half-life (2 hrs); CNS: pleasure, arousal, improved concentration, anxiety relief; CV: increased HR & BP, vasoconstriction; Other: suppresses appetite, increases metabolism |
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Term
| Polycyclic Aromatic Hydrocarbons (PAHs) |
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Definition
| compounds responsible for drug interactions when smoking tobacco; induce cytochrome P450 1A2; interacts with caffeine (shaking, jittery, heart pounding), several psychiatric agents (clozapine, olanzapine, fluvoxamine, haloperidol), theophylline (narrow therapeutic window) |
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Term
| Other Drug Interactions with Smoking |
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Definition
| decreases absorption of injectable insulin due to vasoconstriction; increased risk of stroke, MI, and blood clots when taking Combined Oral Contraceptives (especially women > 35 years old & smoke 15 or more cigs per day |
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Term
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Definition
| compulsive drug use, without medical purpose, in the face of negative consequences |
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Term
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Definition
| drug reaches brain & releases dopamine; dopamine leads to pleasurable feelings, which leads to repeated administration & development of tolerance; discontinuation of drug will lead to withdrawal symptoms |
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Term
| How tobacco users self-titrate |
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Definition
| smoking more frequently, smoking more intensely |
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Term
| Reasons tobacco users maintain nicotine concentration |
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Definition
| maintain pleasurable mood & concentration; prevent or alleviate withdrawal symptoms |
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Term
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Definition
| chest tightness, difficulty concentrating, hunger, irritability |
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Term
| Non-pharmacological relief of Nicotine Withdrawal Symptoms |
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Definition
| relaxation techniques & deep breathing (chest tightness); plan workload appropriately & avoid extra stress if possible (difficult concentrating); drink water & low-calorie liquids & eat low-calorie snacks (hunger); take walks & relaxation techniques (irritability) |
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Term
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Definition
| Ask, Advise, Assess, Assist, Arrange |
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Term
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Definition
| do you ever smoke or use tobacco? |
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Term
| Advise tobacco users to quit |
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Definition
| important to quit as soon as possible; message should be clear, strong, sensitive, & personalized |
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Term
| Assess patients readiness to quit |
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Definition
| how ready are you to quit? |
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Term
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Definition
| not ready to quit - 5 R's; ready to quit - design a treatment plan; recently quit - relapse prevention; |
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Term
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Definition
| quit rate increases with # of sessions between provider & patient |
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Term
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Definition
| not ready to quit in next month; Goal: get patient to start thinking about quitting; Provide motivational counseling in non-judgmental manner (5 R's: relevance, risks, rewards, roadblocks, repetition) |
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Term
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Definition
| ready to quit in next month; patients are ready to take action & are aware of the need to quit; Goal: achieve smoking cessation; assess tobacco history, discuss key issues, facilitate quitting process |
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Term
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Definition
| recent quitter; quit in last 6 months; Goal: maintain abstinence; Things to discuss: status of attempt (social support, identify triggers & temptations, encourage healthy behaviors), slips & relapse, medication compliance, encourage continued abstinence, congratulate success |
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Term
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Definition
| former tobacco user; quit > 6 months ago; Goal: remain tobacco free for life; Things to discuss: Was medication discontinued? offer tips for relapse prevention, encourage healthy behaviors, congratulate continued success |
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Term
| Key Issues involved in helping Patients Quit |
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Definition
| motivations for quitting, confidence in ability to quit, triggers for tobacco use & routines that lead to it, social support during quitting process, weight gain concerns, withdrawal symptoms |
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Term
| Cognitive Coping Strategies |
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Definition
| patients muse recognize just because they think about smoking does NOT mean they have to smoke; review commitment to quit, positive self-talks, pep talks |
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Term
| Behavioral Coping Strategies |
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Definition
| patients should come up with specific actions to deal with potential triggers that may lead to relapse; stress, other tobacco users, oral gratification needs |
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Term
| First-Line Therapies for Smoking Cessation |
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Definition
| NRT (nicotine replacement therapy), psychotropics (bupropion), partial nicotinic agonist (varenicline) |
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Term
| nicotine patch (Nicoderm CQ) |
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Definition
| OTC patch; Dosing Schedule: > 10 cigs/day --> 21 mg patch x 6 wks, 14 mg patch x4 wks, 7 mg patch x2 wks; <10 cigs/day: 14 mg patch x6 wks, 7 mg x2wks; ADRs: skin irritation, insomnia, vivid dreams, headache; Counseling: apply to different area each day & don't use same place for 1 wk, take patch off in evening, don't cut patches in half, remove before MRIs |
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Term
| A&D's of nicotine patches (Nicoderm CQ) |
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Definition
| Advantages: provides consistent levels, easy to hide, compliance is easier; Disadvantages: no ability to titrate dose, allergies to adhesive, patients with dermatologic conditions shouldn't use patch |
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Term
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Definition
| OTC smoking cessation gum product; Dosing: > 25 cigs/day: 4 mg piece q1-2hrs x 6wks, 4 mg piece q2-4hrs x 3 wks, 4 mg piece q4-8hrs x 3 wks; <25 cigs/day: 2 mg piece q1-2hrs x 6 wks, 2 mg piece q2-4hrs x 3 wks, 2 mg piece q4-8 x 3 wks, MAX = 24 pieces/day; Directions: "Chew & Park Technique"; ADRs: mouth/jaw soreness, hiccups, dyspepsia; Warnings: dental work - may stick, TMJ; Counseling: use at least 9 pieces daily in first few weeks, do not chew quickly - use "chew & park", effectiveness of gum reduced by food & drinks like coffee, juices, wine, & soft drinks, DO NOT Eat or Drink for 15 min before or while using gum |
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Term
| A&D's of nicotine gum (Nicorette) |
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Definition
| Advantages: may satisfy oral craving, delays weight gain, titrated to reduce withdrawal; Disadvantages: frequent dosing, gum chewing may not be correct "park & chew" technique, sticks to dental work and C/I in pts with TMJ |
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Term
| nicotine lozenge (Commit) |
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Definition
| OTC smoking cessation lozenge product; Dosing: If first cigarrette is smoked < 30 min from waking --> 4 mg piece q1-2 hrs x 6 wks, 4 mg piece q2-4 hrs x 3 wks, 4 mg piece q4-8 hrs x 3 wks; if first cigarette is smoked > 30 min from waking up --> 2 mg piece q1-2 hrs x 6 wks, 2 mg piece q2-4 hrs x 3 wks, 2 mg piece q4-8 hrs x 3 wks, MAX = 20 lozenges/day; Directions: place in mouth & allow to dissolve slowly, do NOT chew or swallow, rotate to different spots in mouth, dissolves in 20-30 min; ADRs: nausea, hiccups, heartburn, flatulence, cough; Counseling: use at least 9 pieces/day, effectiveness decreased by food & certain drinks (coffee, juice, wine), avoid eating or drinking 15 min before or during use |
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Term
| A&D's of nicotine lozenge (Commit) |
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Definition
| Advantages: satisfy oral cravings, easy to conceal, delays weight gain, dose can be titrated to reduce withdrawal; Disadvantages: frequent dosing, GI side effects are bothersome |
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Term
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Definition
| chew piece slowly till a tingling or peppery sensation is felt; park piece of gum between cheek & gum; resume slow chewing once tingle disappears; when tingle or peppery sensation returns, park; repeat cycle for 30 min |
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Term
| nicotine inhaler (Nicotrol Inhaler) |
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Definition
| prescription oral inhalation product for smoking cessation; Dosing: each cartridge contains 10 mg, only 4 mg is delivered, 6-16 cartridges/day x 3-12 wks then taper over next 6-12 wks; Directions: used with short puffs, 20 min of "active puffing," can puff all at once or in 5 min increments, must be used up in 24 hrs; ADRs: mild throat or mouth irritation, unpleasant taste, cough, dyspepsia, hiccups; Warnings: C/I in bronchospastic diseases; Counseling: use at least 6 cartridges/day in 1st few wks, effectiveness decreased by food & certain drinks, instruct on proper technique |
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Term
| A&D's of nicotine inhaler (Nicotrol Inhaler) |
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Definition
| Advantages: titrated to reduce withdrawal, mimics hand-to-mouth ritual, menthol; Disadvantages: initial irritation, storage limitations, menthol |
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Term
| nicotine nasal spray (Nicotrol NS) |
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Definition
| Rx smoking cessation nasal inhaler; Dosing: one dose = 1 mg = 2 sprays, start with 1-2 doses/hr, increase prn to a MAX of 5 doses/hr or 40 doses/day, taper over 4-6 wks; Directions: prime bottle before use, blow nose to clear passages, tilt head back & insert tip into nostril, breath thru mouth & spray 1x in each nostril, do not sniff or inhale while spraying, sniff gently if nose begins to run; ADRs: hot peppery feeling in back of throat, sneezing, coughing, watery eyes, runny nose; Warnings: C/I in chronic nasal disorders, severe airway disease; Counseling: avoid driving for 5 min after each use, side effects should decrease as tolerance develops, use at least 8 doses/day, very rapid absorption |
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Term
| A&D's of nicotine nasal spray (Nicotrol NS) |
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Definition
| Advantages: dose can be titrated to reduce withdrawal; Disadvantages: initial irritation is bothersome, highest rate of dependency |
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Term
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Definition
| Rx oral antidepressant medication used to treat smoking cessation; Dosing: 150 mg SR tab po qd x 3 days then 150 mg SR tab po BID x 7-12 wks, if not successful by week 7 D/C drug, begin 1-2 weeks before quit date; ADRs: insomnia, dry mouth, tremor, seizures; Drug Interactions: (CYP2B6) medications that lower seizure threshold (antipsychotics, antidepressants, theophylline, systemic steroids); C/I: seizure disorders, history of anorexia or bulimia, d/c of alcohol or benzodiazepines, concomitant use with Wellbutrin, MAO-I use in past 14 days; Warnings: pts w/ history of seizure, cranial trauma, taking meds to lower seizure threshold, severe hepatic cirrhosis, depressive or psychiatric disorders; Counseling: do not consume alcohol while using, avoid bedtime dosing to minimize insomnia, allow at least 8 hrs between BID dosing |
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Term
| A&D's of bupropion SR (Zyban) |
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Definition
| Advantages: oral formulation with BID dosing, beneficial in pts with depression; Disadvantages: seizure risk is increased, long list of precautions/drug interactions |
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Term
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Definition
| Rx nonnicotine oral smoking cessation product that is a partial nicotininc receptor agonist; Dosing: 0.5 mg po qd x 3 days then 0.5 mg po bid x 4 days, then 1 mg po bid for up to 12-24 wks; Directions: start medication 1 week before quit date; ADRs: nausea, sleep disturbances; Drug Interactions: none; Precautions/Warnings: neuropsychiatric symptoms (changes in behavior, suicidal thoughts & behavior, depressed mood, worsening of previous psychiatric conditions); Counseling: take with full glass of water & with food (nausea), nausea & sleep disturbances are usually temporary |
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Term
| A&D's of varenicline (Chantix) |
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Definition
| Advantages: oral formulation with BID dosing, new MOA for pts who have failed others; Disadvantages: nausea is a significant ADR, limited post-marketing data available, no data on pts with coexistent psychiatric conditions |
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