Term
| intro to smoking cessation |
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Definition
| 71.5 million current (2005) smokers in US, 30.4% tobacco product use 12 & over, 25% cigareetes, >75 billion/yr medical cost for smoking related illnesses, yearly 20% of total deaths in US are caused by smoking |
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Term
| health effects of smoking |
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Definition
lung cancer 85%
head & neck cancers 90%
COPD 85%
Heart disease 335% |
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Term
| benefits of smoking cessation |
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Definition
cv events decrease risk~ 1yr
all cause mortality decrease risk 10-15yr
COPD smoking cessation early enough in life can reduce rate of fall in FEV1, delaying the onset of disability or death |
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Term
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Definition
| ganglion cholinergic receptor agonist-effects CNS/PNS stimulation & depression, respiratory stimulation, skeletal muscle relaxation, cathecholamine release by the adrenal medulla, peripheral vasoconstriction, increased BO, HR, CO, & O2 consumption, increased alterness & cognitive function (by stimulating the cerebral cortex) stimulation of the reward center in the limbic cyctem at higher dose. Chronic ingestion leads to physical & psychological dependence & tolerance, 77-92% of smokers are addicted to nicotine, withdrawl is characterized by craving, nervousness, restlessness, irriability, mood, lability, anxiety, sleep distrubances & weight gain |
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Term
| guildelines for treating tobacco use & dependence |
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Definition
| ask every pt who presents if s/he uses tobacco, advise all to quit, assess willingness , provide relapse prevention treatment |
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Term
| treat w/5 A's for willingness to quit |
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Definition
| ask, advise, assess, assist, arrange |
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Term
| treat w/ 5 R's of motivational intervention |
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Definition
| relevance, risks, reward, roadblocks, repetition |
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Term
| evaluation of tobacco use |
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Definition
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Term
| treatment options for smoking cessation |
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Definition
behavioral therapy (ALL PATIENTS)
nicotine replacement therapy (gum, inhaler, nasal spray, patch)
Bupropion SR (Zyban)
Varenicline (Chantix)
2nd line pharm options-clonidine, Nortriptyline |
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Term
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Definition
| support groups, behavior modification program (1yr quit rates up to 30%) |
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Term
| nicotine replacement therapy (NRT) |
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Definition
supplies the body w/low levels of nicotine to help diminish w/drawl symptoms
used as comprehensive smoking-cessation program
doubles quit rates when used in conjunction w/behavioral counseling
many forms available
C/I-active smokers, active peptic ulcers, pregnancy & lactation
Considered 1st line therapy |
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Term
| transdermal nicotine systems (patch) |
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Definition
apply to non-hairy clean dry skin on the upper body or upper outer arm, rotate to different site each day (if allergic rxn try another brand)
most common adverse effect is erythema, burning, pruritis at site
nicotine will continue to be delivered into the bloodstream fot several hours after removal |
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Term
| nicotine polacrilex (Gum) |
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Definition
proper chewing technique is required to promote slow buccal absorption of nicotine, chew piece slowly, park between side of mouth & gum, continue to cew & park intermittently for 30 minutes
gradually reduce the strength of gum & # of pieces chewed to avoid w/drawl symptoms |
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Term
| nicotine nasal spray (Nicotrol) |
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Definition
delivers nicotine more rapidly than gum or patch
peak levels in 10 minutes
adverse effects- nasal & throat irritation, rhinitis, sneezing, coughing, watery eyes
dose 1-2 sprays per hour for 3hrs |
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Term
| nicotine inhaler (Nicotrol inhaler) |
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Definition
plastic rod w/nicotine plug that provides nicotine vapor when puffed on
each inhaler cartridge delivers 4mg of nicotine to buccal space similar to gum
dose: inhale prn, most pts use 6-16 cartridges daily for 3mos then taper over 6-12 weeks |
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Term
| nicotine lozenges (Commit) |
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Definition
full dose of nicotine is released gradually by placing a lozenge in the mouth & sucking on it until it fully dissolves
dose: based on "time to 1st cigarette in am", 4 mg <30 minutes, 2mg >30 minutes
dosing taper- 1 lozenge every 1-2 hrs for 6 wks, then 1 every 2-4 hrs weeks 7-9, then 1 lozenge every 4-8 hrs from weeks 10-12
allow to dissolve slowly over 20-30 minutes
avoid eating or drinking acidic beverage 15 minutes prior to, during, or after using lozenge |
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Term
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Definition
non-nicotine aid to smoking cessation
Atypical antidepressant
considered 1st line therapy for smoking cessation
MOA: unknown w/smoking cessation, but presumed to be mediated ny noradrenergic or dopaminergic mechanisms (inhibits neuronal eruptake of both) |
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Term
| Buproprion (Zyabn) C/I & precautions |
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Definition
C/I-history of seizure disorder, coadministered w/ MAOI, current or prior diagnosis of bulimia or anorexia nervosa
Precautions-do not use w/Wellbutrin or Wellbutrin SR (bupropion as antidepressant) |
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Term
| Bupropion (Zyban) Drug interactions & A/E |
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Definition
Drug intereactions- carbamazepine: decreases serum concentrations of bupropion, cimetidine: increases serum concentrations of bupropion, MAOI: increase toxicity of bupropion
A/E-seizures associated w/high doses, insomnia, irritability, dry mouth, headache, weight gain/loss |
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Term
| Dosing of Bupropion (Zyban) |
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Definition
150 mg SR po qd for 3 days, then increase to 150 mg bid for 7-12 wks
initate therapy while patient is still smoking & establish "target quit date" for 7 days after starting Zyban
Can be combined w/NRT
Decrease dose by 50% in patients w/renal or hepatic insufficiency; monitor carefully for adverse effects |
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Term
| Varenciline (Chantix) MOA |
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Definition
alpha-4-Beta 2 nicotinc acetylcholine receptor agonist
pregnancy cat c
MOA: selectively blocks nicotine binding to alpha 4 beta 2 receptors & stimulates the receptor-mediated activity at a significantly lower level than nicotine. partila stimulation of nicotinic receptor helps reduce the severity of the cravings & w/drawl symptoms from nicotine
if a preson smokes while on chantix the sense of satisfaction associated w/smoking may potentially be decreased |
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Term
| Varenciline (Chantix) precautions |
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Definition
coadministration w/nicotine replacement patch 21 mg/day resulted in increased incidence of nausea, HA, vomiting, dizziness, dyspepsia, & fatigue compared to nicotine replacement patch alone
safety & efficacy of coadministering varenicline w/other smoking cessation aids hasn't been established |
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Term
| Varenciline (Chantix)drug interactions |
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Definition
| does not affect major enzymes of cytochrome P450 system & no clinically meanigful drug-drug interactions have been identified |
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Term
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Definition
most common nausea 30%, sleep distrubance 18%, headaches 15%, abnormal dreams 13%, constipation 8%, flatulence, vomiting, & change in taste perception.
several reports of unusual violent behavior or suicidal thoughts that occur w/in a week or more of starting, causative link not yet established
may cause bizarre behavior, suicidal ideation, & suicide
maybe linked to MI, seizure, DM, dizziness & confusion |
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Term
| Varenciline (Chantix)dosing |
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Definition
start one week before the set stop date & continue for 12wks
as effective in acheiving smoking cessation as Zyban
currently considered a 1st line therapy for smoking cessation |
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Term
| summary of smoking cessation |
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Definition
cigarette smoking contributes to % of total deaths in the US each yr
clinical practices guidelines address patietns ready to quit, not ready to quit & those who have recently quit
behavioral therapy + NRT, Buropion or varenicline is recommended
multiple quit attempts may be necessary |
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Term
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Definition
5 nicotine & 2 non-nicotine
Bupropion SR, nicotine gum, nicotine inhaler, nicotine lozenge, nicotine nasal spray, nicotine patch, varenicline
*clinicians also should consider the use of certain combonations of medications identified as effective in the guidelines |
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