Smoking Cessation

leading cause of preventable death/disease in US

smoking

risk of stroke same as that of non-smoker by _______years after quitting

2-5 years

risk of lung cancer reduced by half by _____ years after quitting

10 years

Risk of heart disease is same as that of non-smoker by ________ years after quitting

15 years

systematically identify all tobacco users at every visit

ask

strongly urge all tobacco users to quit

advise

determine willingness to make a quit attempt

assess

aid the patient in quitting (provide counseling & medication)

assist

ensure follow-up care

arrange

Stage 1 - not ready to quit in the next month - GOAL:

Start thinking about quitting (use the 5 R’s to enhance motivation)

Stage 2- ready to quit in the next month - GOAL:

Achieve cessation by assessing tobacco use history, discussing key issues (i.e. triggers), and facilitating the quit process

Stage 3- recent quitter (within past 6 months)

Remain tobacco-free for at least 6 months

stage 4; former tobacco user; quit > 6 months ago - GOAL:

remain tobacco-free for life

5 ‘R’s

Relevance

Risks

Rewards

Roadblocks

Repetition

Assess tobacco use history

current & past use

quit attempts

Quit attempts:

how many times, length of cessation, dates

methods/medications used, adherence & duration

reasons for relapse

Withdrawal symptoms occur within ___ days

1-2

Withdrawal symptoms can pass within ______ weeks

2-4

common symptoms of withdrawal

irritability

anxiety

difficulty concentrating

depression

insomnia

Follow up on the quitting process

one week, one month - additional follow-ups as needed

Pharmacological methods for smoking cessation

nicotine replacement therapy

psychotropics (bupropion SR)

Partial-nicotinic receptor agonist (varenicline)

Strength of nicotine gum for patients who smoke within 30 minutes of waking

4 mg

Strength of nicotine gum for patients who smoke after 30 minutes of waking

2mg

contraindications of NRTs

underlying CV disease (MI within past 2 weeks, arrhythmias, serious/worsening angina)

Which NRT dosage form has the ‘chew & park method’

nicotine gum

Disadvantages to nicotine gum

need frequent dosing

proper chewing technique needed

may not be appropriate in certain situations

disadvantages of nicotine patches

unable to manage acute withdrawal

not recommended for patients with dermatological conditions

T/F: you must remove nicotine patches prior to an MRI

true

What is the max dose of a nasal spray a person can use per hour

5 sprays

disadvantages of nicotine nasal spray

frequent dosing

nasal admin may be problematic

Rx ONLY

when should bupropion be initiated?

1-2 weeks PRIOR to quit date

BBW on bupropion SR that was removed by FDA in 2016

neuropsychiatric symptoms & suicide risk in young adults

Which cessation product may delay weight gain

bupropion SR

when should CHANTIX be initiated?

1 week prior to quit date

disadvantages of Chantix

dosed with food & water

monitoring for neuropsychiatric symptoms

Rx ONLY