Self-Care: Smoking Cessation (Exam I)

tobacco

forms of ______ include cigarettes, smokeless tobacco (chewing tobacco, oral snuff), pipes, cigars, clove cigarettes, bidis, and hookah (water pipe smoking)

circulation

after quitting smoking tobacco for 2 weeks to 3 months, _______ improves, walking becomes easier, and lung function increases

mucus

after quitting smoking tobacco for 1 to 9 months, lung cilia regain normal function, the ability to clear lungs of _____ increases, and coughing, fatigue, and shortness of breathe decreases

chronic heart disease

after quitting smoking tobacco for 1 year, excess risk of _____ decreases to half that of a continuing smoker

stroke

after quitting smoking tobacco for 5 years, risk of _____ is reduced to that of people who have never smoked

lung cancer

after quitting smoking tobacco for 10 years, _____ death rate drops to half that of a continuing smoker, risk of cancer of mouth, throat, esophagus, bladder, kidney, and pancreas decrease

smoked

after quitting smoking tobacco for 15 years, risk for chronic heart disease is similar to that of people who have never _______

physiological

tobacco cessation treatment should address the ______ and the behavioral aspects of dependence

trigger

smoking is commonly associated with specific activities such as driving, talking on the phone, eating, drinking coffee or alcohol, and smoking with others: repeated smoking in these situations cause the development of routines that _____ smoking, therefore it is important to identify ones _____ as part of the quitting process

1-2

physiologic withdrawal symptoms of tobacco/nicotine begin ____ days after stopping and peak in the first week with gradual decline over 2-4 weeks: symptoms include irritability, frustration, anger, anxiety/depression, difficulty concentrating, insomnia, restlessness, cravings, impaired performance, constipation, dizziness, and/or increased dreaming

caffeine

constituents in tobacco smoke induce CYP1A2 enzymes which metabolize ______ causing their levels to increase to around 56% upon quitting

50%

nicotine withdrawal effects might be enhanced by increases caffeine levels, therefore one who quits should decrease caffeine intake by ______ and no caffeine in the evenings

hormonal contraceptives

smokers who use combined _________ have an increased risk of serious cardiovascular adverse effects like strokes, myocardial infarction (MI), and thromboembolism

35

smoking tobacco/nicotine does not decrease the efficacy of hormonal contraceptives, though women who are ____ years of age or older AND smoke at least 15 cigarettes per day and a contraceptive with estrogen are at significant elevated risk of cardiovascular adverse effects

ask

when helping patients quit, implement the 5 A's: the 1st A is _____ about the tobacco use

advise

when helping patients quit, implement the 5 A's: the 2nd A is _____ tobacco users to quit

assess

when helping patients quit, implement the 5 A's: the 3rd A is _____ readiness to make a quit attempt

assist

when helping patients quit, implement the 5 A's: the 4th A is _______ with the quit attempt

arrange

when helping patients quit, implement the 5 A's: the 5th A is ______ follow-up care

stage 1

patients differ in their readiness to quit, _____ means the patient is not ready to quit in the next month

stage 2

patients differ in their readiness to quit, _____ means the patient is ready to quit in the next month

stage 3

patients differ in their readiness to quit, _____ means the patient is a recent quitter, and has quit within the past 6 months

stage 4

patients differ in their readiness to quit, _____ means the patient is a former tobacco users and quit less than 6 months ago

relevance

methods for enhancing motivation to quit smoking implement the 5 R's: the 1st R is _______

risks

methods for enhancing motivation to quit smoking implement the 5 R's: the 2nd R is _______

rewards

methods for enhancing motivation to quit smoking implement the 5 R's: the 3rd R is ______

roadblocks

methods for enhancing motivation to quit smoking implement the 5 R's: the 4th R is _____

repetition

methods for enhancing motivation to quit smoking implement the 5 R's: the 5th R is ______

2

when assisting patient with quitting, set a quit date at least ___ days but no more than 2 weeks to allow time for the patient to prepare: they can do this by removing tobacco products from home, discuss plans with family and friends, and identifying triggers

1

when assisting patient with quitting, follow up after ___ week, then 2 weeks, then 1 month, then as needed

heart disease

exclusions for self-treatment of tobacco dependence includes if the patient has serious _______ including recent MI, irregular heartbeat, and/or severe angina

18

exclusions for self-treatment of tobacco dependence includes if the patient has high blood pressure not controlled with medication, is pregnant, breastfeeding, or is less than ____ years of age

10

nicotine replacement therapy (NRT) is not recommended for pregnancy smokers, smokeless tobacco users, individuals smoking fewer than _____ cigarettes per day, and adolescents (NRT use in minors requires a prescription)

behavioral counseling

the recommended treatment for special populations trying to quit smoking is ______

nicotine gum

chewing gum containing nicotine and polacrilex that is used to aid smokers in quitting smoking: sugar free chewing gum base containing buffering agents to enhance buccal absorption

2, 4

nicotine gum is available in strengths of ___ mg and ___ mg and flavors of original, cinnamon, fruit, and mint

Nicorette Gum

nicotine gum brand product used over the counter to aid in smoking cessation

nicotine lozenge

lozenge containing nicotine and polacrilex formulation that delivers around 25% more nicotine than equivalent gum dose: contains buffering agents to enhance buccal absorption

2, 4

nicotine lozenge is available in strengths of ___ mg and ___ mg, flavors of mint and cherry, and size original or mini

Nicorette Lozenge

nicotine lozenge brand product used over the counter to aid in smoking cessation

time to first cigarette (TTFC)

dosage for nicotine gum & lozenge is based on the _____ as an indicator of nicotine dependence

2 mg

use the ____ gum/lozenge if the first cigarette of the day is smoked more than 30 minutes after waking

4 mg

use the _____ gum/lozenge if the first cigarette of the day is smoked less than 30 minutes after waking

1-6

in the first ____ weeks of using gum/lozenge therapy, you take take 1 piece every 1-2 hours not exceeding 24 pieces of gum or 20 lozenges per day

7-9

in ____ weeks of using gum/lozenge therapy, you take take 1 piece every 2-4 hours not exceeding 24 pieces of gum or 20 lozenges per day

10-12

in ____ weeks of using gum/lozenge therapy, you take take 1 piece every 4-8 hours not exceeding 24 pieces of gum or 20 lozenges per day

park

directions for using nicotine gum includes chewing slowly, then stop chewing at first sign of peppery taste or tingling sensation, _____ between cheek & gum, then chew again when peppery taste or tingle fades

dissolve

directions for using nicotine lozenge includes placing it in the mouth and allowing for lozenge to _____ (nicotine release may cause warm, tingling sensation), do not chew or swallow, occasionally route to different areas of the mouth, and lozenges will dissolve completely in about 20-30 minutes

9

to improve chances of quitting, use at least ____ pieces of nicotine gum/lozenges daily during the first 6 weeks

smoking

the nicotine gum/lozenge will NOT provide the same rapid satisfaction that _____ provides, the effectiveness of the nicotine gum/lozenge may be reduced by some foods and beverages like coffee, juices, wine or soft drinks

15

do not eat or drink for ____ minutes before or while using the nicotine gum or lozenge

rapid

chewing the lozenge or using incorrect gum chewing technique can cause excessive and _____ release of nicotine release of nicotine resulting in lightheadedness/dizziness, nausea and vomiting, hiccups, and/or irritation of throat and motuh

adverse effects

_____ of nicotine gum and lozenges includes mouth/throat irritation, hiccups, and/or gastrointestinal complaints (dyspepsia, nausea)

gum

adverse effects associated with nicotine _____ only is jaw muscle aches (avoid in TMJ), and may stick to dental work

transdermal nicotine patch

continuous (24-hour) nicotine delivery system in which nicotine is well absorbed across the skin: transdermal delivery to systemic circulation avoids hepatic first-pass metabolism and plasma nicotine levels are lower and fluctuate less then with smoking

light smoker

if your patient is a _____ meaning they smoke less than 10 cigarettes a day, they should start with step 2 of transdermal nicotine patches (14 mg for 6 weeks) and then step 3 (7 mg for 2 weeks)

heavy smoker

if your patient is a ______ meaning they smoke more than 10 ciagarrets a day, they should start with step 1 of transdermal nicotine patches (21 mg for 6 weeks), then step 2 (14 mg for 2 weeks), then finally step 3 (7 mg for 2 weeks)

NicoDerm CQ

brand of nicotine transdermal patch used over the counter to aid in smoking cessation

1

choose an area of skin on the upper body or upper outer part of the arm when applying a transdermal nicotine patch: make sure the skin is clean, dry, hairless, and not irritated and apply the patch to a different area each day! do not use the same area agains for at least _____ week

10

directions for using transdermal nicotine patches include removing protective liner and applying adhesive side of patch to skin, peel off remaining protective covering, press firmly with palm of hand for _____ seconds, then finally make sure the patch sticks well to the skin especially around the edges

24

wash your hands after applying your nicotine patch due to potential nicotine on hands getting into eyes or nose causing stinging or redness: do not leave the patch on the skin for more than _____ hours, doing so may lead to skin irritation

rubbing alcohol

adhesive remaining on skin may be removed with ______ or acetone, dispose of used patch by folding it onto itself, completely covering adhesive area: water will not harm the nicotine patch if it is applied correctly and patients may bathe, swim, shower, or exercise while wearing the patch

cut

do NOT _____ patches to adjust the dose, this can unpredictably effect nicotine delivery and/or the patch may be less effective: keep new and used patches out of the reach of children and pets

4

after patch removal, skin may appear red for 24 hours, if skin stays red more than ____ days or if it swells or a rash appears, contact health care provider -- do not apply new patch

dermatologic

local skin reactions (redness, burning, itching) usually caused by adhesive are experienced by up to 50% of patients therefore should be avoided in patients with ________ conditions like psoriasis, eczema, and/or atopic dermatitis