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19 Cards in this Set
- Front
- Back
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Smoking cessation in women
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Women tend to:
-Anticipate difficulty and expect failure -Perceive more barriers (weight gain, tension, irritability) -PMS compared to follicular phase Women have higher behavioral and lower nicotine dependence |
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Effect of quitting smoking on lung function
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Gains function in first two years
Then follow normal aging lung function curve |
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Model for treatment of tobacco use and dependence
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Ask about tobacco use
-Make smoking status a vital sign Advise to quit -Use patient's concerns (emphysema, heart attack, peridontal disease, osteoporosis, impotence) Assess willingness to make a quit attempt Assist in quit attempt -Combination therapy (pharmacotherapy and behavioral modification) Arrange follow-up |
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Osteoporosis and smoking
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Smoking is an independent risk for osteoporosis and fracture
Bone quality is lower in smokers compared with nonsmokers by age 36 |
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Enhancing motivation to quit
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Relevance
Risks Rewards Roadblocks Repetition |
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Smoking behavioral modifications
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Identify high risk situations
Recognize smoking cues and triggers Avoid high risk situations Substitute alternative or coping behaviors |
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Smoking counseling
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Practical counseling
-Withdrawal lasts 7-10d -Get rid of cig. paraphernalia -Substitute other behaviors with trigger situations -Don’t drink ETOH Intra-treatment social support -Ask how its going Extra-treatment social support -Friends, family members -Stimulus control -Aversion therapy |
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Behavioral therapy augments pharmacotherapy for smoking cessation
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Medication + Intense therapy
-35% success No medication + no therapy -5% success |
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Nicotine gum
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Serum concentration 1/3-2/3 that of 1 ppd smoker
Acid environment decreases absorption therefore no coffee, juice, soda, food 1/2 hr before, during, or after Requires education-chew and park 1 1-2 pieces/hr recommended 23% to 39% quit rate at 1 yr Scheduled dosing better than ad lib Mouth ulcers not from gum but from quit attempt (40%) |
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Nicotine patch
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Requires least instruction
Slow onset of action and lack of control over release is a negative 10% to 30% 1-yr quit rate Difference in efficacy between the sexes controversial Efficacy not affected by HRT Serum concentration nearly the level of a 1 ppd smoker 44mg patch no more effective 25mg 16hr patch no more effective than 15mg 16hr Tx > 8 weeks no more effective |
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Nicotine nasal spray
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Dose 0.5 mg in each nostril 8 to 40 X /day
1 year abstinence rate 18% to 26% (very high attrition rate in studies) Very rapid onset of action Serum concentration 1/3-3/4 that of 1 ppd smoker Rx only |
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Nicotine oral inhaler
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Plugs soaked with nicotine (6-16/day) X 6 months
Buccal absorption Serum concentration 33-43% of 1 ppd smoker More rapid serum levels than patch or gum 15% success rates Rx only – success is 3 x c/w OTC |
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Nicotine lozenge
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Available in 1, 2 & 4mg doses
Quit OR 3.4 c/w 3.14(gum) and 5.47 (bupropion) SL placement Recommended dose 20-40mg/d OTC Serum nicotine level 25-27% higher than equivalent doses of gum |
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Gum vs. Patch vs. Spray vs. Inhaler
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Gum, patch, spray, inhaler, SL tab trials
(n=94) – OR= 1.66, 1.81, 2.35, 2.14, 2.05, respectively Patch has highest compliance (82%) v. gum (38%) v. spray (15%) v. inhaler (11%) Preferences: inhaler (49%), 4 mg gum (24%), 2mg gum (10%), 2mg tablet (10%), nasal spray (7%) |
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Conditions that require special consideration with smoking cessation medication
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Medical contraindications - MI, unstable angina
Cigarette consumption < 10/day Pregnant/breastfeeding women -Risk/benefit in highly addicted: patch (category D), gum (categoryC) -Bupropion is category B Adolescents Depression : bupropion may be used with SSRI and tricyclics but not MAO inhibitors no difference in cessation rate in depressed vs. nondepressed Schizophrenia - smoking prevalence 80-90% and nicotine restores cognitive deficits |
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Bupropion
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Improves smoking cessation
-Especially in COPD Depression related to withdrawal and not drug |
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Varenicline
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Partial nicotine agonist
-Cuts craving and withdrawal -Blocks reward of smoking 73% had adverse effects compared with 65% in placebo |
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Patch + Bupropion and Nicotine lozenge, gum, or inhaler
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Is controller medicine
Is rescue medicine 37% continuous abstinence |
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Summary of smoking cessation
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Smokers with COPD are more heavily dependent and more likely to be female today
While women tend to perceive more barriers they are equally successful at smoking cessation Women respond poorly to NRT but equally to varenicline & bupropion c/w men pharmacoRx + counseling is associated with better success Individualized Rx programs employing NTR and/or bupropion or varenicline are best |
