Pt 1 Smoke Ex 2_10

Front 1

Nicotine

Back 1

10 s --> dopamine in midbrain --> psychoactive - compulsive - behavioral - environmental - waiting to relieve withdraw symptom when having reward in the next cigar

Front 2

Nicontine is stimulant - antidepressant

Back 2

heart - brain - others NE - dopamine - Ach - serotonin ---> inc BBP, HR, contract, constrict, metab, pleasure, attention

Front 3

xx 1st cigar in day vs during

Back 3

a4p2 nicotinic cholinergic receptor in brain ----> arousal (loss of tolerance) vs relieve withdraw symptom

Front 4

Tobacco Smoke vs Nicotine

Back 4

low tar/nicotine --> inhale more to get enough -- > on clothes for 2nd hand smokers

Front 5

Cardiovascolar

Back 5

inc platelet -- inc CO --> dec O2 -- Epi/Norepi --> ischemia - arrhythmias - sudden death -- inc LDL - dec HDL

Front 6

Cancer

Back 6

67 cancinogenic - mouth throat pharynx larynx

Front 7

Respiratory

Back 7

inc cough - sputum - inflam --> narrow air way - dec lung function -- quit 2 wk b4 surgery

Front 8

Fertility - pregnancy

Back 8

reduce infer - birth defect - sudden infant death (2nd hand on clothes)

Front 9

Others

Back 9

inc gluconeogenesis - CHO - ulcer - Osteoporosis

Front 10

xx Drug interaction Oral contraceptive -- Insulin -- Opioid

Back 10

induce CYP 1A2 ----> metabolize more need more drug ------------ estrogen inc clotting ---> no OC if 15 cigar qs - 35 yrs

Front 11

xx Reduce _______________ dose when stop smoking

Back 11

Insulin, theophylline, ollanzapine

Front 12

Treatment Nicotine Addiction

Back 12

combine pharmacological wt behavioral counseling

Front 13

Exclusion for Self treatment

Back 13

serious heart disease -- uncontrolled BP -- pregnant - < 18 yrs - PUD

Front 14

Non-Pharmacologic txt

Back 14

behavioral - cognitive - positive self talk - avoid routine - triggers - group support - EthOH inc urge craving for others ---- Self help works a little

Front 15

xx Nasal - Inhaler - Lozenge - Gum - Patch vs cigarette

Back 15

decrease magnitude withdraw ----- longer onset (less habit forming) ---- 15 - 30-60 - 3-12 hrs -- vs 10 mins ------no cardiac event ----- NOT smoke concurrently -------> too much nicotine --> nausea, perspiration, vomit, hypersalivation

Front 16

xx Nicotin Gum

Back 16

buccally peak 30 min to 2-3 hrs --- bite-park-bite around the mouth for 30 mins max 24 qd --- fixed schedule ----- rinse acidic food/ drink (or poorly absorb) -- no food 15 mins b4 - not smoke concurrently

Front 17

-- Nicorette - Mini Lozenge

Back 17

quick acting - 20-30 mins -- rotate around not swallow -- max 5 p 6h - 20 qd --- NO longer than 12 wk ---- FIXED schedule --- rinse acidic food - no food 15 mins b4

Front 18

Nicotine patch

Back 18

no rapid release pk 6-9 hr --- qAM (or vivid dream in pm) - neck and waist - rotate --- remove hs --- fold when discard --- not cutting --- remove when MRI (mental inside)

Front 19

Nicotine nasal spray

Back 19

Rx only - fast 10-15 mins -------- NO sniff, inhale --

Front 20

Nicotine inhale

Back 20

Rx only --- no rapid release --- look like cigarette - keep in warm - rinse acid food - no food 15 mins b4

Front 21

Zyban - sustain release Bupropion

Back 21

Rx - 1st line - can smoke 1st 2 wk (wait for Zyban to reach SS) -- block dopamine and norepinephrine reuptake -- cause SEIZURE - suicide ideation - Cat C -- no Co-admin MAOI -

Front 22

Chantix - Varenicline - NO seizure

Back 22

> 18 yrs --- 1st line -- partial agonist a4b2 nicotine Ach receptor -- can smoke 1st wk 4 days to reach Steady State (a4b2 can't be act by nicotine) ------ After meal ---------- suicide thought ------ no fly or air control --- Steven Johnson syndrome ------- Insomia

Front 23

Combine therapy

Back 23

when fail - long (bupropion- patch) control withdraw wt short (gum - lozenge - spray - inhaler) prn for relapse (pc or other smokers) --------- wacht for inc BP

Front 24

Clonidine - Catapress - not approval

Back 24

Rx - 2nd line -- NOT stop abruptly --> inc BP --

Front 25

Nortriptyline - Pamelor - not approval

Back 25

Rx - 2nd line -- 10-28 days to reach SS -- NO coadmin MAOI - no abruptly

Front 26

5 A

Back 26

Ask - Advise - Assess ---> willing to quit Assist - Arrange

Front 27

5 R

Back 27

Relevance - Risk - Rewards - Roadblocks - Repetion

Front 28

Contraindication

Back 28

pregnant women, smokeless tobacco user,

Front 29

First line treatment

Back 29

Burpropion SR (Zyban) ------- Nicotine gum, nasal spray, inhaler, patch, lozenge ------- Varencicline (Chantix)

Front 30

Second line treatment

Back 30

nortriptyline (Pamelor), clonidine (Catapress)

Front 31

psoriasis, eczema, atopic dermatitis

Back 31

NOT nicotine patch

Front 32

Esophagitis

Back 32

NOt nicotine gum or lozenge

Front 33

xx Dentures, braces, or temporomandibular joint disease (TMJ): - no sticky

Back 33

lozenge or patch could be options (NOT nicotine gum)

Front 34

xx Serious CV disease, pregnant, nursing, light smokers, adolescents

Back 34

refer

Front 35

/ thru out the day / noncompliance

Back 35

nicotine patch

Front 36

Smoke intermittently followed by no smoking periods /

Back 36

nicotine gum or lozenge

Front 37

Relevance:

Back 37

think about why quitting is important to them (ex: effecting their health and family’s health)

Front 38

- Risks:

Back 38

ask patient to identify risks of smoking (also review risks with patient)

Front 39

- Rewards:

Back 39

ask patient to identify beneficial effects of quitting -

Front 40

Roadblocks:

Back 40

help patient to identify barriers to quitting & develop ways to avoid or address each barrier

Front 41

- Repetition:

Back 41

repeat motivation intervention ---Continue to work with patients who have not been successful or are not motivated to quit

Front 42

Ask:

Back 42

identify all tobacco users at every visit

Front 43

- Advise:

Back 43

strongly urge all tobacco users to quit

Front 44

- Assess:

Back 44

determine willingness to make quit attempt
Categorize to tailor counseling: not ready to quit in next month, ready to quit in next month, recent quitter (past 6 months), former user (quit > 6 months)

Front 45

- Assist:

Back 45

aid patient in quitting

Front 46

- Arrange:

Back 46

schedule follow-up contact -- Follow-up recommended within 1st week of quitting -- 2nd follow-up recommended within 1 month of quitting -- Periodic follow-up to monitor and provide support

Front 47

Nicotine bind receptor and kinds of treatment (10)

Back 47

a2b4 Nicotine NS - Nicotine Inhaler - Nicoderm - Habitrol - Lozenge - Gum - Zyban - Chantix - Catapress - Pamelor

Front 48

5A willing to quit

Back 48

Ask to id - Advices urge - Assess the willingness - ------> if willing Assist aiding - Arrange schedule

Front 49

5R intervention for those unwilling to quit

Back 49

Relevance the imp - Risks - Rewards benefit- Roadblocks barrier- Repetition motivation

Front 50

First-line treatments

Back 50

Bupropion SR - Nicotine gum, nasal spray, inhaler, patch, lozenge - Varenicline

Front 51

Second-line treatments:

Back 51

nortriptyline, clonidine

Front 52

catagory D for pregnancy

Back 52

patch and inhaler

Front 53

combination therapy: only FDA approve are

Back 53

zyban and Nicotine patch

Front 54

which drug cause severe renal impairment

Back 54

only chantix cause severe renal impairment

Front 55

ask patient if they need advise to assess
mcqueena5201: if they do, then assist and arrange time

Back 55

patient say no not ready to quit right so give them relevance information about risks and reward ask what are the roadblocks and repetition