Skin Cancer, Smoking Cessation

Front 1

Types of Skin Cancer

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Basal Cell Carcinoma, Squamous Cell Carcinoma, Melanoma

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Basal Cell Carcinoma

Back 2

Most common, aggressive and invasive in dermis and epidermis ;
translucent nodule w/ smooth surface or persistent non-healing sore

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Squamous Cell Carcinoma

Back 3

2nd most common, slow growing and can metastasize ;
occurs on face, ears, neck, lips, backs of hands ;
isolated papule or plaque, scaly red patch

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Melanoma

Back 4

Less common, greatest threat of mortality ;
malignant tumor, common to meetastasize ;
trunk(men), legs(women), head/neck ;
use ABCDE of moles

Front 5

Risk Factors of Skin disease

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1. excessive sun exposure or tanning booths ;
2. Skin type- fair skin, burns easily ;
3. Nevi (mole or birth mark) large #s or large size ;
4. family history
5. history of skin cancer
6. live close to equator
7. history of severe sunburns

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ABCDE's of Melanoma

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A-Asymmetry (1 half doesn't match the other)
B-Border irregularity (edges ragged, notched)
C-Color variance (not uniform)
D-Diameter (bigger than 6mm)
E-Evolving (any change)

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Warning signs of skin cancer

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1. open sore, wart like growth, scaly patch 3+ weeks
2. reddish patch--frequently occuring
3. shiny bump or nodule

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3 major bands in UV spectrum

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UVC, UVB, UVA

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UVC (germicidal radiation)

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very little reaches Earth, not a cause of skin cancer

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UVB (Sunburn radiation)

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reaches earth surface (strongest from 10am-4pm) ;
provides Vit D3 synthesis ;
responsible for skin cancer, wrinkles, epidermal hyperplasia, collagen damage

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UVA

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penetrates deeper in the skin ;
contributes to premature aging of the skin, suppresses immune system, damages DNA ;
generates a tan, TANNING BEDS

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Transmit or Reflect UVR

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1. penetrates clouds
2. fresh snow
3. sand and white paint
4. water
5. dry clothing

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UV index

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developed by EPA ;
rates amount of UV radiation reaching Earth ;
1-11+

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4 things done to prevent sun-induced skin disorders

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SLIP! SLOP! SLAP! WRAP!

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SLIP

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slip on a shirt ;
Cover up (long sleeves, pants, dark colors, tightly woven, dry clothing)

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SLAP

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slap on a hat ;
2-3 inch brim, tightly woven fabric

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WRAP

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wrap on sunglasses ;
long hours in sun can cause cataracts ;
UV-blocking sunglasses

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SLOP

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slop on sunscreen ;
protects against sunburn, skin damage, skin cancer

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degree of protection with sunscreen is based on :

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sun protection factor (SPF), UVA protection, substantivity

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SPF

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measures the length of time a product protects against skin reddening from UVB, compared to how long hte skin takes to redden without protection

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FORMULA for SPF

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MED of protected skin / MED of unprotected skin ;
MED= minimal erythema dose

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Measures of UA protection

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1. UVA x200 less potent ;
2. high SPF products block more UVA
3. Broad-spectrum=passed a test, high protection against UVA, UVB

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Substantivity

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ability of the sunscreen product to remain effective during prolonged exercise, sweating, and swimming ;
cream-based vehicles are more water resistant

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Water resistant

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retains SPF for at least 40 mins

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Very water resistant

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retains its sun protection for at least 80 mins

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Chemical Sunscreens

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*absorb UVR-blocks transmission to epidermis
*colorless
*variable on UVA and UVB

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Physical sunscreens

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*reflect and scatter UVR
*thick, opaque
*block UVA and UVB

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Aminobenzoic Acid (PABA)

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ingredient in sunscreens ;
major sensitivity ;
stains clothing

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Benzophenones

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Common ingredient in sunscreens ;
increasing reports of sensitivity

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Avobenzone

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Best UVA coverage among chemical sunscreens

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Titanium Dioxide & Zinc Oxide

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Physical sunscreens ;
not combined with avobenzone

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Apply chemical sunscreens when and how often?

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15-30 minutes before exposure to UVR ;
~1oz of sunscreen needed

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When should you reapply sunscreen?

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1 oz every 2 hours at minimum

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ADRs of sunscreen:

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rash, vesicles(blisters), hives, exaggerated sunburn, photosensitivity, staining of clothing

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precautions/warnings for sunscreen

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1. avoid eyes
2. do not use in children <6months

Front 36

some health consequences of smoking

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1. kidney damage
2. emphysema
3. cancers (bladder, esophageal, lung)
4. bone problems
5. cardiovascular disease
6. reproductive issues

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Forms of tobacco

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cigarettes, spit tobacco, pipes, cigars, waterpipes

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# of cigarettes in a pack? # of packs in a carton?

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1. 20
2. 10

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Addiction

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compulsive drug use, without medical purpose, in the face of negative consequences

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Withdrawal symptoms of smoking

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begin within 24-48 hours after quitting;
peak in with 1st week ;
subside with 2-4 weeks ;
cravings- may never go away

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Tobacco dependence has what 2 parts?

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1. physiological
2. Behavioral

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5 A's to help a patient quit smoking

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1. Ask-about tobacco use
2. Advise-tobacco users to quit
3. Assess-readiness to quit
4. Assist-with quit attempt
5. Arrange-follow up care

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Stage 1 of readiness to quit

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not ready to quit in the next month ;
get them to start thinking about it
use the 5 R's to motivate

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Stage 2 of readiness to quit

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ready to quit in the next month ;
1. Assess tobacco use history
2. Facilitate the quitting process

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Stage 3 of readiness to quit

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recent quitter, quit in the last 6 months ;
Maintain abstinence

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Stage 4 of readiness to quit

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former tobacco user, quit >6 months ago ;
remain tobacco free for life

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When should 1st follow up be for a patient who recently quit smoking?

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within the 1st week after quitting

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5 R's that provide motivational counseling for those people not ready to quit smoking

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1. Relevance
2. Risks
3. Rewards
4. Roadblocks
5. Repetition

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Non-pharm methods of quitting smoking

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1. Cold turkey
2. Tapering
3. Formal cessation programs
4. Aversion therapy

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FDA approved 1st line therapy for smoking cessation

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1. Nicotine Replacement therapy(NRT)
2. Physchotropics
3. Partial Nicotinic Agonists

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Nicotine Replacement Therapy (NRT)

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reduces physical withdrawal from nicotine ;
doubles quit rates

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Precautions with NRT

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Severe Cardiovascular disease ;
All are pregnancy Category D ;
CANNOT SMOKE WHILE ON THIS

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NRT patch

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Nicoderm CQ = OTC

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Dosing for Nicoderm CQ if patient smokes >10 cigs/day? What changes if more cigs/day are smoked?

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Step 1: 21mg x6weeks
Step 2: 14mg x2weeks
Step 3: 7mg x 2 weeks

Only change is 14mg x6weeks, 7mg x2weeks

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Directions of use for Nicoderm CQ

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apply to clean, dry hairless area ;
remove after 24 hours

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ADRs for Nicoderm CQ

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Skin irritation (rotate sites) ;
insomnia ;
vivid dreams (remove patch at night)
headache

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NRT gum

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Nicorette

Front 58

What is the dosing schedule for Nicorette Gum and Lozenge based on?

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TTFC : Time To First Cig

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Directions of use for Nicorette Gum

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"Chew and Park Technique"
1. Chew slowly--tingling or peppery sensation
2. Park piece between cheek and gum
3. repeat for 30 mins

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ADRs for Nicorette Gum? Precautions?

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Mouth soreness/Jaw soreness ;
hiccups ;
Dental work

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important patient counseling tip for Nicorette Gum, Lozenge, and Nicotrol Inhaler

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do not eat or drink 15 minutes before using

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NRT lozenge

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Nicorette lozenge-OTC

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What is the maximum # of pieces of Nicorette gum/day? Nicorette lozenges?

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1. 24 per day
2. 20 per day

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Directions for use for Nicorette Lozenge

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place in mouth and allow to dissolve slowly ;
do not chew and rotate to different spots in mouth

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ADRs for Nicorette Lonzenges

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Nausea, hiccups, heartburn, flatulence, cough, headache

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NRT inhaler

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Nicotrol Inhaler-RX

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Directions for use for Nicotrol Inhaler

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use short puffs, can puff for 20 mins or break into 5 minute increments, must be used in 24 hours

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ADRS of Nicotrol inhaler

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Mild throat or mouth irritation, unpleasant taste, cough

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1 Advantage of Nicotrol Inhaler? 1 disadvantage?

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1. Advantage-mimics hand-to-mouth action
2. Disadvantage-expensive

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NRT nasal spray

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Nicotrol NS-RX

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Directions for use of Nicotrol NS

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prime the bottle, blow nose, breath thru mouth and spray once in each nostril, do not sniff or inhale, do not blow nose right away

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ADRs of Nicotrol NS

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Hot peppery feeling in back of throat, sneezing, coughing, watery eyes, runny nose

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Patient counseling for Nicotrol NS

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1. avoid driving for 5 minutes after each use
2. use at least 8 doses/day

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Psychotropic medication for smoking cessation

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Bupropion SR (Zyban)-RX

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Dosing schedule for Bupropion SR

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150mg x3 days, then 150mg BID x7-12 weeks
*if unsuccessful by week 7-d/c drug*

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When should Buproption SR be started?

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1-2 weeks before quit date

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ADRs of Bupropion SR

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insomnia, dry mouth, nervousness, rash, tremor

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Contraindications of Bupropion SR

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seizure disorder, anorexia, MAOIs in past 14 days

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Precautions/Warnings of Bupropion SR

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seizures, cranial trauma, lowered seizure threshold, severe hepatic cirrhosis, depressive disorders

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Major counseling tips of Bupropion SR

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Avoid alcohol, avoid bedtime dosing, 8hrs between doses

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Partial Nicotinic Agonist

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Varenicline (Chantix)-RX

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Dosing schedule for Chantix

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.5mg x3days, .5mg bid x4days, 1mg bid

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Directions for use for Chantix

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Start medication 1 week before quit date

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ADRs of Chantix

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Nausea, sleep disturbances, GI disturbances

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Precautions/Warnings of Chantix

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changes in behavior, suicidal thoughts, skin reactions, increased cardiovascular events

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Patient counseling for Chantix

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take with full glass of water and with food ;
nausea is a significant ADR but should be temporary