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32 Cards in this Set
- Front
- Back
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Why attempt smoking cessation?
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Smoking cessation at any age improves life expectancy and reduces incidence of smoking related disease
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What percent of smokers want to quit?
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70%
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What percent of smokers make at least one quit attempt annually?
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40%
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How many smokers are successful at quitting attempt?
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only 10%
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Smoking cessation reduces cigarette related disease
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- circulation improves in 30 days
- lung function improves in 3 months (decrease in cough and sputum production) - risk for cardiac events decreases by 50% - risk for cardiac events approaches that of never-smokers - at 5 yrs, risk for bladder, cervical, oral and esophageal cancer decreases towards the risk for never smokers - at 10 years, risk for pancreatic cancer decreases to never-smoker risk - at 10 years, risk for lung cancer is 30-50% of risk for current smokers - at 15 years, risk for stroke approaches that of never smokers |
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Smoking Cessation & Life Expectancy
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Cessation age: increase in life expectancy
60: 3 years 50: 6 years 40: 9 years 30: 10 years |
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The 5 “A”s for Patients Willing to Quit
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ASK about tobacco use
ADVISE to quit ASSESS willingness to make a quit attempt ASSIST in quit attempt ARRANGE for follow-up |
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How many attempts are required before success with quitting?
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Nicotine dependence is a chronic relapsing disorder requiring 5 to 7 quit attempts
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How should you advise to quit?
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Old men: coughing, phlegn
Teenage girl: periodontal dz Teenage boy: impotence Women: wrinkles, osteoporosis, early menopause Parents: 70% spontaneous abortion 36% Preterm Birth 98% Full term low birth weight 25% perinatal death SIDS Pneumonia in 1st year |
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Smoking and osteoporosis
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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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ASSESS willingness to make a quit attempt
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What is it going to take for you to quit smoking?
Relevance (smoking related illness) Risks (of continuing) Rewards (decrease FEV1 decline, sputum, coughing) Roadblocks (What stopped you when you last tried to quit?) Repetition |
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Fagerstrom test for nicotine dependence
(FTND) |
How bad is the addiction?
- when is first cig? - difficulty to refrain? - which cig would you hate to give up? - how many cigs/day - do you smoke more frequently after waking up? - do you smoke when you are so ill that you are in bed most of the day? |
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Controller therapy for smoking cessation
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Nicotine patch
Bupropion Varenicline |
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Rescue therapy for smoking cessation
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Nicotine inhaler
Nicotine nasal spray Nicotine gum Nicotine Lozenge |
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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 Serum concentration nearly the level of a 1 ppd smoker 44mg patch no more effective 25mg 16hr patch no more effective than 15mg 16hr (Risky because relapse in the early morning, but you should use it for pregnant and nursing women) Tx > 8 weeks no more effective |
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Bupropion
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Selectively inhibits reuptake of noradrenaline & dopamine
150mg q. day X 3; then 150mg bid X 7-12wks (start slowly because can cause seizures) More cost effective than placebo, NTP alone or in combination with NTP Safe & effective in COPD More effective in men smoking greater than 1ppd & women smoking < 1ppd Sustained therapy for 1 year increased quit rate @1 ½ yr (55 v.42% :B v. P) but not @ 2 yr (41 v.40%) |
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Varenicline
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Partial Nicotine Agonist Effect (has the potential to relieve craving and withdrawal)
Start slowly because it causes nausea and vomiting Adverse effects: ABNORMAL DREAMS Improves continuous abstinance rates (compared to buproprion) |
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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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What decreases absorption of rescue therapy with smoking cessation?
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Slower absorption… coffee, sofa and acid containing foods decrease the absorption
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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 Most rapid rate of absorption, but feels like hot poker up the nose |
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Nicotine Gum
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Serum concentration 1/3-2/3 that of 1 ppd smoker
Acid environment decrease absorption therefore no coffee, juice, soda, food 1/2 hr before, during, or after Requires education-CHEW and PARK (b/c you can get nicotine toxic and .: hate it) 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 Lozenge
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Available in 1, 2 & 4mg doses
Quit OR 3.4 c/w 3.14(gum) and 5.47 (bupropion) SubLingual placement Recommended dose 20-40mg/d OTC Serum nicotine level 25-27% higher than equivalent doses of gum |
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Does Nicotine Replacement Therapy acutally help?
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Gives you 2 fold replacement increase than if quitting cold turkey
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Pregnant/breastfeeding women
and Smoking Cessation |
Risk/benefit in highly addicted: patch (category D), gum (categoryC)1
Bupropion is category B Use 16 hour patch |
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Depression
and Smoking Cessation |
bupropion may be used with SSRI and tricyclics but not MAO inhibitors
no difference in cessation rate in depressed vs. nondepressed |
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Schizophrenia
and Smoking Cessation |
smoking prevalence 80-90% and nicotine restores cognitive deficits
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Cigarette consumption < 10/day
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Do not need nicotine replacement, may need bupropion and behavioral modification
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Does medication change success rates when quitting smoking?
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medication doubles the success rate
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Behavioral Therapy in Smoking Cessation
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Identify high risk situations
Recognize smoking cues and triggers Avoid high risk situations Substitute alternative or coping behaviors (like exercise) |
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3 types of counseling most effective
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Practical counseling
Intra-treatment social support - physician support and encouragement Extra-treatment social support - help from friends and family |
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What is Rapid Smoking?
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smoking cigarette after cigarette to create an eversion to smoking
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Effective Behavioral Modification Techniques
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Stimulus control
- Get ride of anything that is going to cause you to smoke… ash tray, joe camel shirt Aversion therapy |
