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Flashcards in Smoking Cessation Deck (14)
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1

Paxton's epidemiology #funfact regarding smoking.

Who have greater risk for dependence and greater difficulty quitting smoking?

Women

2

What NT does nicotine work on most?

DA

3

What are the S/S of nicotine withdrawal?

- irritability, frustration, anger
- dysphoric or depressed mood
- anxiety
- difficulty concentrating
- restlessness
- increased appetite or weight gain
- decreased HR
- insomnia

4

Describe the overall treatment for smoking cessation?

1 . Nicotine meds to deliver nicotine SLOWLY (risk of abuse low)

2. Counseling and combination cessation therapies

5

What is the general recommendation regarding nicotine replacement?

1. Patch
- controls withdrawl sxs throughout the day

PLUS

2. Short-acting form (gum, lozenge)
- control "breakthrough" cravings

Be thoughtful about NRT in pt w/vascular disease (Vasoconstrictor)

6

What is the SSRI used for smoking cessation?

Haha which one of you dingles put that this is an SSRI? Downey Jr would be mad at you

Bupropion

- start tab 7-14d prior to anticipated quit date

7

What is Varenicline MOA?

Partial agonist that binds selectively to a4b2 nicotinic Ach receptor with GREATER affinity than nicotine

- blocks nicotine from binding
- stimulates receptor but lesser degree --> still have DA release to reinforce smoking to relieve craving/withdrawal sxs

8

How would you describe to the patient how to use Varenicline?

Start 1 week before quit date

Plus behavior support/counseling

Longer lead-in time (starting more than 1wk prior) has shown more improved 24wk cessation rates

9

Varenicline Clinical Pearls

1. use for pt who have never attempted cessation AND those who have
2. pt needs MOTIVATION to quit
3. can use for up to 24wk
4. Not allowed by pilots, truckers, bus drivers, air traffic controllers**
5. C.I. in preg/breastfeeding
6. No taper required

10

Varenicline drug Interactions

- minimally metabolized = minimal med interactions

** w/ETOH = increased intox, aggressive behavior, amnesia

11

Varenicline ADRs

- dd Nausea (becomes less severe w/continued use)
- insomnia, abn dreams

12

What was the original BBW on Varenicline? (now removed)

Neuropsychiatric sxs and exacerbations of pre-existing psych illness (e.g. agitation, hostility, depressed mood, suicidal ideation)

Stop varenicline if serious mood or behavioral changes

13

Smoking cessations and pregnancy considerations?

Counseling is preferred tx

Nicotine = Cat D
- NRT during pregnancy probably safer for fetus than smoking

Bupropion, varenicline = Cat C

14

What does smoking do to fetus?

Increased incidence of LBW

Associated w/peri and post-natal complications