Pharmacy CE Smoking Cessation

cigarette smokers die approximately ___ years younger than nonsmokers

10

nicotine will reach brain in ____ seconds when inhaling cigarette

15 seconds

according to CDC prevalence of smoking in US

18%

nicotine withdrawal symptoms will subside within....

2-4 weeks

Which of the following is NOT a component of the "5 A's" for tobacco cessation intervention?

Aware: make patients aware of health consequences of smoking

The most common cause of death attributable to smoking is:

a. Cardiovascular disease

A 28 year-old restaurant manager comes to your clinic with lower back pain that he attributes to long hours of standing. He has been to the clinic three times in the last five years with minor complaints. He smokes between one and two packs a day and claims that it relieves the stress of his job. He reports that he has never seriously tried to quit. If the patient clearly indicates that he is not willing to make an attempt to quit at this time, which of the following would be the most beneficial response/action of the clinician?

a. Employ motivational interviewing techniques to increase the likelihood that he will attempt to quit in the future.

A 51 year-old woman is coming to see you as a new patient. She is now living with her daughter and son-in-law, who will be having their first child in three months. She has been a smoker all of her adult life and has made a couple of attempts to quit in the past, but has not been successful for more than a couple of months. She wants to quit smoking by the time the baby is born. Which of the following strategies is likely to be the most effective in helping this patient quit smoking?

a. Recommend FDA-approved medication plus counseling

Which of the following are potential benefits of electronic cigarettes (e-cigarettes) for current smokers?

a. Reduced exposure to carcinogens and toxins present in tobacco smoke

Which of the following statements is false?

a. The daily cost of most smoking cessation medications is more than double the daily cost of smoking a pack of cigarettes

Use of an FDA-approved medication for smoking cessation approximately __________ patients' chances of quitting smoking for 6 or more months.

a. doubles

What is the number for the national toll-free Quit Line?

b. 1-800 QUIT NOW

AJ is a 40-year-old female interested in starting OTC nicotine replacement therapy for her upcoming quit attempt. She is participating in a group cessation class and has set a quit date 10 days from now. She has been smoking for 20 years and currently smokes 1½ packs of cigarettes daily. Her only other medical problem is exercise-induced asthma, for which she takes albuterol prn. If AJ were interested in the nicotine patch, which of the following regimens would be most appropriate during the initial four to six weeks of treatment:

b. 21mg daily

This same patient then tells you that he is having a particularly difficult time not smoking after meals. What could you suggest that he do to deal with the temptation in this specific situation?

b. Brush your teeth immediately after each meal

This patient is now seeing you four months later. She admits to still sneaking an occasional cigarette, which she smokes in the bathroom under the ventilation fan, when the baby's crying wakes her up at night. It is winter and too cold to go outside to smoke. How would you advise that she deal with the situation?

b. Discuss specific coping techniques for the situation

The following will occur if one drinks a coffee or cola immediately before chewing a piece of nicotine gum:

b. Nicotine absorption will be decreased.

GB is requesting advice for a nicotine replacement therapy medication. She smokes about a half a pack of cigarettes a day. When asked, she indicates that she has dental issues that include TMJ (jaw pain). Which of the following should GB not use?

b. Nicotine gum

A 63 year-old retired general contractor is seeing you because he is starting to experience shortness of breath when playing with his grandchildren. He is currently a 1 pack a day smoker but acknowledges that he has smoked up to 3 packs a day when he was younger. He tells you that he would like to stop smoking. After a brief counseling session, he agrees to use the nicotine patch and identifies a quit date of two weeks from today. How soon would you follow-up with this patient?

b. On or within a few days of his quit date

Mr. Crosby comes to the pharmacy for a refill of his medicines. He tells you that he has been taking Zyban (bupropion SR) 150mg BID for 10 days and that his last cigarette was 5 days ago. He states that he is having difficulty sleeping. You advise him to:

b. Take the second dose of the day earlier, but not less than 8 hours after the first dose of the day

Which of the following medications has the simplest dosing regimen?

b. nicotine patch

What is the number for the national toll free tobacco Quit Line?

c. 1 800 QUIT NOW

For most patients, nicotine withdrawal symptoms will generally subside within how long after quitting?

c. 2-4 weeks

A 57-year-old male, who had been smoking about 1 pack per day, started using the 21 mg nicotine patch 7 days ago. He states that the patch is working well, but he still is experiencing some intermittent, situational urges to smoke, especially after eating, which was his primary trigger. What would be the most appropriate adjustment to medication therapy?

c. Add a short-acting NRT formulation, such as the gum or lozenge as needed

RC is a 35-year-old male who comes to your pharmacy regularly for his medications. His profile consists of a medication for hypertension and an asthma inhaler. He is 10 pounds overweight, maintains a reasonably healthy diet, and swims three times a week. He smoked almost a pack of cigarettes a day for 15 years but quit "cold turkey" three days ago, because he had been experiencing increased shortness of breath over the past several months. Today he tells you that he has quit smoking. He says he has been very agitated and has had trouble sleeping the past two nights. He also expresses strong urges to smoke, especially upon waking in the morning. It is clear that he would benefit by using a medication to alleviate his withdrawal symptoms. After discussing his withdrawal symptoms and the non-prescription medication options with you, he chooses the NicoDerm CQ transdermal patch. Which of the following is TRUE regarding the proper use of the nicotine patch?

c. If experiencing difficulty sleeping, he can try removing the patch at bedtime and applying a new patch in the morning.

Which of the following counseling points is appropriate to discuss with AJ regarding the nicotine patch?

c. Should be applied to a low-friction area of the body, generally between neck and waist.

Which of the following are the two parts of tobacco dependence that require treatment?

c. behavioral and physical

The primary chemical in the brain that is responsible for the pleasure associated with smoking is:

c. dopamine

When using nicotine gum, lozenge, or oral inhaler, patients should be advised not to eat or drink anything other than water:

d. A and B

Which of the following is proven to increase a patient's success with quitting?

d. All of the above

A 40 year-old is seeing you to get pain medication for a knee injury he suffered playing softball. He tells you that he smoked his last cigarette the previous week and has been using OTC nicotine gum to help maintain his abstinence. He has been dealing with urges with heavier use of the gum. What basic information would you share with this patient to support his abstinence?

d. All of the above would be appropriate.

For which of the following nicotine replacement therapy products is dosing based on time-to-first cigarette (TTFC)?

d. B and C

FB, a 33-year-old female, requests your assistance with stopping smoking. Upon questioning, you gain the following information: She has smoked 15 cigarettes per day for 15 years and has one previous failed quit attempt when she was able to abstain for two weeks. She has a history of bulimia and moderate but controlled hypertension and is not pregnant. Currently the only meds she is taking is atenolol 25 mg QD. Based on the above information, which of the following medications would NOT be appropriate for FB?

d. Bupropion SR

A 25 year-old graduate student has scheduled an appointment for her annual physical. During the visit you discuss her smoking (~half pack/day) and she expresses interest in quitting. She has been smoking since she was 18. You suggest a nicotine patch and provide the telephone number of the tobacco quit line. You promise to call her after she has started using the patch to see how she is progressing and to offer counseling. Which of the following would you avoid as an element of practical counseling?

d. Scaring the patient into quitting by showing her pictures of diseased lungs

E-cigarettes have been proven to be:

d. neither safe nor effective for smoking cessation

Use of an FDA-approved nicotine replacement therapy medication for smoking cessation approximately __________ patients' chances of quitting smoking for 5 or more months.

doubles

T or F. The metabolism of caffeine is increased upon quitting smoking.

false

Which of the following side effects of varenicline tends to be most common among patients?

nausea

compounds responsible for majority of drug interactions with smoking

polycyclic aromatic hydrocarbons