Tobacco use cessation

pharmacotherapy

The addition of appropriate (blank) can significantly double the probability of a successful quit attempt particularly when used in conjunction with counseling.

40-60 mg

The oral minimum acute lethal dose of nicotine in adult humans is (blank) (<1mg/kg). - Lethal doses produce convulsions quickly and death follows as a result of peripheral or central respiratory paralysis or cardiac failure.

unintentional injury

(blank - not listed in pic) contributed to more years of potential life lost than any other cause of death in 2020

Nitrosamines

(blank) (known carcinogen) levels in spit tobacco are 10 to 100 times higher than the levels in the inhaled smoke from one cigarette and 20,000 times higher than the level allowed in food by the FDA and the Department of Agriculture.

true - Brief tobacco dependence treatment is effective, and every patient who uses tobacco should be offered at least brief treatment. Brief interventions, lasting as little as 3 minutes can improve abstinence.

T/F The intensity of tobacco counseling (e.g. amount of time) increases its effectiveness.

False Except in the presence of contraindications, one or more pharmacotherapies should be recommended to all patients attempting to quit.

T/F no pharmacotherapies should be recommended to patients attempting to quit.

true - Cigar smoking is associated with increased risk of early death from coronary heart disease.

T/F: A cigar smoker's intake of nicotine and other toxins may exceed that of a typical cigarette smoker's.

true but almost 38 million americans still smoke - FYI: NC is the largest tobacco producing state in the nation

T/F: Adult cigarette smoking is declining

False: There is NO evidence of increased cardiovascular risk with NRT except with acute disease.

T/F: There is evidence of increased cardiovascular risk with NRT.

Ask about tobacco use. Advise tobacco users to quit. Assess readiness to make a quit attempt. Assist with the quit attempt. Arrange follow-up care.

what are the 5 A's?

19 seconds

Cigarettes have been described by Dr. Richard D. Hurt of the Mayo Clinic as "the Holy Grail of drug delivery devices." Nicotine is delivered to the brain within (blank) seconds of inhalation of smoke from a cigarette.

vaping pneumonia

Lung injury: -UNC Hospital has been seeing cases of "(blank)" -These occurred in teens who had never smoked cigarettes, only JUULed. Prolonged hospitalizations involving respiratory failure.

weight gain - The average patient will gain 4-10 lbs. - Appropriate pharmacotherapy can help delay or decrease weight gain. - The average weight gain at 2 year tobacco-free anniversary is about 5 lbs.

Fear of (blank) is cited as the reason for returning to smoking by 1/5 of male smokers 1/3 of female smokers

leukoplakia

This demonstrates the typical white patch or (blank) usually associated with site where the user holds the tobacco. Gingival recession associated with spit tobacco use is also apparent. - Recession occurs early on

Nicotine Effects

these are all effects of what drug? •Increase in heart rate/blood pressure •Enhances information processing •Reduces fatigue •Sedative action •Reduces anxiety •Induces euphoria

1mg (2 sprays of 0.5mg per nostril)

one dose of Nicotine Nasal Spray is how many mg nicotine?

•Development of tolerance •Withdrawal syndrome •Used in larger amounts or over a longer period than intended •Social, occupational, recreational activities reduced or given up •Use continues despite knowledge of problem

what are the 5 Criteria for Substance Dependence Dx (Diagnostic and Statistical Manual IV-TR)

Nicotine Gum Nicotine Lozenge Nicotine Transdermal Patch Nicotine Oral Inhaler Nicotine Nasal Spray

what are the 5 NRTs

Relevance: Tailor your advice and discussion to the patient's level and situation. Risks: Provide new information on the risks of continued tobacco use. Rewards: Outline benefits of quitting that the patient may not have considered. Roadblocks: Help patients identify the barriers to quitting and offer solutions for their consideration. Repetition: Reinforce your motivational message.

what are the 5 R's to Enhance Motivation For Patients Not Ready to Quit

NRTs and Bupropion SR

what are the two categories of 1st line pharmacotherapies?

D1320 - The 22 to 40 year-old population are more likely to have regular dental visits than physician visits and can benefit substantially from dental practice cessation efforts.

whats the D code for: Tobacco counseling for the control and prevention of oral disease.

Nicotine Nasal Spray

•Available by prescription •Aqueous solution of nicotine in 10 ml spray bottle •Each metered dose delivers: 50 µL spray (0.5 mg nicotine) •Rapidly absorbed through nasal mucosa (4-15 minutes) •Wide variation in plasma nicotine concentration among subjects •Highest addiction potential of all NRT's

Nicotine Oral Inhaler

•Available by prescription •Nicotine inhalation system: Reusable mouthpiece Cartridge contains 4 mg nicotine •Delivers approximately 2 mg of nicotine absorbed via the buccal mucosa over 20 minutes of puffing •Replaces hand-to-mouth habit

E-cigarettes

•Battery-operated devices that heat a liquid solution into an aerosol •Different names: "e-cigs," "mods," "vape pens," "vapes," "tank systems," and "electronic nicotine delivery systems" (ENDS) •Different styles: shaped like cigarettes, cigars, pipes, pens, USB sticks, and other items •

Clove Cigarettes - Kretek

•Delivers significant quantities of nicotine and carbon monoxide. •Taste, aromatic odor, and novelty contribute to appeal. • Hemorrhagic pulmonary edema and aspiration pneumonia have been reported as a consequence of laryngeal anesthesia from eugenol. - are a tobacco alternative popular for their unique smell, taste and appearance.

Nicotine Transdermal Patch

•Delivers steady dose of nicotine • Available both by prescription and over-the-counter • Lowest addiction potential of all NRT's

Bupropion SR

•Doubles abstinence rates vs. placebo •Only non-nicotine medication approved by FDA for smoking cessation treatment •Mechanism: presumably blocks neural reuptake of dopamine and/or norepinephrine

Hookah Bars

•Increasingly popular social venue. Smoking tobacco in water pipes. •Water cools the smoke and filters some of particulate matter. •Nicotine levels rose from 1.11 ng/ml at baseline to a maximum of 60.31 ng/ml 45 minutes.

Bupropion SR

•Marketed as Zyban for smoking cessation or Wellbutrin SR for depression

Spit Tobacco

•Moist snuff is the only tobacco product in the US that has shown an increase in sales every year since the mid 1980's. •Sales increased from 36.1 million lbs ($438 million) in 1986 to 58.4 million lbs ($1.6 billion) in 1999. - Significant health risks •Numerous carcinogens •Nicotine addiction •Physical dependence •Withdrawal symptoms after abstinence

Bidis

•Small brown hand-rolled cigarettes of tobacco hand-rolled in tendu leaf •Imported from India and Southeast Asia •Available in a variety of flavors •Produce higher tar and carbon monoxide levels •Nicotine concentration (21.2 mg/g) significantly greater than traditional filtered cigarettes •Meta-analysis demonstrated increased risk for oral cancer for these smokers compared to non-smokers (OR=3.1, 95% CI) - Although they contain less tobacco than the standard US cigarette, they produce higher levels of carbon monoxide (39.3 mg/bidi) and tar (77.9 mg/bidi).