What does NRT stand for?
Click to see answer
Nicotine Replacement Therapy.
Click to see question
What does NRT stand for?
Nicotine Replacement Therapy.
How many participants were involved in the 'Why I Smoke Test'?
What is the purpose of the 'A' in the STAR strategy?
Anticipation guidance.
What are some bone and oral health problems caused by smoking?
Bone density loss and oral health issues.
What is the relationship between the number of counseling sessions and smoking cessation success?
There is a strong relation; more counseling sessions combined with medications increase the likelihood of successful cessation.
What does NRT stand for?
Nicotine Replacement Therapy.
How many participants were involved in the 'Why I Smoke Test'?
23 participants.
What are common side effects of Clonidine?
Dry mouth (40%), drowsiness (33%), dizziness (16%), sedation (10%), constipation (10%), hypotension.
When was the information about Combination NRT documented?
8 September 2022.
What is an example of oral NRT?
Nicotine Pastille.
What is the significance of the number 65 in the context provided?
The context does not specify its significance.
What is the purpose of Nicotine Replacement Therapy?
To help individuals quit smoking by reducing withdrawal symptoms.
What does a total score of 5 to 7 on the Fagerstrom Test suggest?
Moderate Dependence; may offer NRT options alone or in combination (e.g., patches with lozenges or gums).
What are some strategies to manage withdrawal symptoms according to the DEAD acronym?
Delay smoking, drink water, take deep breaths, do something else, and focus on a destination.
What score indicates a higher level of nicotine dependence in the Fagerström Test?
A score of 25.
What is one major health risk associated with smoking?
Cancer.
What are the health risks associated with tobacco use?
Increased risk of cancer, heart disease, and respiratory issues.
What is an example of oral NRT?
Nicotine Gum.
What is the purpose of Nicotine Gum?
To help individuals quit smoking by reducing withdrawal symptoms.
What is the purpose of the 'Why I Smoke Test'?
To assess reasons and motivations for smoking.
What does the 'S' in the STAR strategy stand for?
Set a quit date.
What does the 'T' in the STAR strategy represent?
Tell others.
What is the primary intervention goal for smokers unlikely to stop without help but would benefit from treatment?
Engage smoker in treatment.
What is Clonidine used for in smoking cessation?
It reduces cravings and withdrawal symptoms.
What is the Fagerström Test used for?
To assess nicotine dependence.
What are the three types of Environmental Tobacco Smoke (ETS)?
First-hand ETS, Second-hand ETS, Third-hand ETS.
What is a key symptom of substance dependence?
Physical dependence.
How many cigarettes per day is considered heavy smoking?
More than 20 cigarettes per day.
What is classified as very heavy smoking?
More than 25 cigarettes per day.
What is the significance of the date 8 September 2022 in the context of quitting?
It can be set as a quit date.
In which conference was the combination of Varenicline and NRT discussed?
Dublin SRNT 2009.
What is Combination NRT?
A treatment that includes a long-acting formulation (21 mg patch) and a short-acting formulation (4 mg gum, lozenge, or oral inhaler).
What does NRT stand for?
Nicotine Replacement Therapy.
What management technique is discussed in relation to tobacco use?
Behavioral Management.
What are biological factors in tobacco use risk?
Factors related to nicotine dependence.
When was the Fagerström Test last updated?
8 September 2022.
What does a Time to First Cigarette (TTFC) of less than or equal to 30 minutes indicate?
High dependence.
What does a TTFC of more than 30 minutes indicate?
Low dependence.
What is the primary intervention goal for smokers unlikely to stop but could do so with help?
Increase motivation.
What does ETS stand for in the context of tobacco use?
Environmental Tobacco Smoke.
When was the 'Why I Smoke Test' conducted?
8 September 2022.
Which cardiovascular diseases are linked to smoking?
Stroke and coronary heart disease.
What is the combination therapy discussed in the document?
Varenicline and Nicotine Replacement Therapy (NRT).
When was the study on Varenicline and NRT published?
8 September 2022.
What is the purpose of the 'Why I Smoke Test'?
To understand the reasons behind an individual's smoking behavior.
What are the two most important questions in the Fagerstrom Test under time constraints?
What is the primary intervention goal for smokers likely to stop with minimal help?
Trigger quit attempt.
What is the primary intervention goal for smokers unlikely to stop?
Initially increase motivation to make smoker receptive to treatment.
What is a key focus in behavioral management for smoking cessation?
Facilitating patients who are willing to quit, unwilling to quit, and those experiencing withdrawal symptoms.
What is the significance of 8 September 2022?
It is a specific date, but no context is provided.
What aspects of nicotine dependence should students be able to describe?
Pathophysiology, epidemiology, risk factors, clinical presentation, diagnosis, and assessment.
What does the number 16 represent in this context?
It is unclear without additional information.
What lung diseases can smoking exacerbate?
COPD and asthma.
What does the 'R' in the STAR strategy involve?
Remove tobacco products.
What type of medication is Clonidine?
An anti-hypertensive and specific noradrenergic agonist.
What is the focus of the session on 8 September 2022?
Understanding Tobacco Use and Dependence.
What is one key area covered in the session?
Assessment of Tobacco Use and Dependence.
What type of methods are used for the assessment of tobacco use and dependence?
Objective methods.
What is Varenicline used for?
It is used for smoking cessation.
What is a key advantage of transdermal nicotine replacement therapy (NRT)?
It is preferable for patients with difficulty taking multiple doses.
How does the duration of therapy for transdermal NRT compare to oral NRT?
Transdermal NRT has a shorter duration of therapy compared to oral NRT.
How can smoking cessation affect patients with co-morbid alcohol and other drug substance use?
It can improve the chances of alcohol abstinence.
In what scenario can transdermal NRT be used in combination with oral NRT?
For background craving relief and breakthrough craving.
What is the first step in the 5A model for pharmacists?
ASK.
How can clinicians support clients in the Maintenance stage?
By supporting lifestyle changes.
What is a recommended action if a smoker had a positive experience with pharmacotherapy?
Re-treatment with the same agent might be appropriate.
What is an important affirmation for clients in the Maintenance stage?
Affirming the client's resolve and self-efficacy.
How many Disability-Adjusted Life Years (DALYs) were lost due to smoking in the Philippines?
64,913 DALYs.
What should be considered if a smoker had a negative experience with pharmacotherapy?
Consider an alternative agent.
What alternative method can be used for smoking cessation in pregnant women?
Intermittent Nicotine Replacement Therapy (NRT) monitored by healthcare providers.
What should be explained to clients regarding medications?
How to use medications.
What sleep-related issue may arise during nicotine withdrawal?
Insomnia.
What is the starting dosage of Nortriptyline for smoking cessation?
25 mg PO OD, started 1-2 weeks before the quit date.
What are the comparisons made in smoking cessation aids?
Comparisons between NRT, Varenicline, Bupropion, and their combinations.
What is the brand name for Varenicline?
Champix or Chantix.
How does tolerance relate to the reward pathway sensitivity?
Tolerance leads to increased reward pathway sensitivity.
What benefit does oral NRT provide for smokers not ready to quit?
With NRT support, twice as many quitters achieve six months of sustained abstinence.
What is the maximum number of pieces of NRT that can be used in 6 hours?
No more than five pieces.
What are some risk factors associated with tobacco use?
Genetic predisposition, social environment, and mental health issues.
What does NRT stand for?
Nicotine Replacement Therapy.
What is a common psychological symptom associated with substance use?
Craving or strong desire to use the substance.
What is a key skill students should develop for smoking cessation?
Select and adjust appropriate regimens based on nicotine dependence and patient-specific characteristics.
What is the purpose of using a Nicotine Inhaler?
To help individuals quit smoking by providing a controlled dose of nicotine.
Who should not be offered first-line smoking cessation agents?
Patients who smoke less than 10 cigarettes/day, pregnant or breastfeeding women, children and adolescents under 18, and smokeless tobacco users.
What does the Fagerstrom Test for Nicotine Dependence (FTND) measure?
The level of nicotine dependence in smokers.
What types of consequences are considered in the Extended Decisional Balance?
Consequences to self, consequences to others, your own reaction, and reaction by others.
Is the use of electronic cigarettes recommended as an alternative to NRT?
No, their use is not recommended as an alternative to NRT.
What does a total score of 1 to 2 on the Fagerstrom Test indicate?
Low Dependence; may not need NRT, but monitoring for withdrawal symptoms is recommended.
What is Cytisine?
A partial nicotinic-acetylcholine agonist with a structure similar to nicotine.
What is the title of the material?
Smoking Cessation Clin Pharm 182.
What does the acronym 5R stand for in smoking cessation?
Relevance, Risks, Rewards, Roadblocks, Repetitions.
What are some side effects of using Vernonia cinerea?
Tongue numbness, decreased appetite, and dislike for cigarette smoke’s taste and smell.
How does NRT help after cessation regarding weight?
It helps control weight gain, particularly with gum.
What does Republic Act 9211 regulate?
Tobacco Regulation Act of 2003.
How does social image affect tobacco use?
It can influence individuals' decisions to smoke.
What type of support is recommended for hospitalized patients trying to quit smoking?
Behavioral support and Nicotine Replacement Therapy (NRT).
Name three common withdrawal symptoms from tobacco use.
Irritability, anxiety, and difficulty concentrating.
What law governs the copyright of this material?
Republic Act (RA) 8293 or the 'Intellectual Property Code of the Philippines'.
What is the date of the clinical practice guideline update by Fiore et al.?
May 2008.
What is a common change in appetite experienced during withdrawal?
Increased appetite.
What forms of oral nicotine replacement therapy (NRT) are mentioned?
Gums, lozenges, and pastilles.
What urinary cotinine level indicates non-exposure to ETS?
< 5 ng/mL.
What are some reasons for negative experiences with pharmacotherapy?
Poor adherence, side effects, palatability issues, and cost.
What does a Carbon Monoxide Analyzer measure?
Smoke intake over the preceding hours.
What is the rationale for the 'not-a-puff' rule after quitting?
To prevent relapse.
Is the health impact of ETS the same across different groups?
No, health problems may vary across groups exposed to different ETS.
What is an example of oral NRT?
Nicotine Inhaler.
When was the information about Oral NRT (Nicotine Inhaler) noted?
8 September 2022.
When was the information about Oral NRT (Nicotine Gum) noted?
8 September 2022.
What is a significant challenge for patients with mental health disorders regarding smoking cessation?
They have lower quit rates despite being motivated like the general population.
What factors should be considered when selecting a smoking cessation aid?
Patient’s preference, previous experience, previous levels of smoking, current medical conditions, medication adherence issues, concerns about weight gain, and out-of-pocket costs.
What is the purpose of Combination NRT?
To enhance smoking cessation success by using multiple forms of nicotine replacement.
What type of support is important for patients with mental health disorders during smoking cessation?
Psychosocial support.
What is Vernonia cinerea?
A plant under the Asteraceae family used as a traditional medicine.
Who is best suited to manage Combination NRT?
Smoking cessation specialist clinics.
When was the Nicotine Pastille introduced?
8 September 2022.
What psychological factor contributes to tobacco use?
The feeling of satisfaction.
What is the initial dose of Cytisine?
9 mg per day for 25 days.
What should be monitored when using Combination NRT?
Hypertension.
What is leukoplakia?
Precancerous white patches in the mouth caused by smokeless tobacco.
What law governs the copyright of the material?
Republic Act (RA) 8293 or the 'Intellectual Property Code of the Philippines'.
What is the purpose of the DEAD acronym?
To provide strategies for coping with withdrawal symptoms.
What is Varenicline used for?
As a smoking cessation aid that reduces withdrawal symptoms and cravings.
What is the focus of the Precontemplation stage in smoking cessation?
Current smoking without a quitting plan within 6 months.
Why is smoking cessation important for pregnant and breastfeeding women?
To promote the health of both the mother and the child.
What is a key technique for building a relationship with clients in smoking cessation?
Build rapport.
What is a symptom indicating a loss of control in substance use?
Loss of control over substance use.
What is the final step in the 5A model?
ARRANGE follow-up support.
What should clinicians support to help clients in the Action stage of change?
A realistic view of change through small steps.
What does Republic Act 10351 restructure?
The excise tax on alcohol and tobacco products.
What effect does nicotine have on acetylcholine receptors?
Nicotine decreases the sensitivity of acetylcholine receptors.
Name two first-line agents for smoking cessation.
Varenicline and Bupropion SR.
How should oral NRT be used, fixed schedule or prn?
On a fixed schedule.
What technique can help clients identify high-risk situations?
Functional analysis.
How does oral NRT provide oral gratification?
It satisfies the oral fixation associated with smoking.
What should students compare regarding drugs for smoking cessation?
Mechanism of action, indication, appropriate dose, side effects, proper use, monitoring, and efficacy.
How does smoking affect reproductive health?
It can lead to difficulty in getting pregnant, pre-term delivery, stillbirth, and birth defects.
What is more effective for smoking cessation: counseling alone, medication alone, or a combination of both?
A combination of counseling and medication is more effective.
What is the purpose of the Why I Smoke Test (WIST)?
To assess reasons for tobacco use.
What is smokeless tobacco?
Tobacco that is not burned.
How many symptoms indicate mild nicotine dependence according to DSM-V?
2 to 3 symptoms.
How quickly does NRT reach peak plasma concentration?
Within 15 to 30 minutes.
What is recommended for a total score of 3 to 4 on the Fagerstrom Test?
May offer NRT options such as patches, inhaler, lozenges, or gums.
What is Silver Nitrate Mouthwash used for in smoking cessation?
It reacts with nicotine to form nicotinic acid.
What should clinicians help clients identify during the Maintenance stage?
Drug-free sources of pleasure (new reinforcers).
What triggers withdrawal symptoms in tobacco users?
Abrupt cessation of tobacco use or reduction in the amount used.
What caution should be taken when using transdermal NRT?
Use with caution in cardiovascular patient groups and patients with severe eczema or psoriasis.
What system does inhaled nicotine primarily affect?
The mesolimbic dopamine system.
How soon do withdrawal symptoms appear after stopping tobacco use?
Within 24 hours.
Which receptor does nicotine bind to in the brain?
The 4 β 2 nicotinic acetylcholinergic (nACh) receptor.
What is the half-life of cotinine in urine?
Approximately 20 hours.
What is the primary purpose of transdermal NRT?
To help individuals quit smoking by reducing withdrawal symptoms.
What does 'ASSIST' involve in the 5A model?
Helping the patient with a quit plan and providing support.
What is an important first step for clinicians in the Precontemplation stage?
Establish rapport, ask permission, and build trust.
What should you not do with this material according to the notice?
Reproduce or communicate it without authorization.
What is the significance of the Executive Order on a Nationwide Smoking Ban?
It prohibits smoking in public places across the country.
What does 'ASSIST' involve in the 5A model?
Helping the patient with a quit plan and providing support.
What is the recommended usage of oral NRT during Step 1?
At least 9 pieces per day to increase chances of quitting.
What is the final step in the 5A model?
ARRANGE.
What is the focus of the Contemplation stage in smoking cessation?
Current smoking with a quitting plan within 6 months.
What is the duration of the starter pack for Varenicline?
2 weeks.
What is the purpose of combination NRT?
To enhance smoking cessation effectiveness.
What is one method to reduce smoking before quitting?
Cigarette fading or smoking reduction pre-quit.
How can clinicians help clients tip the decisional balance scales toward change?
By eliciting and weighing pros and cons of substance use and change.
What is the dosing for days 1 to 3 of Varenicline?
0.5 mg PO OD.
What is pathophysiology in the context of tobacco dependence?
The study of the functional changes in the body caused by tobacco use.
What are the diagnostic criteria for tobacco dependence?
Criteria include tolerance, withdrawal symptoms, and continued use despite harm.
What should a clinician do when a client experiences a recurrence or relapse in smoking cessation?
Help the client reenter the change cycle and commend any willingness to reconsider positive change.
What is the evidence regarding the efficacy of electronic cigarettes as an alternative form of NRT?
Insufficient evidence to support their efficacy for smoking cessation.
What is an important strategy for clients who have relapsed?
Assist the client in finding alternative coping strategies.
What does NRT stand for?
Nicotine Replacement Therapy.
What types of cravings does Combination NRT address?
Background craving and breakthrough craving.
Which pharmacological aids can be used for smoking cessation in patients with mental health disorders?
Nicotine Replacement Therapy (NRT) and Bupropion.
What is the date of the information regarding electronic cigarettes?
8 September 2022.
How do social factors influence tobacco use?
Through friends, peer pressure, and family.
What is the Maintenance stage in the Stage of Change model?
It refers to having quit smoking for more than 6 months.
Is a combination of NRT agents more effective than a single agent?
Yes, a combination is more effective.
What is a notable side effect of Silver Nitrate Mouthwash?
It has a disagreeable metallic taste.
What does NRT stand for?
Nicotine Replacement Therapy.
What is the purpose of the WHO Framework Convention on Tobacco Control?
To provide a global framework for tobacco control.
What is Bupropion's role in smoking cessation?
It is an antidepressant that also helps reduce cravings and withdrawal symptoms.
What is Varenicline used for?
It is a smoking cessation aid.
What is one way to distract oneself from withdrawal symptoms?
Do something else.
When was the information about transdermal NRT noted?
8 September 2022.
What was observed in the psychiatric cohort regarding neuropsychiatric adverse events?
More neuropsychiatric adverse events were reported in the psychiatric cohort.
What percentage of DALYs lost due to smoking were attributed to life years lost?
99%.
What type of receptor does Varenicline act on?
Highly-selective nicotinic acetylcholine receptor partial agonist.
What should clinicians review with clients in the Maintenance stage?
Long-term goals.
What is the threshold for active smoking using a Carbon Monoxide Analyzer?
6 ppm.
What commitment should be elicited from clients in smoking cessation?
Commitment to 'not-a-puff'.
How can nausea from Varenicline be mitigated?
Take with food and a full glass of water.
When should Varenicline be started in relation to the quit date?
1 week before the quit date.
What is the correct technique for using gum NRT?
Chew and park.
What is the pooled risk ratio for NRT patches?
1.66 (95% CI: 1.53 to 1.81).
What type of motivation should clinicians aim to change from and to?
From extrinsic to intrinsic motivation.
Who are the authors of the study on Varenicline and NRT?
Bittoun et al.
When was the 'Why I Smoke Test' conducted?
8 September 2022.
Does smoking cessation exacerbate mental health disorders?
No, it does not exacerbate mental health disorders.
What is the DSM-V definition of nicotine dependence?
A problematic pattern of tobacco use leading to clinically significant impairment or distress, as manifested by at least two symptoms occurring within a 12-month period.
How is nicotine absorbed in smokeless tobacco?
Through the lining of the mouth.
What is a potential benefit of using Combination NRT?
Increased effectiveness in reducing withdrawal symptoms and cravings.
What does the 'Disadvantage' in Decisional Balance refer to?
The drawbacks of quitting smoking.
When was the nicotine lozenge mentioned?
8 September 2022.
What is the incidence of side effects with Combination NRT compared to single NRT use?
Not significantly greater.
What effect does Vernonia cinerea have on the rewarding feeling of smoking?
It possibly decreases the rewarding feeling given by smoking.
Which institution is associated with the material?
University of the Philippines Manila.
What is Republic Act 8749?
The Philippine Clean Air Act of 1999.
What other factors contribute to tobacco use?
Easy access, low prices, aggressive marketing, lack of danger awareness, and weak policy implementation.
What are some side effects of Cytisine?
Nausea/vomiting and sleep disturbance.
What should you not do with the material according to the notice?
Reproduce or communicate the material without authorization.
What does NRT stand for in smoking cessation aids?
Nicotine Replacement Therapy.
What does the 'ADVISE' step entail in the 5A model?
Providing clear and personalized advice to the patient.
What does Republic Act 10643 mandate?
The Graphic Health Warnings Law.
What is the purpose of the 'ASSESS' step in the 5A model?
To evaluate the patient's readiness to quit and their level of dependence.
What mood changes can occur during nicotine withdrawal?
Restlessness and depressed mood.
What does persistent desire or unsuccessful efforts to stop using indicate?
A strong urge to quit but inability to do so.
What should clinicians develop in case a client resumes substance use?
A 'fire escape' plan.
How much more successful is Varenicline compared to placebo?
2 to 3 times more successful.
What is the relationship between tolerance and physical dependence in nicotine use?
Tolerance leads to increased craving and physical dependence.
How many deaths were attributed to lung cancer in the Philippines in 2008?
9,871 deaths.
What is the maximum dosage of Nortriptyline that may be titrated to?
75-100 mg/day.
What should clinicians normalize during the Contemplation stage?
Ambivalence.
What is the pooled risk ratio for NRT gum?
1.43 (95% CI: 1.33 to 1.53).
What are some neuropsychiatric side effects associated with Varenicline?
Depressed mood, agitation, suicidal thoughts.
What type of support can enhance smoking cessation efforts?
Extratreatment social support.
What can be done for strong or frequent cravings?
A second piece may be used within 1 hour.
What is the Decisional Balance in the context of smoking cessation?
It involves weighing the advantages and disadvantages of smoking versus quitting.
How can a clinician help a client view a relapse?
Explore the meaning and reality of the recurrence as a learning opportunity.
What are the two main components of the Extended Decisional Balance?
Pros and cons of quitting smoking.
What potential risk do electronic cigarettes pose, particularly among youth?
They may promote nicotine addiction.
Why is it important to individualize the selection of smoking cessation aids?
To accommodate the unique needs and circumstances of each patient.
What is the primary function of Nicotine Replacement Therapy (NRT)?
To bind with nicotinic receptors and release dopamine in the CNS.
What role does supportive contact play in smoking cessation?
Maintain supportive contact to help the client during their change process.
What is an example of oral NRT?
Nicotine lozenge.
What is the title of the material?
Smoking Cessation Clin Pharm 182.
How many chemicals have been found in smokeless tobacco that can cause cancer?
At least 28 chemicals (nitrosamines).
What effect does NRT have on quitting success rates?
It approximately doubles the quitting success rate.
What are some health risks associated with smokeless tobacco?
Heart disease, gum disease, and oral lesions.
What does a total score of 8 or more on the Fagerstrom Test indicate?
High Dependence; may offer NRT options alone or in combination (e.g., patches with lozenges or gums).
How long is Silver Nitrate Mouthwash typically used after eating?
For one week.
How does the price of Cytisine compare to other smoking cessation therapies?
It is cheaper compared to other therapies.
What does the 'D' in DEAD suggest regarding smoking?
Delay smoking.
What concentration of Silver Nitrate is mentioned for the mouthwash?
0.5%.
What is the first-line approach for smoking cessation in pregnant and breastfeeding women?
Behavioral support and counseling.
Why is maintaining supportive contact important for clients?
To explain that the clinician is available to talk between sessions.
What is Bupropion used for?
It is a smoking cessation aid.
What sensations does nicotine produce that contribute to addiction?
Highly pleasurable sensations leading to positive reinforcement.
What is Nortriptyline classified as?
A tricyclic antidepressant (TCA).
What is a major role obligation that may be affected by substance use?
Failure to fulfill responsibilities at work or home.
What does the Why I Smoke Test (WIST) assess?
Reasons for smoking such as stimulation, pleasure, or habit.
What is a key principle of Motivational Interviewing?
Express empathy.
What should clinicians do to express concern in the Precontemplation stage?
Keep the door open for future discussions.
How can a practitioner support a patient's confidence in making changes?
By supporting self-efficacy.
What should clinicians clarify during the Preparation stage?
The client's own goals and strategies for change.
What should a practitioner do when faced with resistance from a patient?
Roll with resistance.
What type of options should clinicians offer to clients in the Preparation stage?
A menu of options for change or treatment.
What is the recommended dosage of Clonidine for smoking cessation?
100 mcg BID, started 2 to 3 days before the quit date.
What is required when ending Clonidine therapy?
Tapering of the dose to avoid withdrawal symptoms.
What does the 'Advantage' in Decisional Balance refer to?
The benefits of quitting smoking.
What type of management is included in the session?
Pharmacological Management.
What constitutes moderate nicotine dependence?
4 to 5 symptoms.
Who is the author of the material?
Charles Mandy G. Ayran, RPh, Pharm.D.
What is classified as severe nicotine dependence?
6 or more symptoms.
What is the purpose of nicotine lozenges?
To help individuals quit smoking by reducing withdrawal symptoms.
What is the purpose of Nicotine Replacement Therapy (NRT)?
To help individuals quit smoking by providing a controlled dose of nicotine.
What does ICD-10 describe in relation to nicotine dependence?
A cluster of behavioral, cognitive, and psychological occurrences that develop after repeated use of nicotine-containing products.
What does the 'ADVISE' step entail in the 5A model?
Providing clear and personalized advice to the patient.
What is the method of delivery for transdermal NRT?
Through the skin via patches.
What is the focus of Motivational Interviewing Technique?
Client-centered counseling style for eliciting behavior change by exploring and resolving ambivalence.
What is the economic cost attributed to smoking according to the Peto-Lopez study?
USD 2.86 billion.
Where is the ventral tegmental area (VTA) located?
In the brain, part of the mesolimbic system.
What was the main finding regarding varenicline in the non-psychiatric cohort of the EAGLES study?
The risk for the composite safety endpoint was lower with varenicline than with bupropion and placebo.
What is the focus of motivational strategies during the Action stage of change?
Engaging the client in treatment and reinforcing the importance of remaining in recovery.
How can CO monitoring be used in smoking cessation?
As a motivational tool.
What is a common form of NRT?
Transdermal patches.
What type of feedback should clinicians provide to clients in the Precontemplation stage?
Personalized feedback about assessment findings.
What is the recommended dosage of gum or lozenge for those who smoke 25 or more cigarettes a day?
4mg gum and lozenge, or 2mg pastille.
What should clinicians explore regarding substance use in the Precontemplation stage?
The pros and cons of substance use.
What is a common side effect of Varenicline?
Nausea (15-40%; dose related).
What is the first stage of Prochaska’s Transtheoretical Model of Change?
Precontemplation.
What are common side effects of oral NRT?
Mouth soreness, hiccups, dyspepsia, jaw ache.
What is the recommended duration of treatment with Nortriptyline?
12 weeks, with some patients needing to extend for 6 months.
What is a single NRT?
Using one form of nicotine replacement therapy.
What are common side effects of Nortriptyline?
Sedation, dry mouth (64-78%), and blurred vision (16%).
What type of medication is Bupropion SR?
Norepinephrine dopamine reuptake inhibitor.
What is an aversive technique in smoking cessation?
Aversive smoking.
When was Varenicline mentioned in the context provided?
8 September 2022.
How is Vernonia cinerea typically administered for smoking cessation?
As infusion tea bags.
What does the acronym DEAD stand for in relation to withdrawal symptoms?
Delay, Escape, Avoid, Distract.
What educational approaches can assist in smoking cessation for patients with substance use issues?
Educational approach and cognitive-behavioral approach.
What should all smokers making a repeat quit attempt be queried about?
Their prior use of pharmacotherapy and their perceptions of treatment options.
Who is the author of the material?
Charles Mandy G. Ayran, RPh, Pharm.D.
What are two common pharmacological agents used in smoking cessation?
Varenicline and Bupropion.
What is a safety concern regarding transdermal NRT during pregnancy?
It may have safety issues in pregnancy.
What is the first step in the 5A model for pharmacists?
ASK.
What is the purpose of the 'ASSESS' step in the 5A model?
To evaluate the patient's readiness to quit and their level of dependence.
What is a key symptom of nicotine dependence?
Tolerance, which means needing to increase amounts of nicotine to achieve the desired effect.
What is a limitation of Cytisine?
Limited availability.
What is the result of nicotine binding to its receptor?
Dopamine release at the nucleus accumbens (nAcc).
What is a key aspect of the Motivational Interviewing Technique?
A collaborative approach to help clients.
What is the recommended dosage of gum or lozenge for those who smoke less than 25 cigarettes a day?
2mg gum and lozenge, or 1mg pastille.
Was the use of varenicline associated with a significantly increased risk of neuropsychiatric adverse events in the psychiatric cohort?
No, it was not associated with a significantly increased risk of neuropsychiatric adverse events.
Why is it important to acknowledge difficulties for clients in the early stages of change?
To provide support and understanding as they navigate challenges.
What is a key advantage of oral NRT for individuals managing withdrawal symptoms?
It allows individuals to titrate nicotine levels acutely.
What is the maximum daily dose for gum?
24 pieces per day.
What characterizes the Precontemplation stage?
Not intending to change a behavior in the foreseeable future (next 6 months).
What is the focus of the Preparation stage in the Stage of Change model?
Current smoking with a quitting plan within 1 month.
What might be a consequence of substance use on important activities?
Reduction or abandonment of important activities.
What is the correct technique for using lozenge NRT?
Dissolve and park.
What does the Contemplation stage involve?
Intending to change a behavior in the foreseeable future (next 6 months) but not in the immediate future.
What is the correct technique for using pastille NRT?
Park and roll.
What is the dosing for day 8 to the end of treatment with Varenicline?
1 mg PO BD.
What technique helps to highlight the differences between a patient's current behavior and their goals?
Develop discrepancy.
What is the minimum smoking requirement for patients to use Bupropion SR?
At least 10 sticks per day.
What is the dosing schedule for Step 1 of oral NRT?
1 piece every 1-2 hours for Weeks 1 to 6.
What is a key consideration for hospitalized patients regarding smoking?
They experience a period of abstinence during hospital confinement.
What is the purpose of the 5R model?
To help individuals understand their motivations and barriers to quitting smoking.
What is the total economic cost of smoking-related illnesses?
USD 6.05 billion.
Which university is associated with this material?
University of the Philippines Manila.
What considerations should be made if a smoker had a positive experience with pharmacotherapy?
Consider increasing dose, frequency, or duration of therapy.
What coping strategies should clinicians help clients practice?
New coping strategies to avoid a return to use.
What urinary cotinine level indicates active smoking?
100 ng/mL.
How does nicotine affect dopamine in the brain?
Nicotine increases dopamine in brain reward circuits.
What are second-line agents in smoking cessation?
Medications used when first-line treatments are ineffective or not tolerated.
How can clinicians raise doubts in clients during the Precontemplation stage?
By exploring the meaning of events that brought the client to treatment or the results of previous treatments.
What happens to dopamine production with continued nicotine use?
There is a downregulation of dopamine production.
What is the primary purpose of Nicotine Replacement Therapy (NRT)?
To aid in smoking cessation.
What type of study is referenced in the summary?
Cochrane database of systematic review, 2013.
What was the estimated lung cancer incidence in the Philippines in 2008?
10,871 cases.
What is the risk ratio (RR) of abstinence for any form of Nicotine Replacement Therapy (NRT) relative to control?
1.58 (95% confidence interval: 1.50 to 1.66).
What does continued use of substances despite social problems suggest?
Substance use is worsening interpersonal issues.
What role can significant others play in the Precontemplation stage?
Helping to intervene with the client.
What is the maximum daily dose for lozenges and pastilles?
20 pieces per day.
What score on the WIST indicates important reasons for smoking?
11 or more.
What is the second stage of Prochaska’s Transtheoretical Model of Change?
Contemplation.
What is a safety consideration when using oral NRT?
Use with caution in cardiovascular patient groups.
What are contraindications for using Nortriptyline?
Drugs or conditions that prolong QT interval, acute recovery post-MI, risk of anticholinergic side effects.
What should be done if local skin reactions worsen during transdermal NRT therapy?
Use hydrocortisone cream (1%) or triamcinolone cream (0.5%).
What is the third stage of Prochaska’s Transtheoretical Model of Change?
Preparation.
What aspects of the client should clinicians emphasize?
The client's free choice, responsibility, and self-efficacy for change.
What is the dosing schedule for Step 2 of transdermal NRT?
Weeks 5 to 6: 14mg/24h or 10mg/16h.
What is the dosing schedule for Step 3 of transdermal NRT?
Weeks 7 to 8: 7mg/24h or 5mg/16h.
What precautions should be taken when using transdermal NRT?
Avoid use 2 weeks post-MI, in serious arrhythmia, unstable angina, and hypertension.
What is the fifth stage of Prochaska’s Transtheoretical Model of Change?
Maintenance.
How did the number of participants reporting suicidal ideation or behavior compare across treatment groups in the psychiatric cohort?
The number was greater in the psychiatric cohort but similar across treatment groups.
What is the relationship between nicotine and the number of receptors?
Nicotine upregulates the number of receptors.
How does NRT use affect long-term abstinence rates for smokers making self-initiated quit attempts?
It is associated with improved long-term abstinence rates.
What should clinicians assist clients in developing to overcome high-risk situations?
Appropriate coping strategies.
What forms of NRT are available?
Gum, lozenge, pastille, patch, inhaler, film-coated tablet, extended-release tablet.
How does nicotine's addictiveness compare to other substances?
Nicotine is more addictive than cocaine and heroin.
What are the available dosages for the nicotine patch?
7mg, 14mg, 21mg.
What should be done if experiencing insomnia while taking Varenicline?
Take the second pill at dinner rather than bedtime.
Which smoking cessation aids are available over-the-counter (OTC)?
Nicorette, Nicoderm, Ezeequit, and Smonil.
What is advised against during Motivational Interviewing?
Avoid arguing.
Who is Bupropion SR preferred for?
Patients who have difficulty taking multiple doses.
What should be done if quitting is successful after 12 weeks of Varenicline?
Continue for another 12 weeks with 1 mg PO BD.
What is the fourth stage of Prochaska’s Transtheoretical Model of Change?
Action.
What is the nicotine delivery per cartridge in the inhaler?
Each cartridge delivers 4 mg of nicotine over 80 inhalations.
What type of questions should be used to encourage discussion in Motivational Interviewing?
Open-ended questions.
What maintenance therapy is recommended if a patient successfully quits?
150 mg qAM for up to 6 months post-quit.
What action can clients take to reinforce their commitment to change?
Publicly announce plans to change.
What does spending a great deal of time obtaining and recovering from substance use indicate?
Time is consumed by the cycle of use and recovery.
What is the recommended duration for transdermal NRT treatment?
May recommend for 3 months, but 8 weeks or less shown to be as efficacious.
What is a key aspect of reinforcing positive change for clients?
Helping them find new reinforcers of positive change.
What are common side effects of transdermal NRT?
Local skin reactions, insomnia, and vivid dreams.
What does substance use in physically hazardous situations imply?
Engaging in substance use despite risks to physical safety.
What must be avoided 15 minutes before or after using oral NRT?
Eating or drinking acidic beverages.
What is the pooled risk ratio for NRT lozenges?
2.00 (95% CI: 1.63 to 2.45).
Is Varenicline effective for pregnant smokers?
Not shown to be effective.
What safety issue may arise with the use of oral NRT during pregnancy?
There may be safety concerns.
What is a potential recommendation for patients using oral NRT?
Patient education or switching to nicotine patch or bupropion SR.
What does the Action stage involve?
Has changed the behavior for less than 6 months.
What should clinicians explore regarding the client's expectations?
Treatment expectancies and the client's role.
What percentage of patients may require discontinuation of transdermal NRT?
5%.
What are some cautions or contraindications for using nicotine inhalers?
Use is cautioned in patients 2 weeks post-MI, with serious arrhythmia, unstable angina, or hypertension.
What is the Fagerstrom Test for Nicotine Dependence (FTND) used for?
To assess nicotine dependence.
What should clients assess regarding their support system during the Action stage?
Whether they have strong family and social support.
What FTND score indicates substantial nicotine dependence?
5 or more.
How long does it take for nicotine from the inhaler to reach its plateau?
Approximately 30 minutes.
What is the FDA pregnancy category for oral NRT?
Category D.
What should clinicians consider to facilitate change?
Lowering barriers to change.
What is the dosing schedule for Step 2 of oral NRT?
1 piece every 2-4 hours for Weeks 7 to 9.
What is the dosing schedule for Bupropion SR from day 4 onwards?
150 mg every 12 hours for up to 7 to 12 weeks.
What is the final stage of Prochaska’s Transtheoretical Model of Change?
Relapse.
What is the pooled risk ratio for NRT inhalers?
1.90 (95% CI: 1.36 to 2.67).
What should clinicians examine in relation to change?
The client's personal values.
What is a disadvantage of oral NRT regarding dosing?
It requires frequent dosing or non-traditional routes of administration.
What is the pooled risk ratio for NRT nasal spray?
2.02 (95% CI: 1.49 to 3.73).
What precautions should be taken regarding kidney function when using Varenicline?
CrCl < 30 mL/min.
What should clinicians gather regarding the client's expectations?
Ideas regarding the client's perceived self-efficacy and expectations regarding treatment.
What potential cardiovascular risk is associated with Varenicline?
May increase CV events in patients with underlying CV disease (not a contraindication).
What is the purpose of affirmations in the OARS technique?
To reinforce positive behavior and self-efficacy.
What are some common side effects of using a nicotine inhaler?
Mouth and throat irritation, coughing, and rhinitis.
How is nicotine absorbed when using an inhaler?
Nicotine is absorbed across the buccal mucosa, not inhaled into the lungs.
What is the FDA Pregnancy Category for Varenicline?
Category C.
What is an important step clinicians should take with permission from the client?
Offer expertise and advice.
What is the nicotine content of the gum and lozenge forms?
2mg and 4mg.
In Motivational Interviewing, who is considered the expert about themselves?
The patient.
What should patients avoid while taking Varenicline?
Driving or operating machinery.
What is the recommended daily dose of cartridges for nicotine inhaler therapy?
6 to 16 cartridges per day.
What characterizes the Maintenance stage?
Changed the behavior for greater than 6 months.
What is the purpose of summaries in Motivational Interviewing?
To consolidate information and clarify understanding.
What should be done if a patient reports serious or unusual behavioral changes while on Bupropion SR?
Immediate discontinuation of the medication.
What is the dosing for days 4 to 7 of Varenicline?
0.5 mg PO BD.
What serious condition can occur when Nortriptyline is co-administered with certain drugs?
Potentially life-threatening serotonin syndrome.
What are the cautions for using oral NRT?
2 weeks post-MI, serious arrhythmia, unstable angina, hypertension.
What characterizes the Preparation stage?
Planning to change a behavior in the near future (next 1 month) and has taken steps toward change.
How many puffs from the inhaler are equivalent to one puff from a cigarette?
10 puffs from the inhaler equal one puff from a cigarette.
What does the OARS technique stand for?
Open-ended questions, Affirmations, Reflective listening, Summaries.
What is the FDA pregnancy category for transdermal NRT?
Category D.
What past experiences should clinicians elicit from clients?
What has worked in the past for them or others they know.
What does the Relapse stage involve?
Moving to a previous stage.
What are the primary benefits of Bupropion SR for smoking cessation?
Reduces craving for smoking and decreases withdrawal symptoms.
What is the dosing schedule for Step 1 of transdermal NRT?
Weeks 1 to 4: 21mg/24h or 15mg/16h.
What is the recommended method of using the nicotine inhaler?
Puff continuously for about 10-20 minutes every hour.
What type of statements should clinicians elicit from clients?
Self-motivational statements of intent and commitment.
When should Bupropion SR be started in relation to the quit date?
1 - 2 weeks before the quit date.
What should clinicians do with self-motivational statements?
Summarize them.
What should be done to manage insomnia or vivid dreams caused by transdermal NRT?
Remove the patch before bedtime if using a 24-hour patch; use a 16-hour patch.
What are common side effects of Bupropion SR?
Insomnia (35-40%) and dry mouth (10%).
What is the FDA pregnancy category for nicotine inhalers?
Category D.
What is the prescription (Rx) status of Bupropion SR?
It is available by prescription.
What can overdose of Nortriptyline cause?
Life-threatening cardiovascular toxicity, seizures, and coma.
What should clinicians negotiate with the client?
A change or treatment plan and behavior contract.
How can clinicians help clients during the Preparation stage?
By enlisting social support.
What is the dosing schedule for Step 3 of oral NRT?
1 piece every 4-8 hours for Weeks 10 to 12.
What is reflective listening?
A technique that involves listening carefully and reflecting back what the patient says.
What is the FDA pregnancy category for Bupropion SR?
Category C; not shown to be effective in pregnant smokers.
What is the initial dosing for Bupropion SR on days 1 to 3?
150 mg in the morning (qAM).
What is the duration of therapy for nicotine inhaler use?
6 months, with tapering in the last 3 months.
What practical barriers should clinicians assist clients in negotiating?
Finances, child care, work, transportation, or other potential barriers.
What is the tapering schedule for nicotine inhaler cartridges?
Weeks 1-8: 6 to 12 cartridges/day; Weeks 9-10: 3 to 6 cartridges/day; Weeks 11-12: Reduce gradually to zero.
What are contraindications for using Bupropion SR?
Epilepsy, eating disorders (anorexia/bulimia), and co-administration with MAOIs (past 14 days).
