Updated: 11/30/2019

Smoking Cessation

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Questions
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Evidence
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Topic
Snapshot
  • A 69-year-old male presents with concerns about his declining health.  His brother recently died of renal cell carcinoma and he is now concerned about his own health.  The patient has a history of type II diabete mellitus, HTN and a 50 pack-year smoking history.  He asks you what he can do to improve his health.
Introduction
  • Smoking is considered the most important modifiable risk factor in the US for cancer and cardiovascular and pulmonary disease
  • All adults should be screened regularly for tobacco use
  • Smoking cessation should be discussed with all smokers at EVERY clinical contact
    • most likely to reduce mortality 
  • Therapies for smoking cessation include:
    • nicotine replacement
    • bupropion
    • varenicline
    • cognitive behavioral therapy (CBT) 
    • combination therapy (multiple treatments from above) are the most effective 
Nicotine Replacement
  • Comes in many forms including:
    • gum
    • inhaler
    • lozenge
    • patch
    • spray
  • Many forms can be purchased over the counter
  • Gums, inhalers, lozenges are excellent for combatting acute cravings 
  • Patches ideal for delivering a basal rate of nicotine
Bupropion (Zyban) 
  • The mechanism of action is believed to involve blockage of the nicotine receptor
  • Prescription only
    • theray should begin 1-2 weeks prior to quit date and then continued 4-6 months after quit date
  • Can be combined with nicotine replacement therapy for increased effectiveness
  • Thought to be especially beneficial in patients with history of depression
  • Side effects:
    • insomnia
    • dry mouth
  • Warnings/contraindications
    • seizure disorder
    • eating disorder
    • recent use of a monamine oxidase inhibitor 
Varenicline (Chantix)
  • Nicotinic receptor partial agnoist
  • Prescription only
    • Therapy should begin 1 week prior to quit date and then continued 4 months after quit date
  • Very effective when combined with nicotine therapy (older sources say NOT to combine them)
  • Side effects:
    • headache
    • nausea
    • insomnia
    • depression/SI 
  • Warnings:
    • may cause neuropsychiatric symptoms or increased suicidality 
    • avoid in patients with history of unstable psychiatric symptoms or suicidality
Cognitive Behavioral Therapy (CBT)
  • CBT is a form of psychotherapy that targets changing maladaptive thinking patterns and the negative behaviors associated with them
    • not been found to be highly effective when used alone for smoking cessation
    • may be helpful when employed with some of the therapies listed above

Please rate topic.

Average 4.5 of 4 Ratings

Questions (4)

(M3.PY.16.19) A 65-year-old male comes into your office for a check-up. He states that he has been feeling tired and short of breath but does not have any fevers or cough. He has a history of smoking 1 pack of cigarettes per day for the last 40 years. He states that, over the last few years, he has had difficulty walking even one block. He cannot climb a set of stairs and states that he has been hospitalized many times over the past year for pneumonia. He is prescribed inhaled corticosteroids along with ipratropium and albuterol. His chest radiograph is shown in Figure A. Which of the following is most likely to decrease this patient's risk of hospitalizations for disease exacerbation and development of lung cancer? Tested Concept

QID: 102960
FIGURES:
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Home oxygen therapy

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Long acting beta2-agonist

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Antibiotics

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Oral corticosteroids

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Smoking cessation

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M 11 E

Select Answer to see Preferred Response

(M3.PY.15.29) A 58-year-old woman presents to her family physician for an annual checkup. During the visit, the patient asks her physician for help quitting smoking cigarettes. She has unsuccessfully tried quitting several times previously and has also failed prior attempts with meditation and exercise. The physician prescribes a partial agonist of the nicotinic receptor to aid the patient in cessation. Which of the following is a potential side effect of this medication? Tested Concept

QID: 102970
1

Impaired kidney function

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Seizure

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Sexual dysfunction

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Suicidal ideation

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Tachycardia

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(M2.PY.15.113) A 35-year-old man presents to his primary care physician for a routine visit. He is in good health but has a 15 pack-year smoking history. He has tried to quit multiple times and expresses frustration in his inability to do so. He states that he has a 6-year-old son that was recently diagnosed with asthma and that he is ready to quit smoking. What is the most effective method of smoking cessation? Tested Concept

QID: 105783
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Quitting 'cold-turkey'

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(0/27)

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Bupropion in conjunction with nicotine replacement therapy and cognitive behavioral therapy

93%

(25/27)

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Buproprion alone

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Participating in a smoking-cessation support group

4%

(1/27)

5

Nicotine replacement therapy alone

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(M3.PY.13.10) A 48-year-old woman presents to her primary care physician for a wellness visit. She states she is generally healthy and currently has no complaints. She drinks 1 alcoholic beverage daily and is currently sexually active. Her last menstrual period was 1 week ago and it is regular. She smokes 1 pack of cigarettes per day and would like to quit. She describes her mood as being a bit down in the winter months but otherwise feels well. Her family history is notable for diabetes in all of her uncles and colon cancer in her mother and father at age 72 and 81, respectively. She has been trying to lose weight and requests help with this as well. Her diet consists of mostly packaged foods. His temperature is 98.0°F (36.7°C), blood pressure is 122/82 mmHg, pulse is 80/min, respirations are 12/min, and oxygen saturation is 98% on room air. Her BMI is 23 kg/m^2. Physical exam reveals a healthy woman with no abnormal findings. Which of the following is the most appropriate initial intervention for this patient? Tested Concept

QID: 102742
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Alcohol cessation

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Bupropion

50%

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Colonoscopy

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Varenicline and nicotine gum

25%

(1/4)

5

Weight loss, exercise, and nutrition consultation

25%

(1/4)

M 11 E

Select Answer to see Preferred Response

Evidence (10)
EXPERT COMMENTS (0)
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