1.
Smoking cessation treatments are clinically effective AND cost-effective.
Correct Answer
A. True
Explanation
Smoking cessation treatments are considered clinically effective because they have been proven to help individuals quit smoking successfully. Additionally, they are considered cost-effective because the cost of these treatments is generally lower than the long-term healthcare costs associated with smoking-related illnesses. Therefore, the statement that smoking cessation treatments are clinically effective and cost-effective is true.
2.
Tobacco dependence is a 3-part problem. Which of the following is NOT a component of the tobacco dependence model?
Correct Answer
B. Fiscal
Explanation
The correct answer is "Fiscal" because it is not a component of the tobacco dependence model. The tobacco dependence model consists of physical, psychological, and behavioral components. Fiscal factors, such as financial costs or taxes related to tobacco use, may play a role in influencing tobacco dependence, but they are not considered a direct component of the model.
3.
The biology of nicotine addiction involves 4 steps. Arrange the following four steps in the correct order:
I. Repeat administration
II. Pleasurable feelings
III. Nicotine stimulates dopamine release
IV. Tolerance develops
Correct Answer
C. III, II, I, IV
Explanation
Nicotine addiction involves a series of steps. First, nicotine stimulates the release of dopamine in the brain (III). This leads to pleasurable feelings (II) which reinforces the desire to continue using nicotine. With repeated administration (I), tolerance to the effects of nicotine develops (IV), meaning that higher doses are needed to achieve the same effect. Therefore, the correct order of the steps is III, II, I, IV.
4.
Nicotine withdrawal symptoms are uncomfortable and long-lasting. What is the peak of nicotine withdrawal?
Correct Answer
B. 1 week
Explanation
Peaks within the 1st week and last for up to 1 month
5.
Arrange the 5 A's that clinicians use to treat nicotine dependence in the correct order:
I. Arrange
II. Assist
III. Ask
IV. Advise
V. Assess
Correct Answer
E. III, IV, V, II, I
6.
Nicotine gum is available in two different strengths: 2 mg and 4 mg. What parameter dictates which strength of the nicotine gum a patient should purchase?
Correct Answer
C. The number of cigarettes the patient smokes a day
Explanation
<25 cigarettes a day = 2 mg >25 cigarettes a day = 4 mg
7.
While using nicotine gum, which of the following do patients tend to complain of?
Correct Answer
E. All of the above
Explanation
Patients tend to complain of hiccups, burping, upset stomach, jaw fatigue, mouth soreness, bad taste, and finding it hard to avoid eating/drinking while using nicotine gum.
8.
Nicotine lozenge is available in two different strengths: 2 mg and 4 mg. What parameter dictates which strength of the nicotine lozenge a patient should purchase?
Correct Answer
D. The time to the first cigarette of the day
Explanation
If the first cigarette is within the first 30 minutes of waking, 4 mg
9.
True or False: Patient who is on either nicotine gum or nicotine lozenge is recommended to use at least 9 pieces of gum/lozenge a day for the first 6 weeks after the quit date.
Correct Answer
A. True
Explanation
Nicotine gum and lozenges are commonly used as aids to help people quit smoking. The recommended dosage for these products is to use them frequently throughout the day, starting from the quit date. This helps to provide a steady supply of nicotine and reduce cravings. Using at least 9 pieces of gum or lozenges a day for the first 6 weeks after quitting is considered an effective dosage to increase the chances of successfully quitting smoking. Therefore, the statement is true.
10.
The nicotine patch is available in three different strengths: 7 mg, 14 mg, and 21 mg delivered over 24 hours. What parameter dictates which strength of the nicotine lozenge a patient should purchase?
Correct Answer
C. Number of cigarettes the patient smokes a day
Explanation
The number of cigarettes a patient smokes per day is the parameter that dictates which strength of the nicotine patch they should purchase. The strength of the patch is determined by the level of nicotine dependence, which is closely related to the number of cigarettes smoked daily. A higher number of cigarettes smoked indicates a higher level of nicotine dependence and therefore a need for a higher strength patch to effectively manage withdrawal symptoms.
11.
FK presents to your pharmacy, states that he is ready to quit and is interested in buying the nicotine patch. Upon inquiring about his nicotine habits, he says that he smokes 6 cigarettes a day. Which nicotine dose would you recommend for this patient?
Correct Answer
B. Step 2 (14 mg) for 6 weeks
Explanation
Based on the information provided, the patient smokes 6 cigarettes a day. According to the recommended guidelines, individuals who smoke less than 10 cigarettes per day should start with a lower nicotine dose. Step 2 (14 mg) for 6 weeks is the appropriate recommendation for this patient as it provides a moderate dose of nicotine to help with withdrawal symptoms and cravings. This dose can be gradually reduced in subsequent weeks to help the patient gradually wean off nicotine.
12.
FK returns the next week with reports of mild tingling, itching, or sometimes, burning. What would you advise him to do?
Correct Answer
D. Rotate the patch to a different site
Explanation
The correct answer is to rotate the patch to a different site. This is because FK is experiencing mild tingling, itching, or burning, which are common side effects of using a nicotine patch. By rotating the patch to a different site, FK can minimize the discomfort and irritation caused by the patch. Applying a new patch to the same site may exacerbate the symptoms. Wearing the patch for a shorter duration or discontinuing the patch and trying nicotine gum are not necessary in this case as the side effects are mild and can be managed by rotating the patch.
13.
FK returns the following month with reports of sleep disturbances. What would you advise him to do?
Correct Answer
C. Wear the patch for only 16 hours instead of 24 hours
14.
Nicotine nasal spray is a product that requires a prescription. What constitutes 1 dose of nicotine for this product?
Correct Answer
D. One spray in each nostril
Explanation
One dose of nicotine for the nicotine nasal spray product is constituted by one spray in each nostril. This means that the correct way to use the product is to administer one spray in each nostril for a complete dose.
15.
What is the maximum duration that the nicotine nasal spray is recommended for use?
Correct Answer
C. 3 months
Explanation
The maximum duration that the nicotine nasal spray is recommended for use is 3 months. This is because using the nasal spray for longer periods may lead to dependence on the spray itself. It is important to gradually reduce the use of nicotine replacement therapy products to eventually quit nicotine dependence altogether.
16.
The nicotine nasal spray is an ideal agent for the highly addicted because it delivers nicotine faster than gum, inhaler, or cigarette.
Correct Answer
B. False
Explanation
The explanation for the answer being False is that the statement is incorrect. The nicotine nasal spray does not deliver nicotine faster than gum, inhaler, or cigarette. In fact, the nasal spray delivers nicotine at a slower rate compared to other forms of nicotine replacement therapy.
17.
Nicotine inhaler mimics the hand to mouth action of smoking a cigarette. Which part of the 3-component nicotine dependence model does this treat?
Correct Answer
D. Behavioral
Explanation
The nicotine inhaler treats the behavioral component of the 3-component nicotine dependence model. This is because it helps to address the habitual behavior of hand-to-mouth action that is associated with smoking a cigarette. By mimicking this action, the inhaler can help individuals break the behavioral patterns and reduce their dependence on nicotine.
18.
Much like smoking a cigarette, the nicotine inhaler provides a mist of nicotine that is absorbed through the lungs.
Correct Answer
B. False
Explanation
Nicotine from an inhaler is absorbed mostly through the buccal mucosa.
19.
Bupropion and varenicline are unique to treating nicotine dependence compared to the other nicotine replacement therapies in that they should be initiated BEFORE the quit date. How much time, prior to quitting, should these drugs be initiated?
Correct Answer
C. 1 week
Explanation
Bupropion and varenicline should be initiated one week prior to the quit date. This is different from other nicotine replacement therapies, as they can be started after the patient quits.
20.
What is the mechanism of action of bupropion?
Correct Answer
D. Dopamine and norepinepHrine reuptake inhibitor
Explanation
Bupropion is a medication that works by inhibiting the reuptake of dopamine and norepinephrine. This means that it increases the levels of these neurotransmitters in the brain, leading to increased dopamine and norepinephrine activity. By doing so, bupropion helps to regulate mood and reduce cravings, making it an effective treatment for depression and smoking cessation.
21.
Bupropion use is contraindicated in which of the following populations?
Correct Answer
D. Two of the above
Explanation
A and C are correct. B prompted the black box warning: some people experience serious neuropsychiatric events, including depression, and suicidal thoughts
22.
What is the mechanism of action of varenicline?
Correct Answer
A. Binds to the alpHa-4-beta-2 neuronal nicotinic acetylcholine receptor
Explanation
Varenicline binds to the alpha-4-beta-2 neuronal nicotinic acetylcholine receptor. This receptor is involved in the addictive effects of nicotine. By binding to this receptor, varenicline blocks the rewarding effects of nicotine and reduces cravings for cigarettes. This mechanism of action helps individuals to quit smoking by reducing the pleasurable sensations associated with nicotine use.
23.
FK has recently stopped using the nicotine patch and is now on prescription-only varenicline. Instead of having sleep pattern disturbances, he now complains of unusual, vivid, strange dreams. What would you advise him to do?
Correct Answer
D. Take the 2nd dose at suppertime rather than bedtime
Explanation
B and E are true but do not relate to the weird dreams.
24.
Which of the following are second-line agents used for smoking cessation?
Correct Answer
D. A & B
Explanation
Clonidine and Nortriptyline are second-line agents used for smoking cessation. These medications are commonly prescribed when first-line treatments, such as nicotine replacement therapy or bupropion, have been ineffective or are contraindicated. Clonidine is an alpha-2 adrenergic agonist that helps reduce nicotine withdrawal symptoms, while Nortriptyline is a tricyclic antidepressant that can help with nicotine cravings. Amtriptyline, on the other hand, is not typically used for smoking cessation. Therefore, the correct answer is A & B.
25.
With all the available treatment options for nicotine dependence, combination therapy is more effective than treatment with a single agent.
Correct Answer
A. True
Explanation
Combination therapy for nicotine dependence refers to using multiple treatment options simultaneously, such as nicotine replacement therapy (patches, gum, etc.) along with medications like bupropion or varenicline. This approach is considered more effective because it targets nicotine addiction from different angles, addressing both the physical and psychological aspects. By combining different treatments, it increases the chances of successfully quitting smoking and reduces withdrawal symptoms. Therefore, the statement is true, as combination therapy has been shown to be more effective than using a single treatment agent alone.
26.
Treatment that has proved to be "more effective than the nicotine patch alone" as stated in the 2008 Guidelines include all of the following EXCEPT:
Correct Answer
E. All of the above
Explanation
The question asks for a treatment that has been proven to be more effective than the nicotine patch alone, and we need to identify the option that is not included in the 2008 Guidelines. The answer is "All of the above" because it includes all the options given in the question. Therefore, the treatment that is not included in the guidelines is "All of the above."
27.
Which of the following agents is NOT recommended in combination therapy with any other nicotine replacement therapy (NTR)?
Correct Answer
E. Varenicline
Explanation
This combination increases nausea and headache side effects.
28.
Which of the following patient populations in which medication may NOT be right for?
Correct Answer
E. All of the above
Explanation
All of the above patient populations may not be suitable for medication. Light smokers may not require medication as their smoking habit is not severe enough to warrant it. Pregnant women need to be cautious about taking medication, especially if it falls under category C or D, as it may pose risks to the fetus. Adolescents may have different physiological and psychological responses to medication, making it necessary to carefully consider the appropriateness of medication for this population. Therefore, all three patient populations mentioned may not be ideal candidates for medication.