5 Pearls on Smoking Cessation
Up to 1
AMA PRA Category 1 Credits ™ and MOC Points
Expires September 9, 2022 active
Podcasts and Audio Content
Welcome to Core IM, a virtual medical community! Core IM strives to empower its colleagues of all levels and backgrounds with clinically applicable information as well as inspire curiosity and critical thinking. Core IM promotes its mission through podcasts and other multimodal dialogues. ACP has teamed up with Core IM to offer continuing medical education, available exclusively to ACP members by completing the CME/MOC quiz.
- Tobacco use is the number one cause of preventable morbidity and mortality worldwide
- Patients are more satisfied with their primary care providers who bring up smoking cessation and provide brief advice
- It is important to acknowledge prior attempts at smoking cessation as well as explore current and past barriers to quitting tobacco. Patients who quit smoking abruptly have a higher likelihood of success than those who use a slow taper, perhaps highlighting the ambivalence that may be present when choosing tapering to a quit date.
- Establish a quit date and advise patients of support systems available such as 1-800-QUIT-NOW, www.smokefree.gov.
- All forms of nicotine replacement therapy (NRT) can help people increase their chances of quitting by 50 to 60%, regardless of setting.
- Five nicotine replacement therapies are available to help patients quit: the nicotine patch, lozenge, gum, inhaler and nasal spray.
- Dosing of the nicotine patch depends on the number of cigarettes a patient smokes each day: 21mg for >10 cigs a day, 14mg for <10 cigs a day. If < 5 cigarettes a day, avoid the patch and use an alternative NRT such as lozenge or gum
- Dosage for the mini lozenge and gum is either 4mg if patients start smoking within 30 minutes of waking, or 2mg if their first cigarette is > 30 minutes after waking.
- Side effects of the nicotine patch, lozenge and gum include nausea and vivid dreams. The nicotine patch can also cause local skin irritation.
- Advise patients that the correct use of the nicotine gum is to “park” it their cheek until the peppery taste of nicotine wears off, then to re-chew and re-park. Nicotine is absorbed through the buccal mucosa. Avoid swallowing to limit GI side effects.
- Varenicline is thought to promote smoking abstinence through stimulation of dopaminergic neurons and consequently decrease tobacco cravings and nicotine withdrawal. It also inhibits the binding of nicotine, leading to diminished reward from smoking a cigarette.
- Side effects of Varenicline include nausea and vivid dreams. Varenicline does NOT cause a significant increase in neuropsychiatric adverse events.
- Bupropion is another option for smoking cessation in patients with depressed mood, however it can lower the seizure threshold.
- Electronic cigarettes (e-cigs) are heavily debated among the public health community because of their unclear safety profile, efficacy in smoking cessation and future health risks.
- E-cigs have been shown to help people quit combustible cigarettes. Patients who chose vaping as a way to quit smoking often continue vaping rather than quitting all nicotine products.
Pearl 5 (Throwback for Spaced Repetition)
- Indications for screening for Barrett's Esophagus is men with GERD > 5 years plus two more risk factors: Causasian race, age > 50, any smoking history and family history of BE or esophageal adenocarcinoma
Susan Mirabel, MD - Host, Editor
Shreya Trivedi, MD - Host, Editor
Martin Fried, MD - Host, Editor
Scott Sherman, MD, MPH - Guest
Michael Fiore, MD, PhD, MBA - Guest
Allison Greco, MD
Nancy Stewart, MD
Those named above unless otherwise indicated have no relationships with any entity producing, marketing, reselling, or distributing health care goods or services consumed by, or used on, patients.
Release Date: September 18, 2019
Expiration Date: September 18, 2022
This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of the American College of Physicians and the Curbsiders. The American College of Physicians is accredited by the ACCME to provide continuing medical education for physicians.
The American College of Physicians designates each enduring material (podcast) for 1 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
ABIM Maintenance of Certification (MOC) Points
Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 1 medical knowledge MOC Point in the American Board of Internal Medicine’s (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider’s responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.
How to Claim CME Credit and MOC Points
After listening to the podcast, complete a brief multiple-choice question quiz. To claim CME credit and MOC points you must achieve a minimum passing score of 66%. You may take the quiz multiple times to achieve a passing score.