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Chapter 62: Smoking Cessation

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JT is a 47-year-old man who is interested in quitting smoking. He has smoked 1.5 packs per day for the last 17 years. He successfully quit cold turkey in the past that lasted for approximately 16 months, but went back to smoking after starting a new job. Based on the various components of nicotine dependence, which reason most likely caused JT to return to smoking?

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a. Psychological dependence.

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b. Physiologic dependence.

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c. He did not use a pharmacologic aid to quit smoking.

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d. Most persons will relapse within 24 months of a quit attempt.

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Answer a is correct. While the physical addiction to nicotine resolves in 1 to 2 weeks after stopping smoking, the person will continue to have the cravings to perform the action of smoking. Because nicotine acts on the pleasure center and reward pathway in the brain, patients tend to equate smoking with pleasure and/or calming sensations. Because the body continues to achieve or recreate these sensations, the need to smoke persists indefinitely, but at diminished levels.

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Answer b is incorrect. In the early weeks of tobacco cessation, patients will seek cigarettes to avoid withdrawal symptoms and the accompanying discomfort. These symptoms last for approximately 1 to 2 weeks. Because JT was abstinent from cigarettes for 16 months, the time period for physical withdrawal symptoms had passed.

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Answer c is incorrect. The maintenance of a successful quit attempt is not altered by the modality which a patient used to quit smoking. Because JT was able to quit "cold turkey," chances of smoking relapsing are not increased.

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Answer d is incorrect. While the risk of smoking relapse is continual and the number of patients who remain tobacco free dwindles with time, a patient cannot consider himself or herself to be at no risk of relapse after 24 months.

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HN has decided that she would like to quit smoking, but is not comfortable quitting without supportive nicotine replacement therapy. She decides that the gum will be her best choice because it is easily concealable among friends, family, and coworkers. She has smoked 1 to 1.5 packs per day for the last 13 years. What is the appropriate starting dose for the nicotine polacrilex gum for HN?

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a. 4-mg piece of gum; not to exceed 24 doses in 24 hours

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b. 4-mg piece of gum; not to exceed 20 doses in 24 hours

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c. 2-mg piece of gum; not to exceed 24 pieces in 24 hours

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