11. Minimal smoking intervention (role playing)

Question 1

Model for treatment of tobacco use and dependence

Answer 1

Ask- screen all patients for tobacco use
Advise- to quit
Assess- willingness to quit
Assist- with quitting
Arrange- follow up

check diagram from notes

Question 2

Test for nicotine dependence

Answer 2

Fagerström Test

Question 3

what is Fagerström Test

Answer 3

• test for Nicotine Dependence is a standard instrument for assessing the intensity of physical addiction to nicotine.
  *The test was designed to provide an ordinal measure of nicotine
  dependence related to cigarette smoking

check questionnaire from notes

Question 4

What drug is recommended for smoking cessation (high nicotine dependence)

Answer 4

varenicline

Question 5

How to enhance motivation to quit smoking

Answer 5

The 5 R’s
- Relevance
-Risk
-Reward
-Roadblocks
-Repetition

Question 6

Relevance

Answer 6

• Encourage the patient to indicate Why quitting is personally relevant, being as specific as possible
• Motivational information has the greatest impact if it’s relevant to a patients disease status or risk, family.social situation ( eg. having children in the home), health concerns, age, gender and other important patient characteristics (eg.prior quitting experience, personal barrier to cessation)

Question 7

Risks

Answer 7

*Ask patient to identify potential negative consequences of tobacco use.
*Highlight what is most relevant to patient.
*emphasize that smoking low tar/low nicotine cigarette or use of other forms will NOT eliminate these risks

Question 8

acute Risk examples

Answer 8

Acute risk : shortness of breath, exacerbation of asthma, increased risk of respiratory infections, harm to pregnancy, impotence, infertility

Question 9

long term risk example

Answer 9

long-term risk : Heart attacks and strokes, lung and other cancers ( larynx, oral, pharynx, esophagus, pancreas, stomach, kidney, bladder, cervix, AML) , COPD(chronic bronchitis, emphysema), osteoporosis, long-term disability and need for extended care

Question 10

environmental risk example

Answer 10

environmental risk : Increased risk of lung cancer, heart disease in spouses, increased risk for low birth weight, SIDS, Asthma, middle ear disease, respiratory infections in children of smokers

Question 11

Reward and examples

Answer 11

Ask patient to identify potential benefits of stopping tobacco.
The clinician may suggest and highlight those that seem relevant to patient eg.
- improve health
-food taste better
-improve sense of smell
-saving money
-feeling better about yourself
-home, car, clothing, breath smell better
- setting a good example for children and decreasing likelihood that they smoke
-healthier babies and children
-performing and feeling better physically
-improved appearance (reduced wrinkling/aging of skin ) whiter teeth

Question 12

Roadblocks and examples

Answer 12

Ask patient to identify barriers to quitting and provide treatment that could address barriers ( problem solving counselling, medicatio).
Typical barrier include :
- withdrawal symptom
-fear of failure
- lack of support
-weight gain
-depression
-enjoyment of tobacco
-being around other tobacco users
-limited knowledge of effective treatment options

Question 13

Repetition

Answer 13

The motivational intervention should be repeated everytime an unmotivated patient visits the clinic.
Tobacco users who have failed in previous quit attempts should be told that most people make repeated quit attempts before they are successful

Question 14

pharmacotherapy of smoking cessation - 1st line agents

Answer 14

-Bupropion
- Nicotine gum
- Nicotine inhaler
- Nicotine lozenge
- Nicotine nasal spray
- Nicotine patch
- Varenicline

Question 15

pharmacotherapy of smoking cessation - 2nd line agents

Answer 15

• Clonidine (alpha 2 agonist)
• Nortriptyline (TCA)
• Cytisine

Question 16

stages of change in overcoming addiction

Answer 16

1. Pre-contemplation = denying problem
2. Contemplation - acknowledging problem, but unwilling to change
3. Preparation/determination= preparing for behavioural change
4. Action/willpower= changing behaviours
5. Maintenance = maintaining changes
6. Relapse ( if applicable) returning to old behaviours and abandoning changes

PCP-AMR