39 cessation tabagisme Flashcards
Motivational interviewing steps (5A)
Ask (ouvre le sujet)
Assess (readiness to change)
Advice - clear tell pt to stop smoking is
Assist: self help ou ressources
Arrange follow up
Stade du changement de Prochaska
precontemplation
contemplation
preparation
action
maintenance
Pharmacotherapy choices (4)
Varenicline
Buproprion
Nicotine replacement therap:
- Nicotine patch
- gums
- lozenge (aka pastilles)
- inhaler
Nortriptyline
Pharmacotherapy combination (prefered choices to start with)
Varenicline plus Nicotine patch > Varenicline alone > NRT or Buproprion
Varenicline when to start
1w before quit date 0.5mg/d x3d
and increase dose to BID then increase to 1 mg
ad 12 months
Varenicline effets secondaires
headache
Insomnia
abnormal dreams
GI upset
Note: NO evidence that varenicline increases neuropsychaitric adverse events
self harm ?? myth?
Varenicline brand name
champix
Nicotine replacement therapy options:
- Nicotine patch
- gums
- lozenge (aka pastilles)
- inhaler
how to choose dose of the Nicotine replacement therapy
depedning how many cigarets a day
nicotine patch adverse effect
local irritation
bupropion when to start and what dosage
begin 1w before quit date at 150mg/d x 3d
then 150mg BID
bupropion side effects
Insomnia, headache, dizziness,
xerostomia,
tachycardia
weight loss
bupropion counter indications
Avoid in seizure disorder, eating disorder, alcohol withdrawal
Nortriptyline (2nd line) side effects
Sedation, dry mouth
Second-line due to side effects
most effectice therapy is when
there is a combination
either nicotine replacement theries together or NRT + other med