January 19, 2016 - Smoking Cessation Flashcards
Harms of Smoking
A fuckton
Cancer, cardiovascular disease, respiratory disease, paediatric disease (if smoking while pregnant), and reproductive problems, among many more.
Leading Preventable Cause of Death and Disease
Smoking
A Lost Decade
Being a smoker reduces your life expectancy by 11-12 years.
Why is it Hard to Quit?
Only about 3% of smokers quit annually.
Smoking and getting the nicotine rush stimulates the dopamine pathway in your brain. This is the “reward” pathway that is critical for mood, motivation and attention, and good memory.
Nicotine Withdrawal
Begins within hours of stopping smoking, peaks within a few days, and lasts for weeks.
Symptoms of nicotine withdrawal include dysphoria and depressed mood, insomnia, irritability and frustration, anger and anxiety, difficulty concentrating, restlessness, and increased appetite.
Benefits of Quitting Smoking
Lung function begins to improve at 3 months
Coronary heart disease risk is reduced by 50% at 1 year
Stroke risk returns to the level of non-smokers in 5 years
Lung cancer risk is 30-50% of that of continuing smokers at 10 years
Cardiovascular heart disease returns to the level of non-smokers at 15 years
Years of Life Gained by Age
Regardless of the age the patient quits smoking at, they can expect to add years to their life.
If they quit at 30, they gain about 10 years
If they quit at 40, they gain about 9 years
If they quit at 50, they gain about 6 years
If they quit at 60, they gain about 4 years
Therapies With No Proven Benefit
Selective serotonin reuptake inhibitors (SSRI)
Laser treatment
Hypnosis
Acupuncture
Unproven Therapies to Quit Smoking
E-cigarettes
Proven Therapies for Quitting Smoking
1) Counselling is key
2) Pharmacologic aides - bupropion and NRT
The 5 A’s
Ask - identify and document tobacco use
Advise - urge the smoker to quit
Assess - is the smoker ready to quit?
Assist - use counselling and pharmacotherapy
Arrange - schedule a follow-up within 1 week of quit date
5 Stages of Change
Pre-contemplative
Contemplative
Preparation
Action
Maintenance
Smoking Cessation Pharmacotherapy
1st Line - nicotine replacement (NRT), varenicline, and bupropion
2nd Line - Nortyptylline
Varenicline
Is a nicotine receptor partial agonist - it stimulates nicotine receptors more weakly than nicotine itself does.
It reduces cravings and decreases the pleasurable effects of smoking.
Bupropion
Used as an anti-depressant and a smoking cessation aid.
Roughly doubles the odds of smoking. Re-uptake/inhibition of dopanine/norepinephrine.
Cannot be used with seizures.
