nicotine dependence

Question 1

when do the benefits of smoking cessation begin

Answer 1

as soon as an individual stops smoking

Question 2

is smoking cessation associated with withdrawal symptoms

Answer 2

yes, temporary withdrawal symptoms caused by nicotine dependence which make it difficult for people to stop

Question 3

withdrawal symptoms cause by nicotine dependence

Answer 3

• nicotine cravings
• irritability
• depression
• restlessness
• poor concentration
• light headedness

Question 4

is weight gain an effect of stopping smoking?

Answer 4

Yes but less likely to occur when drug treatment is used to aid smoking cessation

Question 5

when is weight gain less likely to occur with smoking cessation

Answer 5

when drug treatment is used to aid smoking cessation

Question 6

alternative forms of tobacco (e.g. smokeless tobacco) that are placed in the nose or mouth are not burned - are they safe?

Answer 6

no
also associated with significant health risks e.g. oropharyngeal cancer, CVD, periodontal disease

Question 7

smokeless tobacco cessation reduces the risk of tobacco related health problems but does it have withdrawal symptoms

Answer 7

yes may cause withdrawal symptoms

Question 8

management - smoking cessation in individuals who use smokeless tobacco

Answer 8

• advise them to stop
• offer referral to local specialist tobacco cessation services for interventions and support

Question 9

individuals who smoke tobacco should be advised to stop smoking and be offered interventions and support to facilitate smoking cessation. they should also be advised that stopping in a ………. offers the best chance of lasting success, and that a combination of drug treatment and behavioural support is likely to be the most effective approach .

Answer 9

stopping in one step (‘stop in one go’)

Question 10

a patient wants to stop smoking. you advice them that stopping in one step (‘stop in one go’) offers them the best chance of …

Answer 10

lasting success

Question 11

a patient wants to stop smoking. you have advised them that stopping in one step (stop in on go) offers them the best chance of lasting success, and that the following is likely to be the most effective approach

Answer 11

combination of drug treatment and behavioural support

Question 12

what is the ‘stop in one go’ approach

Answer 12

individual makes a commitment to stop smoking on or before a particular date (the quit date), rather than by gradually reducing their smoking

Question 13

Individuals who are unwilling, or not ready, to stop smoking in one go may benefit from the following approach

Answer 13

‘harm reduction approach’

Question 14

what is the ‘harm reduction approach’

Answer 14

includes cutting down before stopping smoking, reducing smoking (without intending to stop), or temporarily not smoking

Question 15

pt who wish to stop or reduce their harm from smoking should be referred to …. (+ alternative)

Answer 15

local stop smoking services if appropriate - will be provided with advice, drug treatment, behavioural support options e.g. individual counselling or group meetings

alternative: Alle Carr’s Easyway in person group seminar

Question 16

individuals who wish to stop or reduce their harm from smoking who decline referral to local stop smoking services should be referred to…

Answer 16

a suitable HCP who can also offer stop smoking interventions

Question 17

3 effective drug treatments to aid smoking cessation that should be offered alongside behavioural support

Answer 17

• NRT
• varenicline
• bupropion

Question 18

what are the most effective drug treatment options, and thus the preferred choices? (2)

Answer 18

• varenicline
• combination of long acting NRT (e.g. patch) and a SA NRT (lozenges, gum, SL tabs, inhalator, nasal spray, oral spray)

Question 19

the most effective drug treatment options and thus the preferred choices are varenicline or combination of LA and SA NRT. if these are not appropriate, what are the alternatives? (2)

Answer 19

• bupropion
• single therapy NRT

Question 20

brand name for varenicline

Answer 20

Champix (currently unavailable in UK!!)

Question 21

nicotine transdermal patches are generally applied for…

Answer 21

16 hours, patch removed overnight

Question 22

if a patient experiences strong nicotine cravings upon waking, you can use this patch instead

Answer 22

24 hour nicotine patch

Question 23

what is used whenever the urge to smoke occurs, or to prevent cravings?

Answer 23

SA nicotine preparations - gum, lozenges, inhalations, nasal spray etc

Question 24

one one form of NRT more effective than the other

Answer 24

no evidence to show

Question 25

can you use NRT and vereniciline or bupropion together

Answer 25

not recommended

Question 26

can you use varenicline and bupropion together

Answer 26

no

Question 27

when drug treatment is prescribed for smoking cessation, what needs to be agreed with the pt

Answer 27

quit date

Question 28

for patients who have successfully stopped smoking, should you give them something to prevent relapse?

Answer 28

yes consider further course of NRT, vareniciline or bupropion (unlicensed) to prevent relapse to smoking

Question 29

can people who are unwilling or not ready to stop smoking benefit from use of NRT? and why?

Answer 29

yes they can as part of 'harm reduction approach' because the amount of nicotine in NRT is much lower and the way these products deliver nicotine makes them less addictive than smoking tobacco

Question 30

when you offer NRT as part of a harm reduction approach in individuals who are unwilling or not ready to stop smoking, what should you advise them? and how long can you use it for?

Answer 30

NRT will make it easier to reduce how much they smoke and improve their chance of stopping smoking in the long-term NRT can be used for as long as needed to help prevent a return to previous levels of smoking

Question 31

how do e-cigarettes work ?

Answer 31

deliver nicotine without the toxins found in tobacco

Question 32

discuss the effectiveness of nicotine containing e-cigatettes to other cessation options

Answer 32

similar effectiveness to other cessation options such as varenicline or long-acting and short-acting NRT

Question 33

are e-cigarettes less harmful to health than tobacco smoking?

Answer 33

It is likely that e-cigarettes are substantially less harmful to health than tobacco smoking, but long-term effects are still largely unknown

Question 34

can e-cigs help individuals stop smoking

Answer 34

yes

Question 35

can e-cigs be prescribed or supplied by smoking cessation services

Answer 35

no

Question 36

is there any regulation of e-cigs?

Answer 36

they are not licensed drugs but they are regulated by Tobacco and Related Products Regulations 2016

Question 37

sale of e-cigs is prohibited in

Answer 37

children under 18 years of age

Question 38

advice about smoking for pregnant women

Answer 38

always advice to stop smoking completely be informed about risks to unborn child of smoking during pregnancy and harmful effects of exposure to 2nd hand smoke for both mother and baby

Question 39

all pregnant females who smoke or have stopped smoking in the last 2 weeks need to be ...

Answer 39

referred to local stop-smoking services, and ongoing intensive support should be offered during and following pregnancy

Question 40

For pregnant females who are reluctant or unable to attend stop-smoking services, consider alternative options such as (3)

Answer 40

home visits, and providing details for telephone quitlines or online stop-smoking support.

Question 41

smoking cessation should be encourages for which members of the household of a pregnant female

Answer 41

ALL

Question 42

can you give therapy for smoking cessation in pregnancy

Answer 42

yes NRT should be considered alongside behavioural support at earliest opportunity in pregnancy advice that using NRT has much lower risks and is less addictive because of the much lower amount of nicotine and the way the products deliver nicotine can continue after pregnancy if needed to prevent relapse to smoking

Question 43

polycyclic aromatic hydrocarbons found in tobacco smoke can affect the metabolism of some drugs. explain this

Answer 43

they can increase metabolism of some drugs by INDUCING hepatic enzymes this often means requiring an increase in dose