nicotine dependence Flashcards
when do the benefits of smoking cessation begin
as soon as an individual stops smoking
is smoking cessation associated with withdrawal symptoms
yes, temporary withdrawal symptoms caused by nicotine dependence which make it difficult for people to stop
withdrawal symptoms cause by nicotine dependence
- nicotine cravings
- irritability
- depression
- restlessness
- poor concentration
- light headedness
is weight gain an effect of stopping smoking?
Yes but less likely to occur when drug treatment is used to aid smoking cessation
when is weight gain less likely to occur with smoking cessation
when drug treatment is used to aid smoking cessation
alternative forms of tobacco (e.g. smokeless tobacco) that are placed in the nose or mouth are not burned - are they safe?
no
also associated with significant health risks e.g. oropharyngeal cancer, CVD, periodontal disease
smokeless tobacco cessation reduces the risk of tobacco related health problems but does it have withdrawal symptoms
yes may cause withdrawal symptoms
management - smoking cessation in individuals who use smokeless tobacco
- advise them to stop
- offer referral to local specialist tobacco cessation services for interventions and support
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 .
stopping in one step (‘stop in one go’)
a patient wants to stop smoking. you advice them that stopping in one step (‘stop in one go’) offers them the best chance of …
lasting success
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
combination of drug treatment and behavioural support
what is the ‘stop in one go’ approach
individual makes a commitment to stop smoking on or before a particular date (the quit date), rather than by gradually reducing their smoking
Individuals who are unwilling, or not ready, to stop smoking in one go may benefit from the following approach
‘harm reduction approach’
what is the ‘harm reduction approach’
includes cutting down before stopping smoking, reducing smoking (without intending to stop), or temporarily not smoking
pt who wish to stop or reduce their harm from smoking should be referred to …. (+ alternative)
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
individuals who wish to stop or reduce their harm from smoking who decline referral to local stop smoking services should be referred to…
a suitable HCP who can also offer stop smoking interventions
3 effective drug treatments to aid smoking cessation that should be offered alongside behavioural support
- NRT
- varenicline
- bupropion
what are the most effective drug treatment options, and thus the preferred choices? (2)
- varenicline
- combination of long acting NRT (e.g. patch) and a SA NRT (lozenges, gum, SL tabs, inhalator, nasal spray, oral spray)
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)
- bupropion
- single therapy NRT
brand name for varenicline
Champix (currently unavailable in UK!!)
nicotine transdermal patches are generally applied for…
16 hours, patch removed overnight
if a patient experiences strong nicotine cravings upon waking, you can use this patch instead
24 hour nicotine patch
what is used whenever the urge to smoke occurs, or to prevent cravings?
SA nicotine preparations - gum, lozenges, inhalations, nasal spray etc
one one form of NRT more effective than the other
no evidence to show
can you use NRT and vereniciline or bupropion together
not recommended
can you use varenicline and bupropion together
no
when drug treatment is prescribed for smoking cessation, what needs to be agreed with the pt
quit date
for patients who have successfully stopped smoking, should you give them something to prevent relapse?
yes consider further course of NRT, vareniciline or bupropion (unlicensed) to prevent relapse to smoking
can people who are unwilling or not ready to stop smoking benefit from use of NRT? and why?
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
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?
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
how do e-cigarettes work ?
deliver nicotine without the toxins found in tobacco
discuss the effectiveness of nicotine containing e-cigatettes to other cessation options
similar effectiveness to other cessation options such as varenicline or long-acting and short-acting NRT
are e-cigarettes less harmful to health than tobacco smoking?
It is likely that e-cigarettes are substantially less harmful to health than tobacco smoking, but long-term effects are still largely unknown
can e-cigs help individuals stop smoking
yes
can e-cigs be prescribed or supplied by smoking cessation services
no
is there any regulation of e-cigs?
they are not licensed drugs but they are regulated by Tobacco and Related Products Regulations 2016
sale of e-cigs is prohibited in
children under 18 years of age
advice about smoking for pregnant women
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
all pregnant females who smoke or have stopped smoking in the last 2 weeks need to be …
referred to local stop-smoking services, and ongoing intensive support should be offered during and following pregnancy
For pregnant females who are reluctant or unable to attend stop-smoking services, consider alternative options such as (3)
home visits, and providing details for telephone quitlines or online stop-smoking support.
smoking cessation should be encourages for which members of the household of a pregnant female
ALL
can you give therapy for smoking cessation in pregnancy
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
polycyclic aromatic hydrocarbons found in tobacco smoke can affect the metabolism of some drugs. explain this
they can increase metabolism of some drugs by INDUCING hepatic enzymes
this often means requiring an increase in dose
