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Karan - MBBS Year 1: Respiratory Week 1 > Public Health - Smoking and Smoking Cessation > Flashcards

Public Health - Smoking and Smoking Cessation Flashcards

1
Q

What is in a cigarette?

A
  • Several carcinogens
  • Tar
  • Carbon monoxide
  • Nicotine
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2
Q

How does nicotine work?

A
  • Absorbed through mucosal linings in nose and mouth
  • Passes through lung membranes into bloodstream
  • Transported to brain through arteries
  • Stimulates adrenaline and dopamine release - causes addiction
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3
Q

What are the statistics to do with smoking?

A
  • Main cause of premature death and preventable illness in UK
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4
Q

What have been the main strategies in reducing smoking?

A
  • Increasing minimum age for tobacco sale by 1 year, every year
  • School-based education
  • Enforcement on sales
  • Doubling budgets for ‘stop smoking’ campaigns
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5
Q

What are some services available in Essex that promote smoking cessation?

A
  • NRT
  • Online seminars
  • Workshops and courses to manage smoking cessation
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6
Q

Describe NRT

A
  • Nicotine replacement therapy supported with behavioural changes
  • Don’t produce carbon monoxide
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7
Q

How can young people be exposed to smoking?

A
  • Young people harmed through second hand smoking, role models and direct exposure
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8
Q

What are the current objectives to prevent vaping in young people?

A
  • Improves awareness amongst healthcare professionals
  • Improves understanding of risks and how they can be minimised
  • Investigating psychosocial, environmental factors that may encourage someone to start smoking
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9
Q

What are the current 2 methods of smoking cessation?

A
  • PHARMACOLOGICAL - NRT (not with varenicline or bupropion) and varenicline/bupropion (not together)
  • NON-PHARMACOLOGICAL - Counselling and advice
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10
Q

What are the types of NRT available?

A
  • Short- and long-acting
  • No evidence any particular product is more effective than any other
  • Dual therapy is effective
  • Patch strength vary depending on how many cigarettes smoking per day
  • Can be used during pregnancy but non-pharmacological preferred
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11
Q

Describe varenicline.

A
  • Nicotine-receptor partial agonist
  • Blocks stimulation of dopamine system
  • Prevents nicotine binding
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12
Q

How does smoking cessation in varenicline work?

A
  • 500micrograms daily for 3 days, then
  • 500micrograms twice daily for 4 days, then
  • 1mg TWICE daily for 11 weeks (reduced to 500micrograms BD if not tolerated)
  • Cautioned in psychiatric illness and those with a history of seizures
  • Contraindicated in pregnant/breastfeeding women
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12
Q

Describe bupropion. PART 1

A
  • Initially used for depression
  • Thought to inhibit presynaptic dopamine transporters
  • 150mg daily for 6 days, 150mg daily - total course length of 7-9 weeks
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13
Q

Describe bupropion. PART 2

A
  • Lower doses in elderly
  • Discontinue if abstinence
  • Contraindicated in pregnant/breastfeeding women and those with history of seizures
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14
Q

What would you do in the following situation?

Steph, 29, comes to see you in practice with a view to wanting to quit smoking. This is something that she has wanted to do for a long time, but has always struggled. Smoking has always given her that
buzz in her life, and her primary concern is associated with the fact that her prominent mental health issues may relapse. She has a past history of low mood associated with self harm and suicidal ideations, although this is now controlled with citalopram (anti-depressant).

A
  • Has clearly been planning to make change for sometime
  • Explore what causes her to smoke?
  • Varenicline cautioned in history of mental ill-health, probably best to avoid at least to begin with
  • NRT PLUS behavioural support
  • Which specific products? Discuss options with Steph and what might be preferred
  • Side effects of NRT: difficulty sleeping, dizziness, headaches, irritation with patches
  • Other supportive interventions e.g. exercise - would also support with low mood
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15
Q

What would you do in the following scenario:

Georgina, 27, comes to see you to inform you that she is pregnant. She is really happy with this news, however is concerned that she is a smoker. She has a desire to stop as she does not want to cause harm
to her baby, but at the same time, knows that this is going to be difficult.

A
  • Re-assure – she is doing the right thing and whilst challenging will be achievable
  • What does she know about the harms of smoking in pregnancy? Pre-term, lower birth weight, worse health
  • Behavioural support - most mothers will not want to consume something that will harm their child
16
Q

What would you do in the following scenario:

John, 70, comes to see you with a will to want to quit smoking. He has smoked for the majority of his life and you calculate that he has a 70 pack year history. He is diagnosed with COPD and this is well controlled with inhalers. He is also on theophylline. His urgency comes from the fact that his friend was recently diagnosed with end stage lung cancer and has since passed away. He does not want the same thing to happen to him so is keen to get your advice.

A
  • Urgency – need a highly effective approach
  • High pack year history; he is clearly motivated to quit but I would want to stress how he can see health improvements and quickly
  • Varenicline? NRT?
  • Some patients don’t want to take varenicline; most tend to be happy with NRT
  • Varenicline does not have any clinically meaningful interactions, but watch for theophylline with other interactions as it is a potent enzyme inducer. Theophylline dose may need to be increased
  • PLUS behavioural support
17
Q

What would you do in the following scenario:

Alfie, 35, wants to quit smoking. He has heard of a “killer condition” called COPD and wants to avoid this. He has tried Nicorette and other products associated with smoking cessation but these haven’t
suited him. Unfortunately he has also found that the postcode lottery means that his area do not fund varenicline. He has written a strongly worded letter to the commissioning group responsible, but wants to know what he can do in the meantime.

A
  • Talk about COPD more; clearly alarmed by it and worried
  • As in the chat, explore why smokes?
  • Explore how was using NRT; we know patients don’t use medicines as they should. Did he use a combination? Which specific product did he use?
  • Could self-fund varenicline
  • Buproprion?
  • Behavioural support

Karan - MBBS Year 1: Respiratory Week 1 (10 decks)

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