Smoking cessation Flashcards
Stages of smoking cessation
- Pre-comtemplation: Not motivated, no intention
- Contemplation: Weighing pros and cons of quitting, thinking to quit within next 6 months
- Preparation: Intends to quit within next month with some steps taken
- Action: In quitting process
- Maintenance: Abstained smoking for ≥6 mo
- Termination: No longer smoking, confident of not relapsing
5 “As” that can be used by pharmacists to find out smoker’s change
- Ask: Do you smoke?
- Advice: Have you ever thought about quitting?
- Assess: Do you plan to stop within the next month?
- Assist: help patient according to stage
- Arrange: follow-up with patient
5 “Rs” that can be used by pharmacists to communicate with patients in the contemplation stage
- Relevance: relate to disease condition and smoking
- Risk: Explain consequences and complications of smoking
- Rewward: Emphasise benefits of quitting
- Roadblocks: reasons for not wanting to quit
- Repetition: talk to smoker again next visit if smoker don’t want to quite
What is “START” in smokers at the preparation stage?
- S: Set a quit date, within 1 mo
- T: Tell family, friends and colleagues about plan to quit
- A: Anticipate and plan for challenges that may cause relapse
- R: Remove cigarettes and tobacco from home, car, workplace
- T: Talk consistently to HCP to get help to quit
Five principles of motivational interview for
- Develop discrepancies: identify discrepancies in clients current behaviour and change to current behaviour
- Express empathy
- Avoid argument
- Roll with resistance: reframe smoker’s concern, invite them to consider new perspective
- Support self-efficacy: Help smokers believe in themselves
Non-pharmacological options to quit smoking. In what kind of smokers are non-pharmacological options most suitable?
- Cold turkey
- Gradual reduction
- Practical counselling
For smokers smoking < 15 cigs a day
Dosing regimen for nicotine lozenges. State the usual dose, maximum dose, maximum duration.
Nicotine 1 mg lozenge q1-2h
- Usual dose: 8-12/day
- Max: 25/day
- Gradually cut down, then stop when using 1-2 loz/day
- Max duration: 6 months
Counselling points for administration of nicotine lozenges?
- Suck slowly until peppery taste becomes strong
- Park between cheek and gum for absorption of nicotine, then suck again when peppery taste fades
- Repeat for 30 minutes
- Do not chew or swallow lozenge
- Avoid acidic food 15 mins before using lozenges
(similar to nicotine gum)
Dosing regimen of nicotine gum? When to use the 2 mg gum or 4 mg gum?
Chew 1 piece (2-4 mg) when urge to smoke arises
- 4 mg gum: if >20 cigs/d, 1st within 30 mins of waking up, or failed previous attempt to quit with 2 mg gum
- 2 mg gum: any situations that is not 4 mg gum
- Usual dose 8-12 gums/d for 12 weeks, then taper every 2 weeks
Strengths of nicotine patch available
- Nicotinell patch: 21, 14, 7 mg/24h
- Nicorette patch: 25/15/10 mg/16h
Patient smokes 22 cigarettes a day and wants to use nicotinell patch. Suggest the dosing regimen for him
Dosing regimen of Nicotinell for >20 cigarettes a day
- 21mg patch for 4 weeks
- 14 mg patch for 4 weeks
- 7 mg patch for 4 weeks
Patient smokes 18 cigarettes a day and wants to use Nicorette patch. Suggest the dosing regimen for him
Dosing regimen of Nicorette for >15 cigarettes a day
- 25 mg for 8 weeks
- 15 mg for 2 weeks
- 10 mg for 2 weeks
Patient smokes 18 cigarettes a day and wants to use nicotinell patch. Suggest the dosing regimen for him
Dosing regimen of Nicotinell for ≤20 cigarettes a day
- 14 mg patch for 4 weeks
- 7 mg patch for 8 weeks
Patient smokes 13 cigarettes a day and wants to use Nicorette patch. Suggest the dosing regimen for him
Dosing regimen of Nicorette for >15 cigarettes a day
- 15 mg for 8 weeks
- 10 mg for 4 weeks
Counselling points for nicotine patch
- Apply to clean, dry, non-hair skin
- For 24h patch: apply in morning upon rising, reapply every 24h
- For 16h patch: apply in morning upon rising, remove at bedtime
- Alternate application site to minimise irritation
- Sites of application: hip, chest, upper arm/thigh
