Smoking Cessation

Question 1

Assess smoking dependence

Answer 1

How many cig/day?
Do you smoke after waking up?
Do you smoke in forbidden area?
Do you smoke more in the morning?
Would you hate to give up your morning cigarette?
Do you smoke when sick?

Question 2

Assess willingness to quit

Answer 2

Would you consider quitting in next 6 months?
1. Not ready to quit in the next 6 months.
2. Thinking about quitting in the next 6 months.
3. Ready to quit in the next month.

Question 3

1.Not ready to quit ( in the next 6 months)

Answer 3

Strongly advise patient
- to stop
-help identify personal benefits of quitting using 4R ( Relevant/ Risk/Reward/Repeat)
-encourage visiting QUIT helpline

Question 4

4R’s model

Answer 4

Advise the RELEVANT of quitting smoking
Stress the RISK
Identify REWARDS
REPEAT these often
( Use QUIT helpline)

Question 5

2. Patient thinking about quitting in the next 6 months

Answer 5

Strongly advice patient to stop
Help identify personal BENEFITS
BARRIERS to quitting and formulate a strategy for this.

Question 6

3. Ready to quit!!! In the next month

Answer 6

-Help patient set a date
-Inform family and friends
-Organise/Introduce to support group
-Review past attempts and reason for failure
-GIVE TIPS- how to quit- discuss high risk situations,
-RELAPSE prevention ( discuss skill and problem solving technique)-

Question 7

High smoking dependence- depend on how many positive answer to questionaire

Answer 7

High and smoking at least 25cig/day
- use NRT ( 21mg patch and 4mg gum +/- BUPROPION ( NA and dopamine reuptake inh)

Less than 10cigarette/day—> no NRT required

Question 8

BUPROPION

Answer 8

Use several week before quit date and use it for subsequent 3 months.
Contraindicated in Seizure and Hypertension ( not within 4 weeks of AMI, UAP and arrythmias)
50% get local skin reaction and 5% intolerance.

Question 9

Nicotine replacement patch

Answer 9

start 21mg and then wean over 6 weeks

Question 10

Nicotine gum

Answer 10

4mg ( Do not exceed 80mg/day)
If use patch concurrently 21mg patch, then max gum /day is 15 gum = 60mg

Question 11

Post quitting phase

Answer 11

Regular Follow up
positive reinforcement
Liase with local GP
Encouraging attendance
Encourage using support group
QUIT helpline on web

Question 12

Compliance

Answer 12

1. Determine their understanding/knowledge of their illness and treatment
2. Prescribe least complex schedule
3. Use daily routine as medication prompt
4. Education about drugs and side effects
5. Consider dose dispenser or calenders and now medication apps (Max-Pill reminder;Medisafe pill reminder; Medadvisor medication Manager)
6. Involve family, partner and friends.
7. Monitor their response and provide written examinations.

Question 13

How would assist this patient quit smoking?

Answer 13

I would first assess their readiness for smoking and then consider educating the patient if they are in the contemplative stage by explaining the benefits of quitting smoking using the 4R’s model. Firstly by advising the relevant of quitting smoking to their medical conditions, the risks to their health/ medical comorbidities, identifying the rewards such as return of taste and financial benefits (1 pack/20 cig of cig $50= $350/week=$700/fortnightly= $1400/month
I would then repeat this and emphasis this in subsequent consultations and also advise visiting the QUIT helpline.

Question 14

What do you do once patient has quit smoking?

Answer 14

I would do regular follow up with positive reinforcement. I would also liaise with the GP and encouraging their attendance with GP and also encourage them using the support group as well QUIT helpline.