smoking cessation

Question 1

pharmacotherapy that may be used for smoking cessation

Answer 1

nicotine replacement therapy, varenicline or bupropion

Question 2

combination nicotine replacement therapy

Answer 2

patch and oral form

Question 3

NRT should be used in caution in patients with

Answer 3

recent myocardial infarction
unstable angina
severe arrhythmias or recent cerebrovascular events

Question 4

what should be prescribed

Answer 4

Varenicline and nicotine replacement therapy
for people who have abstained using a standard course of varenicline the clinician may prescribe a further course to prevent relapse

Question 5

second line treatments

Answer 5

bupropion and nortriptyline

Question 6

symptoms of lung cancer

Answer 6

New or changed cough
Chest and/or shoulder pain
Shortness of breath
Hoarseness
Weight loss / loss of appetite
Persistent or recurrent chest infection
Fatigue
DVT
Abnormal chest signs
Finger clubbing
Cervical and/or supraclavicular
lymphadenopathy
Features suggestive of lung cancer
metastasis (e.g. brain, bone, liver or skin)
Pleural effusion
Thrombocytosis

Question 7

AAAA

Answer 7

ask - if they are current smoker
assess- stage of change, willingess
advise - instruct to quit
assist - discuss benefits of quitting, exposing others to passive smoking, what are the things you like and dont like about smoking, recommend pharmacotherapy

arrange follow up

Question 8

when to use pharmacotherapy

Answer 8

In the absence of contraindications, pharmacotherapy (nicotine replacement therapy, varenicline or bupropion) is an effective aid when accompanied by behavioural support, and should be recommended to all people who smoke who have evidence of nicotine dependence. Choice of pharmacotherapy is based on efficacy, clinical suitability and patient preference.

Question 9

what kind of NRT to use

Answer 9

Combination nicotine replacement therapy (NRT) (ie patch and oral form) accompanied by behavioural support is more effective than NRT monotherapy accompanied by behavioural support, and should be recommended to people who smoke who have evidence of nicotine dependence.

Question 10

when to use verenecline

Answer 10

Varenicline should be recommended to people who smoke and who have been assessed as clinically suitable for this medication; it should be provided in combination with behavioural support.

Question 11

can you use verenecline and NRT

Answer 11

For people who are attempting to quit smoking using varenicline accompanied by behavioural support, clinicians might recommend the use of varenicline in combination with nicotine replacement therapy, compared with varenicline alone.

Question 12

when to use buppropion

Answer 12

Bupropion sustained release should be recommended to people who have been assessed as clinically suitable for this medication; it should be provided in combination with behavioural support. Bupropion is less effective than either varenicline or combination nicotine replacement therapy.

Question 13

when to use nortriptyline

Answer 13

Nortriptyline should be considered as a second-line pharmacotherapy agent because of its adverse effects profile.