Smoking Cessation

Question 1

Smoking cessation - key harms of smoking (4)

Answer 1

Reduced life expectancy
Increased risk of disease (CVD, respiratory, cancer)
Pregnancy complications
Secondary smoke effects on children

Question 2

Smoking cessation - benefit timeline of quitting (heart attack and lung cancer)

Answer 2

Heart attack: after 15 years, risk equals a non-smoker
Lung cancer: after 10 years, risk drops by half

Question 3

Smoking cessation - withdrawal symptoms (6)

Answer 3

Irritability
Frustration
Insomnia
Headache
Anxiety
Weight gain (likely when using NRT)

Question 4

Smoking cessation - key questions to ask (5)

Answer 4

How many cigarettes per day
Motivations to quit
Any pervious attempts and how they went
How soon after waking do they smoke
How long have the smoked for

Question 5

Smoking cessation - nicotine patch (strength, dose, directions)

Answer 5

7, 14, or 21 mg
16 or 24 hr preparations
Apply to upper arm, chest or hip in the morning (rotate)
For 16 hr, remove 1 hour before bed
24 hr recommended for morning craving patients
16 hr recommended if patch causes sleep disturbances

Question 6

Smoking cessation - mouth spray (dose, directions)

Answer 6

4 sprays per hour prn, max 64 sprays in 24 hours
Used for cravings (peaks in 13 mins)

Question 7

Smoking cessation - gum (strength, directions)

Answer 7

2, 4, 6 mg
Chew until flavour is strong then rest in cheek. Chew again when flavour subsides
Should last 30 mins

Question 8

Smoking cessation - inhalator (strength, directions)

Answer 8

15 mg per cartridge
Insert cartridge into mouthpiece and inhale
Each cartridge lasts total of 40 mins
Max 6 cartridges per day

Question 9

Smoking cessation - sublingual tablet (strength, dose, directions)

Answer 9

2 mg, take 1-2 per hour
Place under tongue and allow to dissolve
Max 40 per day

Question 10

Smoking cessation - lozenge (strength, directions)

Answer 10

1, 2, 4 mg
Move around in mouth until dissolved (15 mins)
Do not chew or swallow
Max 15 per day

Question 11

Smoking cessation - nasal spray (absorption route, directions)

Answer 11

Absorbed through nasal mucosa
1 spray into each nostril twice per hour PRN
Max 64 sprays per day

Question 12

Smoking cessation - extra support (counselling) (6)

Answer 12

NHS stop smoking service (incl. CBT)
SeSmoking cessation - t a quit date and commit
Inform the pt of withdrawal symptoms and reassure that the first few days will be the worst
Manage cravings through activities
Best chance of quitting is immediate switch to NRT
Smoke free national helpline

Question 13

Smoking cessation - preventing relapse advice (3)

Answer 13

Avoid being around smokers
Change normal routines
Alternative strategies to cope with stress

Question 14

Smoking cessation - POMs (drugs, important info) (3)

Answer 14

Cytisinicline, varenicline, bupropion
Do not prescribe with NRT
Should be started before quit dates (specific instructions per drug)
18+