Smoking Cessation Flashcards
Smoking Risks
Increased Risk of:
- Heart disease
- Stroke
- Cancer
- Emphysema
- Bronchitis
- Asthma
- Renal disease
- Eye disease
Indigenous Australians
Smoking rates are considerably higher than the non-indigenous community in every age group
Rates of Smoking are Highest in…
- Low socio-economic groups
- Poorly educated
- Rural and remote areas
- 25-40 year olds
- Singles
- Indigenous
- Mental illness
- Substance abusers
- Labour workers
Why do People Smoke
- Heritable 50%
- Addiction
- Enjoyment
- Peers
- Alcohol
- Boredom
- Weight control
Passive Smoking
- Second hand smoke
- Increased heart disease, asthma, some cancers, SIDs
- Predispose children to allergies
1950 vs 2015
These days there is:
- Less smokers
- No cigerette advertising
- Smoking bans in certain public places
- Plain packaging
- Smoking cessation products
- Anti-smoking advertisements
- Tax increases
Smoking in Public places
- Must be 5m from boundary of hospital or day therapy facility
Clinically Significant Compounds of Cigerettes
Tar-based compounds: carcinogenic properties and coat lungs
Carbon monoxide: reduces the oxygen-carrying capacity of red blood cells
Nicotine: produces dependance by activation of dopaminergic systems
Smoking and Cancer
- Causes 20-30% of all human cancers
- 1.5million new cases of lung cancer per year world-wide (80% from tobacco)
- Contains over 60 carcinogens
- Benzo(a)pyrene damades p53 gene
Role of Pharmacist
Provide lifestyle and pharmacotherapy advice. Perform brief intervention and educate public.
5 A’s of intervention
ASK about smoking and interest in quitting
ADVISE all smokers to quit in a clear, non judgmental, personalised manner
ASSESS smoker’s level of dependancy, readiness to quit and barriers to quitting
ASSIST them to quit with professional counselling and pharmacotherapy
ARRANGE a follow-up review and support
Assessing Nictone Dependace
Dependance is present if one or more of the following are true:
- TTFC of 30min
- 10 per day
- Withrawal syptoms from cessation
NRT Evidence
- Increases quitting success by 1.5-2 times
- Not able to conclude which if any is more effective than another
- 1/3 still relapse
NRT Purpose
Replaces smoker’s source of nicotine in order to reduce nicotine withdrawel symptoms while the smoker focuses on breaking smoking habits. Once achieved, smoker weans off NRT
What Proportion of Smokers Want to Quit?
> 70%
Average Number of Unaided Quit Attempts per Person
21
Why Do Smokers Want to Quit?
- Health/Fitness
- Money
- Peer pressure
- Passive smoking concerns
- Example to children
- Restricted smoking areas
- Wanting to regain control
Why is it Difficult to Quit?
- Fear of failure
- Withdrawal symptoms
- Motivation
- NRT misuse
- Barriers: Alcohol, weight gain, stress
- Not prepared for difficult situations
- Let slip ups become relapses
Nicotine Addiction
Highly addictive beacuase of its:
- Fast absorbtion
- High plasma concentration
Nictoine addiction is lifelong and varies in intensity
Nicotine Dosing
- Many factors influence individual nicotine requirements
- Smokers titrate their dose of nicotine to feel satisfied (compensatory smoking/light cigs)
Nicotine Overdosing
- Nausea
- Stomach cramps
- Vomiting
- Headache
- Sweating
- Breathing difficulties
- Heart palpitations
- Not fatal
Liver Enzymes
- Nicotine is metabolised by liver enzyme P450 - CYP2A6
Fast Metabolisers
- Smoke more/ require more nicotine
- More addicted
- Find NRT less effective
- Inhale deeper and have higher levels of CO
- At higher risk of lung cancer
Withdrawal Symptoms
- Urges to smoke
- Irritability/anxiety/anger/restlessness
- Lack of concentration
- Increased appetite
- Depressed mood
- Sleep disturbance
- Constipation
- Mouth ulcers
- Decreased heart rate
- Increased skin temperature
Immediate Effects of Smoking
- Increase in blood pressure, heart rate and muscle tension
- Decrease in lung volume, skin temperatur and oxygen
Visually Noticable Effects of Smoking
- Stained fingers, moustaches and teeth
- Greyish skin and premature wrinkles
General Effects of Smoking
- Decreased circulation
- Gangrene
- Out of breath
- Cough
- Phlegm
- Wheeze
Effects of Second and Third Hand Smoke:
- Asthma
- Respiratory disease
- Middle ear infections
- Colic
- CVD
- Cancers
- COPD
Smoking and Life Expectancy
- Over the Age of 30, 1 cig = 6 less hrs
- Long term smokers lose 10-15 years
- Those with mental health issues lose 25 years
Benefits of Quiting
- 20mins – BP, HR, skin temp
- 8hrs – Oxygen levels back to normal
- 24hr – chance of heart attack is reduced
- 2days – sense of taste and smell improve
- 1mth – Immune system recovers
- 1-3mths – circulation to extremities returns
- 3mths – lungs improve –easier to exercise
Benefits of Quitting 22 - 1yr – risk of heart attack dropped by ½
- 5yrs – stroke risk – same as non-smoker
- 10yrs – risk lung cancer 30-50%
- 15yrs – risk CVD - same as non-smoker
- Immediate ↓risk of smoking related
diseases - Save money
Caffeine and Smoking
- Smokers need more
- Quitters need less
- Half caffeine when quitting
- Too much caffeine mimics nictotine withdrawal
Methods of Quitting
- Cold Turkey
- NRT
- Non-nicotine based products
Products With No Conclusive Evidence
- NicoBloc and other products in pharmacies and online
- Acupuncture
- Laser
- Hypnotherapy
- E-cigs
NRT Products Available
- Patch
- Gum
- Lozenge, mini lozenge, cool drops
- Inhalator
- Mouth spray (mist)
- Oral mouth strips
Nicotine Patch
- Apply to upper torso or arms in a clean, dry hairless area
- Rotate to a different area every day
- Use for 3 months
- Side effects: Irritation, dont stick, abnormal dreams
- No evidence to reduce or wean
Nicotine Gum
- Chew slowly for 30min when required for up to 3 months
- Side effects: hiccups, nausea, indigestion, headache, dizziness, sore throat
- While using, dont eat or drink acidic drinks or swallow saliva
Nicotine Lozenges
- Dissolve in mouth over 30min when required for up to 3 months
- Side effects: hiccups, nausea, indigestion, headache, dizziness, sore throat
Nicabate Minis (Lozenges)
- 3x faster than gum
- Conveniently packaged
- Dissolve slowly in mouth
- Side effects: hiccups, nausea, indigestion, headache, dizziness, sore throat
Nicotine Inhalator
- Mouthpiece and cartridges containing nicotine
- Contents are continously puffed for 20min and held in mouth, when required
- Side effects: cough, soree mouth, throat irritation, headache, dizziness
Nicotine Cooldrops
- Small lozenge dissolved in mouth for 20min when required
- Side effects: hiccups, nausea, indigestion, headache, dizziness, sore throat
Nicabate Mouth Strips
- Oral films dissolved in mouth for 3 min
- Relief in 50sec
- Side effects: hiccups, nausea, indigestion, headache, dizziness, sore throat
NRT Contradictions
- Children
NRT Approaches
- Single medication
- Combination therapy (Increases quit rate by 34-54%)
- Pre-quit nicotine patch (Doubles quit rate)
- Reducing oral NRT
- Using NRT as gateway to quitting
NRT Conclusions
- Safe, effective, low risk of addiction
- Consider combination therapy as first line
- No evidence for weaning
- Must be used as directed for 8-12 weeks
- Consider side effects
- Continue with NRT if relapse occurs
- Available on PBS
Prescription Products
- Zyban and Champix
- Available on PBS
- Start on low dose while smoking
- Quit 1-2 weeks after commencing medication
- Only PART of an overall quit smoking plan
E-Cigarette
- Contain: E-juice, nicotine, propylene glycol, flavour, other chemicals
- Heats and vaporises nicotine and chemicals
- Some non smokers take it up and become addicted to nicotine
- Safer than smoking tobacco
- Not regulated or legal
- 20% of of Aus have tried and 7% of smokers use
