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PHRM1012 > Smoking Cessation > Flashcards

Smoking Cessation Flashcards

1
Q

Smoking Risks

A

Increased Risk of:

  • Heart disease
  • Stroke
  • Cancer
  • Emphysema
  • Bronchitis
  • Asthma
  • Renal disease
  • Eye disease
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2
Q

Indigenous Australians

A

Smoking rates are considerably higher than the non-indigenous community in every age group

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3
Q

Rates of Smoking are Highest in…

A
  • Low socio-economic groups
  • Poorly educated
  • Rural and remote areas
  • 25-40 year olds
  • Singles
  • Indigenous
  • Mental illness
  • Substance abusers
  • Labour workers
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4
Q

Why do People Smoke

A
  • Heritable 50%
  • Addiction
  • Enjoyment
  • Peers
  • Alcohol
  • Boredom
  • Weight control
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5
Q

Passive Smoking

A
  • Second hand smoke
  • Increased heart disease, asthma, some cancers, SIDs
  • Predispose children to allergies
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6
Q

1950 vs 2015

A

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
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7
Q

Smoking in Public places

A
  • Must be 5m from boundary of hospital or day therapy facility
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8
Q

Clinically Significant Compounds of Cigerettes

A

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

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9
Q

Smoking and Cancer

A
  • 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
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10
Q

Role of Pharmacist

A

Provide lifestyle and pharmacotherapy advice. Perform brief intervention and educate public.

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11
Q

5 A’s of intervention

A

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

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12
Q

Assessing Nictone Dependace

A

Dependance is present if one or more of the following are true:

  • TTFC of 30min
  • 10 per day
  • Withrawal syptoms from cessation
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13
Q

NRT Evidence

A
  • Increases quitting success by 1.5-2 times
  • Not able to conclude which if any is more effective than another
  • 1/3 still relapse
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14
Q

NRT Purpose

A

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

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15
Q

What Proportion of Smokers Want to Quit?

A

> 70%

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16
Q

Average Number of Unaided Quit Attempts per Person

A

21

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17
Q

Why Do Smokers Want to Quit?

A
  • Health/Fitness
  • Money
  • Peer pressure
  • Passive smoking concerns
  • Example to children
  • Restricted smoking areas
  • Wanting to regain control
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18
Q

Why is it Difficult to Quit?

A
  • Fear of failure
  • Withdrawal symptoms
  • Motivation
  • NRT misuse
  • Barriers: Alcohol, weight gain, stress
  • Not prepared for difficult situations
  • Let slip ups become relapses
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19
Q

Nicotine Addiction

A

Highly addictive beacuase of its:
- Fast absorbtion
- High plasma concentration
Nictoine addiction is lifelong and varies in intensity

20
Q

Nicotine Dosing

A
  • Many factors influence individual nicotine requirements

- Smokers titrate their dose of nicotine to feel satisfied (compensatory smoking/light cigs)

21
Q

Nicotine Overdosing

A
  • Nausea
  • Stomach cramps
  • Vomiting
  • Headache
  • Sweating
  • Breathing difficulties
  • Heart palpitations
  • Not fatal
22
Q

Liver Enzymes

A
  • Nicotine is metabolised by liver enzyme P450 - CYP2A6
23
Q

Fast Metabolisers

A
  • 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
24
Q

Withdrawal Symptoms

A
  • 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
25
Q

Immediate Effects of Smoking

A
  • Increase in blood pressure, heart rate and muscle tension

- Decrease in lung volume, skin temperatur and oxygen

26
Q

Visually Noticable Effects of Smoking

A
  • Stained fingers, moustaches and teeth

- Greyish skin and premature wrinkles

27
Q

General Effects of Smoking

A
  • Decreased circulation
  • Gangrene
  • Out of breath
  • Cough
  • Phlegm
  • Wheeze
28
Q

Effects of Second and Third Hand Smoke:

A
  • Asthma
  • Respiratory disease
  • Middle ear infections
  • Colic
  • CVD
  • Cancers
  • COPD
29
Q

Smoking and Life Expectancy

A
  • 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
30
Q

Benefits of Quiting

A
  • 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
31
Q

Caffeine and Smoking

A
  • Smokers need more
  • Quitters need less
  • Half caffeine when quitting
  • Too much caffeine mimics nictotine withdrawal
32
Q

Methods of Quitting

A
  • Cold Turkey
  • NRT
  • Non-nicotine based products
33
Q

Products With No Conclusive Evidence

A
  • NicoBloc and other products in pharmacies and online
  • Acupuncture
  • Laser
  • Hypnotherapy
  • E-cigs
34
Q

NRT Products Available

A
  • Patch
  • Gum
  • Lozenge, mini lozenge, cool drops
  • Inhalator
  • Mouth spray (mist)
  • Oral mouth strips
35
Q

Nicotine Patch

A
  • 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
36
Q

Nicotine Gum

A
  • 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
37
Q

Nicotine Lozenges

A
  • Dissolve in mouth over 30min when required for up to 3 months
  • Side effects: hiccups, nausea, indigestion, headache, dizziness, sore throat
38
Q

Nicabate Minis (Lozenges)

A
  • 3x faster than gum
  • Conveniently packaged
  • Dissolve slowly in mouth
  • Side effects: hiccups, nausea, indigestion, headache, dizziness, sore throat
39
Q

Nicotine Inhalator

A
  • 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
40
Q

Nicotine Cooldrops

A
  • Small lozenge dissolved in mouth for 20min when required

- Side effects: hiccups, nausea, indigestion, headache, dizziness, sore throat

41
Q

Nicabate Mouth Strips

A
  • Oral films dissolved in mouth for 3 min
  • Relief in 50sec
  • Side effects: hiccups, nausea, indigestion, headache, dizziness, sore throat
42
Q

NRT Contradictions

A
  • Children
43
Q

NRT Approaches

A
  • 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
44
Q

NRT Conclusions

A
  • 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
45
Q

Prescription Products

A
  • 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
46
Q

E-Cigarette

A
  • 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

PHRM1012 (15 decks)

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