Smoking Cessation Flashcards
What can be offered with regards to smoking cessation?
- Nicotine replacement therapy
- Varenicline
- Buproprion
One is not favoured over another.
When should NRT, Varenicline or buproprion be prescribed?
Either on or before a particular target stop date.
How long should your prescription of NRT, varenicline or bupropion last?
Only 2 weeks after the target stop date.
2 weeks for NRT
3-4 weeks for varenicline or buproprion
But 12 weeks is the recommended course for varenicline.
Can you combine the NRT, varenicline or bupropion?
No
If the person is unsuccesful, can you prescribe again and start over?
Do not offer a repeat prescription within 6 months unless special circumstances have intervened.
What are some S/E of NRT?
Nausea & Vomiting
Headaches
Flu-like symptoms
For patients with a high level of nicotine dependence or who have failed to stop with single forms of NRT in the past, what can your prescribing strategy be?
NICE recommend offering a combination of nicotine patches and another form of NRT (such as gum, inhalator, lozenge or nasal spray)
What is the MOA of varenicline?
It is a nicotinic receptor partial agonist
How long is the recommended course of treatment?
12 weeks (But monitor regularly)
What is more effective, varenicline or bupropion?
Varenicline
What are some common S/E of Varenicline?
Nausea is the most comon
Others: Headache, Insomnia, Abnormal Dreams.
Is Varenicline contraindicated in pregnancy or breast feeding or both?
Yes in both.
In what circumstance should Varenicline be used with caution?
In patients with a history of depression or self harm.
Can worsen this.
What is the MOA of bupropion?
A norepinephrine and dopamine reuptake inhibitor, and nicotinic antagonist
When should varenicline be prescribe?
1 week before the target stop date.
When should bupropion be prescribed?
1 to 2 weeks before the patients target date to stop.
With bupropion, what neurological problem is there is small risk of developing?
Bupropion carries a significant risk of seizures in certain patient groups and as such there are specific clinical situations in which its use is contraindicated and certain instances where it should only be used if the benefits of smoking cessation outweigh the risks of treatment.
When is bupropion contraindicated?
- Epilepsy
- Pregnancy
- Breast feeding.
- Eating disorders (relative contraindication)
- Central nervous system tumour.
- Acute alcohol or benzodiazepine withdrawal.
In 2010, what has NICE recommended regarding smoking and testing in pregnancy?
All women should be tested for smoking using a carbon monoxide monitor.
When should pregnant women be referred to an NHS Stop Smoking Service?
- All women who smoke
- Stopped smoking within the last 2 weeks
- A CO reading of 7 ppm or above
What is the first line intervention to help pregnant women stop smoking?
- Cognitive behavioural therapy,
- Motivational interviewing or structured self help
- Support from NHS stop Smoking Services.
What is second line?
NRT
Remove the patches before going to bed.
Remember bupropion and varenicline are contraindicated.
