Smoking Cessation

Question 1

What can be offered with regards to smoking cessation?

Answer 1

• Nicotine replacement therapy
• Varenicline
• Buproprion

One is not favoured over another.

Question 2

When should NRT, Varenicline or buproprion be prescribed?

Answer 2

Either on or before a particular target stop date.

Question 3

How long should your prescription of NRT, varenicline or bupropion last?

Answer 3

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.

Question 4

Can you combine the NRT, varenicline or bupropion?

Answer 4

No

Question 5

If the person is unsuccesful, can you prescribe again and start over?

Answer 5

Do not offer a repeat prescription within 6 months unless special circumstances have intervened.

Question 6

What are some S/E of NRT?

Answer 6

Nausea & Vomiting

Headaches

Flu-like symptoms

Question 7

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?

Answer 7

NICE recommend offering a combination of nicotine patches and another form of NRT (such as gum, inhalator, lozenge or nasal spray)

Question 8

What is the MOA of varenicline?

Answer 8

It is a nicotinic receptor partial agonist

Question 9

How long is the recommended course of treatment?

Answer 9

12 weeks (But monitor regularly)

Question 10

What is more effective, varenicline or bupropion?

Answer 10

Varenicline

Question 11

What are some common S/E of Varenicline?

Answer 11

Nausea is the most comon

Others: Headache, Insomnia, Abnormal Dreams.

Question 12

Is Varenicline contraindicated in pregnancy or breast feeding or both?

Answer 12

Yes in both.

Question 13

In what circumstance should Varenicline be used with caution?

Answer 13

In patients with a history of depression or self harm.

Can worsen this.

Question 14

What is the MOA of bupropion?

Answer 14

A norepinephrine and dopamine reuptake inhibitor, and nicotinic antagonist

Question 15

When should varenicline be prescribe?

Answer 15

1 week before the target stop date.

Question 16

When should bupropion be prescribed?

Answer 16

1 to 2 weeks before the patients target date to stop.

Question 17

With bupropion, what neurological problem is there is small risk of developing?

Answer 17

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.

Question 18

When is bupropion contraindicated?

Answer 18

• Epilepsy
• Pregnancy
• Breast feeding.
• Eating disorders (relative contraindication)
• Central nervous system tumour.
• Acute alcohol or benzodiazepine withdrawal.

Question 19

In 2010, what has NICE recommended regarding smoking and testing in pregnancy?

Answer 19

All women should be tested for smoking using a carbon monoxide monitor.

Question 20

When should pregnant women be referred to an NHS Stop Smoking Service?

Answer 20

• All women who smoke
• Stopped smoking within the last 2 weeks
• A CO reading of 7 ppm or above

Question 21

What is the first line intervention to help pregnant women stop smoking?

Answer 21

• Cognitive behavioural therapy,
• Motivational interviewing or structured self help
• Support from NHS stop Smoking Services.

Question 22

What is second line?

Answer 22

NRT

Remove the patches before going to bed.

Remember bupropion and varenicline are contraindicated.