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PM2C: Therapeutics and Patient Care: Summer > Smoking Cessation > Flashcards

Smoking Cessation Flashcards

1
Q

How does smoking affect health?

A
  1. Increased morbidity (disease in a specific area) and mortality
  2. Increased risk of cancer, cardiovascular disease, respiratory disease
  3. Adverse effects on fertility, osteoporosis, peptic ulcers, general diminished health
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2
Q

Describe how tar in cigarettes damage users?

A
  1. Suspended particles in cigarrette smoke
  2. Benzo(a)pyrene (carcinogens)= cancer development
  3. Stick brown residue that stains fingers, lungs and teeth
  4. Narrows bronchioles, increased mucuous and decreased cilia activity
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3
Q

Describe how carbon monoxide in cigarettes damage users?

A
  1. Has a higher affinity for haemoglobin compared to oxygen
  2. Leads to production of more red blood cells
  3. Less oxygen in the body
  4. Heart works harder to increase blood pressure and heart rate
  5. Increased cardiovascular disease and reduced exercise tolerance (fatigue)
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4
Q

Describe how nicotine in cigarettes damage users?

A
  1. Disrupts normal neurotransmitter activity by causing chemical changes and addiction
  2. Activates the reward pathway which leads to dependence due to pleasure
  3. Withdrawal symptoms
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5
Q

What is the cycle of development of dependence?

A
  1. Smoking: adds nicotine
  2. Nicotine travels to the brain quickly
  3. Stimulates the release of dopamine (pleasure and calmness)
  4. Decrease in dopamine leads to withdrawal symptoms
  5. Desire for another cigarettes
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6
Q

What is second hand smoking?

A
  1. Smoke that contains many chemicals, irritants and toxins
  2. Increases the risk of lung cancer, heart disease and stroke
  3. Can cause:
    - Ear infections
    - Frequent asthma attacks
    - Respiratory symptoms and infections
    - Greater risk of sudden infant death syndrome
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7
Q

What is the effect on drug metabolism from smoking and give examples of those affected?

A
  1. Polycyclic aromatic hydrocarbons affect some liver enzymes such as cytochrome p450 systems
  2. Enzyme induction leads to faster clearance of medication
  3. Leads to reduction in serum levels and decreased efficacy
  4. Drugs: theophylline, ropinorole and anti-psychotics
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8
Q

What are the barriers involved in smoking cessation?

A
  1. Nicotine craving and withdrawal symptoms
  2. Denial of pleasurable effects of smoking
  3. Lack of motivation
  4. Fear of failure
  5. Social and situational triggers
  6. Worries about weight gain
  7. Concerns about nicotine replacement therapy
  8. Habit hard to break
  9. Not receiving sufficient support
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9
Q

What are the main short term benefits of quitting smoking?

A
  1. Blood pressure decreases and oxygen levels return to normal in the blood
  2. chances of heart attack and stroke decrease
  3. Sense of smell and taste heighten
  4. Nerve endings regrow and nicotine by-products are removed from body
  5. Bronchial tube relaxes and total lung capacity improve
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10
Q

What are the long term benefits of quitting smoking?

A
  1. 2-12 weeks: Circulation improves
  2. 3-9 months: Cough, wheezing and breathing problems improve as lung function increases by 10%
  3. 5 years: Risk of heart attack falls down to about half compared to a smoker
  4. 10 years: Risk of lung cancer falls to half of smoker. Risk of heart disease becomes that of a normal person.
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11
Q

What are the smoking withdrawal symptoms that can last from few days to couple of weeks?

A
  1. Cravings: 2-3 minutes each time
  2. Increase appetite
  3. Dizziness
  4. Lack of concentration
  5. Decreased heart rate
  6. Constipation
  7. Cough
  8. Sleep disturbances
  9. Mood swings
  10. Anxiety
  11. Tingiling sensation
  12. 4 weeks to subside
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12
Q

What are the common withdrawal symptoms?

A
  1. Night time awake
  2. Poor concentration
  3. Urge to smoke
  4. Aggression
  5. Restlessness
  6. Depression
  7. Increased appetite
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13
Q

What are the two factors that you need to assess when quitting smoking?

A
  1. Motivation

2. Nicotine dependence

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14
Q

How do you identify opportunities in the community?

A
  1. New Year resolution
  2. Beginning of lent
  3. Government advertising campaigns
  4. New smoking cessation products
  5. Newspaper headlines on smoking or smoking illnesses
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15
Q

What are the interventions a pharmacist can do in smoking cessation?

A
  1. Brief verbal advice (5 to 10 minutes)
  2. Offered at least once a year to people who continue to smoke
  3. Advise smoker to stop even if they’re not ready
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16
Q

What are the most successful interventions a pharmacist can have to stop someone quit smoking?

A
  1. Behavioural therapy with medication

2. Brief advice

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17
Q

What are the NICE guidelines about interventions?

A
  1. Individual behavioural counselling
  2. Group behaviour therapy
  3. Pharmacotherapies
  4. Self help material
  5. Telephone counselling and quit lines
  6. Mass media
18
Q

What is motivational interviewing?

A
  1. Counselling style designed to help individuals continuously resolve their change
  2. Changes their perception of consequences
19
Q

What is motivational interviewing principles?

A
  1. Motivation to change is determined by the individual
  2. Responsibility for individual to change his or her view
  3. Pursue their means of change increases success
  4. Patient centered approach
20
Q

What are the smoking cessation steps?

A
  1. Allow time to decide whether the person wants to give up
  2. Talk them through smoking habits and ways to support them
  3. Develop a plan to give up tailored to them
  4. Finalise their plan and support them as they work through plan
21
Q

Expand step 1 and describe what to do on smoking cessation?

A
  1. Congratulate them on their decision to give up or if they’re not ready to give up
  2. Congratulate them seeking the information
  3. Explain the support that can be offered
  4. Highlight the benefits of giving up smoking
  5. Ready to give up smoking now or not: dependence level, confidence level, stage of change
22
Q

Expand step 2 and describe what to do on smoking cessation?

A
  1. Provide individualised support and care
  2. Ask them to keep a smoking diary
  3. Discuss smoking habits
  4. Personal benefits and smoking triggers/challengers
  5. Importance of giving up smoking
23
Q

What are the five D’s when confronted with urge to smoke?

A
  1. Delay for a short while
  2. Drink water
  3. Deep breathing
  4. Do something different
  5. Discuss it with someone else
24
Q

How does nicotine replacement therapy work?

A
  1. Use of nicotine to relieve symptoms
  2. Gradual reduce in nicotine levels, lead to reduced cravings
  3. Used in conjunction with behavioural programme or counselling
25
Q

How do you choose the right nicotine replacement therapy product?

A

Reflect patient’s needs, tolerability and cost considerations:

  1. Number of cigarettes smoked per day
  2. Time to 1st cigarette of the day
  3. Speed at which nicotine is delivered from the NRT
  4. Ease of use
  5. Importance of behavioural replacement
  6. Ability to adjust and titrate dose
  7. Local irritant effects
26
Q

What are the key questions that are used to help a customer quit?

A
  1. How many cigarettes do you smoke per a day?

2. Do you smoke within 10 minutes of waking?

27
Q

Describe the steps of how to do Nicotine replacement therapy?

A
  1. Product used for 8 to 12 weeks, towards end time it should be gradually stopped
  2. Combine products together for greater effect
  3. NRT can be used prior to reduce use in an attempt to stop
28
Q

What are the different forms of Nicotine replacement therapy products?

A
  1. Gum
  2. Sublingual tablet
  3. Lozenge
  4. Patch
  5. Inhalator
29
Q

What other advice is given with nicotine replacement therapy?

A
  1. Cope with withdrawal symptoms
  2. Do not deliver as much nicotine as cigarettes
  3. Need a lot of commitment to stop smoking completely
  4. After 1 to 2 months, taper off medication
  5. Must not smoke one puff whilst on medication
30
Q

Describe sublingual tablets as a NRT product to and what are the doses?

A
  1. Aged 12 to 18 (8 week treatment to reduce use over 4 weeks)
  2. 8 to 24 (2mg tablets) per day, maximum 40/day
  3. 20 cigs and more = 2 tablet per hour
  4. 20 cigs or less = 1 tablet per hour
31
Q

Describe lozenges as a NRT product to and what are the doses?

A
  1. For those who smoke within half an hour of waking up
  2. Equal to 30 or more cigarettes per a day: 1 -2 mg
  3. Maximum of 15 or 30 lozenges per day (normally 8 to 12)
  4. Used in pregnancy and lactation
  5. Leave underneath tongue or side of cheek
32
Q

Describe gum as a NRT product to and what are the doses?

A
  1. Chew one piece whenever you have the urge to smoke
  2. 2mg and 4mg = (20- 30 cigs a day)
  3. 4mg= (30 cigs or more)
  4. Population for 12-18 = max of 12 week use
  5. Chew slowly until taste is strong and rest between cheek and gum to allow absorption
33
Q

Describe nasal spray as a NRT product to and what are the doses?

A
  1. Rapid relief of withdrawal symptoms
  2. 10mg/ml of a maximum of 2 doses per hour
  3. One spray into each nostril
  4. Age 12 to 18 is a max of 12 weeks
  5. Daily limit of 64 sprays (2 sprays to each nostril every hour)
34
Q

Describe patches as a NRT product to and what are the doses?

A
  1. Can be used in pregnancy and lactation
  2. One patch can be: 7, 14 or 21 mg in 24 hours (sleep disturbances but useful in morning urge)
  3. One patch can be: 10, 15 or 25 mg in 16 hours
  4. ONE patch DAILY (highest strength for 6 to 8 weeks) (reduce over 4 weeks)
  5. Rotate to different areas of the skin as it can cause irritation
35
Q

Describe inhalators as a NRT product to and what are the doses?

A
  1. Use whenever the urge to smoke is needed
  2. Maximum 6 cartridges per a day (15mg inhalator)
  3. 40 minutes of intense use: leads to cartridge replacing
  4. Use with care in patients with diseases of lungs and throat
36
Q

Describe quick mist mouth spray as a NRT product to and what are the doses?

A
  1. 1mg: 1 to 2 sprays whether the urge to smoke every 30 minutes to an hour
  2. Max 4 sprays in one hour
  3. 64 sprays in 24 hours
  4. Suitable for smokers willing to stop straight away
37
Q

Describe what the POM medication Bupropion (zyban) is, how it works and a quit date?

A
  1. Typical anti-depressant: 150mg
  2. Works on brain pathway on addiction and withdrawal
  3. Acts on noradrenaline and dopamine re-uptake inhibitor
  4. Antagonist at nAChR
  5. Advise patients to set a quit date in second week
38
Q

What are the doses for Buproprion (Zyban) and the main counselling points?

A
  1. Day 1-6: 150mg
  2. Day 7 onwards: 150mg twice a day (7-9 weeks) (8 hours apart)
  3. Helps with addiction and withdrawal symptoms
  4. Side effects:
    - Insomnia
    - Fever
    - Dry mouth
    - GI effects
39
Q

Describe what the POM medication Varenicline (champix) is, how it works and a quit date?

A
  1. Prescribed as part of a programme for behavioural support
  2. Selective nicotine partial agonist
    - Binds to receptor with high affinity to affect dopamine release
    - Blocks access to the receptor by nicotine to reduce pleasure effects
    - Increases likelihood of abstinence
40
Q

What are the counselling points you should give for Varenicline?

A
  1. Patients should set a quit date and start taking Champix 1-2 weeks prior to this date
  2. Black triangle drug= report any adverse effects
  3. Beyonds 12 weeks after stopping smoking, dose of 1mg twice a day

PM2C: Therapeutics and Patient Care: Summer (25 decks)

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