Smoking Cessation Flashcards
How does smoking affect health?
- Increased morbidity (disease in a specific area) and mortality
- Increased risk of cancer, cardiovascular disease, respiratory disease
- Adverse effects on fertility, osteoporosis, peptic ulcers, general diminished health
Describe how tar in cigarettes damage users?
- Suspended particles in cigarrette smoke
- Benzo(a)pyrene (carcinogens)= cancer development
- Stick brown residue that stains fingers, lungs and teeth
- Narrows bronchioles, increased mucuous and decreased cilia activity
Describe how carbon monoxide in cigarettes damage users?
- Has a higher affinity for haemoglobin compared to oxygen
- Leads to production of more red blood cells
- Less oxygen in the body
- Heart works harder to increase blood pressure and heart rate
- Increased cardiovascular disease and reduced exercise tolerance (fatigue)
Describe how nicotine in cigarettes damage users?
- Disrupts normal neurotransmitter activity by causing chemical changes and addiction
- Activates the reward pathway which leads to dependence due to pleasure
- Withdrawal symptoms
What is the cycle of development of dependence?
- Smoking: adds nicotine
- Nicotine travels to the brain quickly
- Stimulates the release of dopamine (pleasure and calmness)
- Decrease in dopamine leads to withdrawal symptoms
- Desire for another cigarettes
What is second hand smoking?
- Smoke that contains many chemicals, irritants and toxins
- Increases the risk of lung cancer, heart disease and stroke
- Can cause:
- Ear infections
- Frequent asthma attacks
- Respiratory symptoms and infections
- Greater risk of sudden infant death syndrome
What is the effect on drug metabolism from smoking and give examples of those affected?
- Polycyclic aromatic hydrocarbons affect some liver enzymes such as cytochrome p450 systems
- Enzyme induction leads to faster clearance of medication
- Leads to reduction in serum levels and decreased efficacy
- Drugs: theophylline, ropinorole and anti-psychotics
What are the barriers involved in smoking cessation?
- Nicotine craving and withdrawal symptoms
- Denial of pleasurable effects of smoking
- Lack of motivation
- Fear of failure
- Social and situational triggers
- Worries about weight gain
- Concerns about nicotine replacement therapy
- Habit hard to break
- Not receiving sufficient support
What are the main short term benefits of quitting smoking?
- Blood pressure decreases and oxygen levels return to normal in the blood
- chances of heart attack and stroke decrease
- Sense of smell and taste heighten
- Nerve endings regrow and nicotine by-products are removed from body
- Bronchial tube relaxes and total lung capacity improve
What are the long term benefits of quitting smoking?
- 2-12 weeks: Circulation improves
- 3-9 months: Cough, wheezing and breathing problems improve as lung function increases by 10%
- 5 years: Risk of heart attack falls down to about half compared to a smoker
- 10 years: Risk of lung cancer falls to half of smoker. Risk of heart disease becomes that of a normal person.
What are the smoking withdrawal symptoms that can last from few days to couple of weeks?
- Cravings: 2-3 minutes each time
- Increase appetite
- Dizziness
- Lack of concentration
- Decreased heart rate
- Constipation
- Cough
- Sleep disturbances
- Mood swings
- Anxiety
- Tingiling sensation
- 4 weeks to subside
What are the common withdrawal symptoms?
- Night time awake
- Poor concentration
- Urge to smoke
- Aggression
- Restlessness
- Depression
- Increased appetite
What are the two factors that you need to assess when quitting smoking?
- Motivation
2. Nicotine dependence
How do you identify opportunities in the community?
- New Year resolution
- Beginning of lent
- Government advertising campaigns
- New smoking cessation products
- Newspaper headlines on smoking or smoking illnesses
What are the interventions a pharmacist can do in smoking cessation?
- Brief verbal advice (5 to 10 minutes)
- Offered at least once a year to people who continue to smoke
- Advise smoker to stop even if they’re not ready
What are the most successful interventions a pharmacist can have to stop someone quit smoking?
- Behavioural therapy with medication
2. Brief advice
What are the NICE guidelines about interventions?
- Individual behavioural counselling
- Group behaviour therapy
- Pharmacotherapies
- Self help material
- Telephone counselling and quit lines
- Mass media
What is motivational interviewing?
- Counselling style designed to help individuals continuously resolve their change
- Changes their perception of consequences
What is motivational interviewing principles?
- Motivation to change is determined by the individual
- Responsibility for individual to change his or her view
- Pursue their means of change increases success
- Patient centered approach
What are the smoking cessation steps?
- Allow time to decide whether the person wants to give up
- Talk them through smoking habits and ways to support them
- Develop a plan to give up tailored to them
- Finalise their plan and support them as they work through plan
Expand step 1 and describe what to do on smoking cessation?
- Congratulate them on their decision to give up or if they’re not ready to give up
- Congratulate them seeking the information
- Explain the support that can be offered
- Highlight the benefits of giving up smoking
- Ready to give up smoking now or not: dependence level, confidence level, stage of change
Expand step 2 and describe what to do on smoking cessation?
- Provide individualised support and care
- Ask them to keep a smoking diary
- Discuss smoking habits
- Personal benefits and smoking triggers/challengers
- Importance of giving up smoking
What are the five D’s when confronted with urge to smoke?
- Delay for a short while
- Drink water
- Deep breathing
- Do something different
- Discuss it with someone else
How does nicotine replacement therapy work?
- Use of nicotine to relieve symptoms
- Gradual reduce in nicotine levels, lead to reduced cravings
- Used in conjunction with behavioural programme or counselling
How do you choose the right nicotine replacement therapy product?
Reflect patient’s needs, tolerability and cost considerations:
- Number of cigarettes smoked per day
- Time to 1st cigarette of the day
- Speed at which nicotine is delivered from the NRT
- Ease of use
- Importance of behavioural replacement
- Ability to adjust and titrate dose
- Local irritant effects
What are the key questions that are used to help a customer quit?
- How many cigarettes do you smoke per a day?
2. Do you smoke within 10 minutes of waking?
Describe the steps of how to do Nicotine replacement therapy?
- Product used for 8 to 12 weeks, towards end time it should be gradually stopped
- Combine products together for greater effect
- NRT can be used prior to reduce use in an attempt to stop
What are the different forms of Nicotine replacement therapy products?
- Gum
- Sublingual tablet
- Lozenge
- Patch
- Inhalator
What other advice is given with nicotine replacement therapy?
- Cope with withdrawal symptoms
- Do not deliver as much nicotine as cigarettes
- Need a lot of commitment to stop smoking completely
- After 1 to 2 months, taper off medication
- Must not smoke one puff whilst on medication
Describe sublingual tablets as a NRT product to and what are the doses?
- Aged 12 to 18 (8 week treatment to reduce use over 4 weeks)
- 8 to 24 (2mg tablets) per day, maximum 40/day
- 20 cigs and more = 2 tablet per hour
- 20 cigs or less = 1 tablet per hour
Describe lozenges as a NRT product to and what are the doses?
- For those who smoke within half an hour of waking up
- Equal to 30 or more cigarettes per a day: 1 -2 mg
- Maximum of 15 or 30 lozenges per day (normally 8 to 12)
- Used in pregnancy and lactation
- Leave underneath tongue or side of cheek
Describe gum as a NRT product to and what are the doses?
- Chew one piece whenever you have the urge to smoke
- 2mg and 4mg = (20- 30 cigs a day)
- 4mg= (30 cigs or more)
- Population for 12-18 = max of 12 week use
- Chew slowly until taste is strong and rest between cheek and gum to allow absorption
Describe nasal spray as a NRT product to and what are the doses?
- Rapid relief of withdrawal symptoms
- 10mg/ml of a maximum of 2 doses per hour
- One spray into each nostril
- Age 12 to 18 is a max of 12 weeks
- Daily limit of 64 sprays (2 sprays to each nostril every hour)
Describe patches as a NRT product to and what are the doses?
- Can be used in pregnancy and lactation
- One patch can be: 7, 14 or 21 mg in 24 hours (sleep disturbances but useful in morning urge)
- One patch can be: 10, 15 or 25 mg in 16 hours
- ONE patch DAILY (highest strength for 6 to 8 weeks) (reduce over 4 weeks)
- Rotate to different areas of the skin as it can cause irritation
Describe inhalators as a NRT product to and what are the doses?
- Use whenever the urge to smoke is needed
- Maximum 6 cartridges per a day (15mg inhalator)
- 40 minutes of intense use: leads to cartridge replacing
- Use with care in patients with diseases of lungs and throat
Describe quick mist mouth spray as a NRT product to and what are the doses?
- 1mg: 1 to 2 sprays whether the urge to smoke every 30 minutes to an hour
- Max 4 sprays in one hour
- 64 sprays in 24 hours
- Suitable for smokers willing to stop straight away
Describe what the POM medication Bupropion (zyban) is, how it works and a quit date?
- Typical anti-depressant: 150mg
- Works on brain pathway on addiction and withdrawal
- Acts on noradrenaline and dopamine re-uptake inhibitor
- Antagonist at nAChR
- Advise patients to set a quit date in second week
What are the doses for Buproprion (Zyban) and the main counselling points?
- Day 1-6: 150mg
- Day 7 onwards: 150mg twice a day (7-9 weeks) (8 hours apart)
- Helps with addiction and withdrawal symptoms
- Side effects:
- Insomnia
- Fever
- Dry mouth
- GI effects
Describe what the POM medication Varenicline (champix) is, how it works and a quit date?
- Prescribed as part of a programme for behavioural support
- 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
What are the counselling points you should give for Varenicline?
- Patients should set a quit date and start taking Champix 1-2 weeks prior to this date
- Black triangle drug= report any adverse effects
- Beyonds 12 weeks after stopping smoking, dose of 1mg twice a day
