Smoking Cessation Flashcards
What are the 3 tobacco indicators?
Adult smoking prevalence
Smoking prevalence amongst 15 year olds
Smoking status of mothers at time of delivery
Give an example of public health strategy to encourage smoking cessation.
“Healthy lives, Healthy people: A Tobacco control plan for England
What are the aims of the smoking cessation strategy?
Stopping promotion of tobacco Making Tobacco products less desirable Effective regulation of tobacco products Helping tobacco users to quit Reducing exposure to second hand smoke Effective communications for tobacco control
What are the impacts of smoking?
Greatest single cause of illness and premature death in UK
100,000 or 50% of smokers die from smoking-related disease
Tobacco and poverty are inextricably linked
Single biggest cause of inequality between the rich and the poor
What are the economic impacts of smoking?
5.5% of total healthcare costs Money spent on buying cigarettes Loss of productivity from smoke breaks Increased absenteeism from smoking-related illnesses Cleaning up of cigarette butts Loss of economic output from deaths
What are the associations between gender and smoking?
Teenage girls are more likely to smoke than teenage boys but there are more men smoking than women
Both genders find it equally difficult to stop smoking
Women are more likely than men to access stop smoking services
More women are concerned about weight gain when they stop smoking
What are the benefits of stopping smoking?
- Increased life expectancy
+10 years if quit at 35 yrs old
+3 years if quit at 65 yrs old - Lung cancer risk stops increasing
- Heart disease risk decreases by 50% in the 1st year
- Rate of progression of COPD slows drastically once smoker stops
- Ex-smokers report being happier, having a greater lift and satisfaction than smokers
- An average smoker saves £1500 a year if they quit
- Smoking increases the rate of clearance of medications and an increased dosage is needed and upon stopping smoking, a reduced dose is needed
- Decreased risk of the following:
Pre-eclampsia
Morning sickness during pregnancy
Ulcerative colitis
Parkinson’s disease
What are the effects of smoking on conception?
Men- Reduces sperm count, makes sperm more immobile and higher incidence of impotence
Women- Hormonal changes that reduce likelihood of becoming pregnant
Smoking reduces the effectiveness of assisted reproductive devices
How does smoking affect pregnancy?
- Increases risk of miscarriage and stillbirth
- Babies are more likely to be born premature and have intrauterine growth restriction
- Babies born to mothers who smoke are twice as likely to die from sudden unexplained death in infancy
- Long term problems:
Behavioural problems
Learning difficulties
Respiratory problems
What are the impacts of smoking on mental health?
High incidence among people who have anxiety and depression
Majority of people with mood disorders will be happier after stopping smoking
Stopping smoking will not worsen their mood disorders
No evidence that smoking helps with psychotic symptoms
Facts on nicotine
On average, smokers get up to 1mg of nicotine with each cigarette, and can get up to 6mg if smoked really hard
Nicotine is absorbed into the blood rapidly in the lungs and reaches the brain in seconds
Nicotine is excreted rapidly and has a half-life of about 90-120 mins
Long term smoking causes the brain to adapt to the high levels and creates an abnormally low dopamine level when smoking is stopped
Give examples of nicotine withdrawal symptoms.
Depression Irritability Restlessness Difficulty concentrating Increased appetite Coughing Constipation Weight gain Mouth ulcers Light headedness (usually <48hrs) Waking at night (usually <1wk)
Facts on nicotine replacement therapy
Nicotine is delivered without the harmful substances of the rest of the cigarette
The problem is that smokers do not use enough of it for long enough
Using 2 or more methods for nicotine replacement works best. Patch for basal nicotine and intermittent nicotine as and when needed
Use NRT 2 weeks before stopping smoking and for at least 8-12 weeks
The higher dose of each NRT is used for the normal nicotine amount absorbed when smoking
During pregnancy
NRT during pregnancy can cause the NRT to reach the baby
Intermittent NRT should be used rather than the constant flow NRT (lozenges)
Liqourice-flavoured nicotine gum (Nicotinell) is contraindicated in pregnancy
Facts on nicotine transdermal patch
- The patches deliver half the nicotine they would normally get from smoking
- Side effects
Skin reaction (5%)
Burning sensation at the site. Change site location to prevent this
Wakefulness/vivid dreams at night. Use the 16hr patch instead and another form of NRT in case they wake up during the night - Contraindications
Hypersensitivity to the patch or any component of it
Children under 12 - Prescription
10mg and 25mg
16hr and 24hr patches
Facts on oral nicotine products
- The nicotine are absorbed through the buccal mucosa
- Chewing gum
Needs to be chewed until there is hot peppery taste and then placed against the cheek
Less than half of the nicotine dose is absorbed
Side effects become less severe with use
Side effects- Burning mouth, Indigestion, hiccups, jaw ache
Contraindications- Hypersensitivity to any component of the gum
Prescription- 2mg and 4mg - Lozenges
Half the nicotine dose is absorbed
Side effects become less severe with use
The taste can be unpleasant at first, but can get used to it
Side effects- Burning mouth, indigestion, hiccups, heartburn (when swallowed)
Contraindications- Hypersensitivity to any component and children under 12
Prescription- Normal (1mg, 2mg, 4mg) and mini lozenge (1.5mg, 4mg) - Microtabs
Should be placed under the tongue where it can be absorbed
Half the nicotine dose is absorbed
Side effects become less severe with use
The taste can be unpleasant at first, but can get used to it
Side effects- Burning mouth, indigestion, hiccups, heartburn (when swallowed)
Contraindications- Hypersensitivity to any component
Prescription- 2mg - Mouth sprays
Side effects become less severe with use
Side effects- Indigestion, hiccups, heartburn (when swallowed), headache, nausea, taste distortion, irritation to the mouth and throat for the first few days
Contraindications- Hypersensitivity to any component, children under 12
Prescription- 2mg. Recommended 1-2 sprays every 30-60 mins. Max 4 sprays/hr, 64 sprays/day - Inhalator
Some people get a sore throat or find that the nicotine taste is unpleasant
Side effects- Indigestion, hiccups, heartburn (when swallowed), coughing,
Contraindications- Hypersensitivity to any component, children under 12 - Strips
Strips are placed on the tongue and allowed to dissolve
Many find that this tastes much better than the other forms of NRT
Side effects- Nausea, indigestion, heartburn, stomach discomfort, mouth discomfort
Contraindications- Hypersensitivity to any component, children under 12
Prescription- 2.5mg. Recommended 1 film every 1-2 hrs, up to 15 a day - Nasal spray
Nicotine is absorbed through the nasal mucosa and is absorbed faster than any other type of NRT
Side effects become less severe with use
Side effects- Sneezing, coughing, watery eyes, burning and itching sensation in the nose
Contraindications- Hypersensitivity to any component, children under 12
Prescription- Every hr
Facts on Varenicline (Champix)
- Mechanism
Nicotinic acetylcholine receptor partial agonist
Results in dopamine release similar to that when nicotine from smoking releases dopamine
The nicotinic receptors are blocked and further smoking does not have an effect on dopamine release and they do not feel satisfied - Side effects
Nausea, headache, difficulty sleeping (insomnia), abnormal dreams
Side effects are less severe with time
Nausea can be reduced when the medication is taken with food
3. Contraindications Allergy Children under 12 Pregnancy Breastfeeding
- Prescription
Start 1 week before stopping smoking and duration for 3 months
1mg BD
Facts on Bupropion (Zyban)
- Mechanism
An atypical antidepressant found to help with smoking
Unclear mechanism but thought to inhibit neuronal uptake of dopamine and noradrenaline
Reduces severity of withdrawal symptoms and reduces desire to smoke - Side effects
Dry mouth, insomnia, headache, low risk of seizures, urticaria - Contraindications
History of seizures, abrupt alcohol/sedative withdrawal, irreversible monoamine oxidase inhibitors, bulimia, anorexia, severe hepatic cirrhosis - Prescription
150mg OD for 6/7, then BD with at least 8 hrs between
Start 1 wk before stopping smoking and continue for 120 tablets
Facts on E-cigarettes
Effectiveness and quality of e-cigarettes are unknown until it is licensed
It is not available on the NHS
People who want to stop smoking can be encouraged to do so with e-cigarettes but should be supported
Who are the groups of smokers who need additional support in stopping smoking?
Young smoker
Smoke first thing in the morning/interrupt their sleep to smoke
Lives with people who smoke
Come from a low paid manual job or are unemployed
Have a mental health problem/illness
Are drug/alcohol dependent
What are the biomarkers of smoking?
- Expired CO
Good to detect amount of smoke for the day, not the day before
Cut-off is 10ppm
Readings can be inaccurate if patients are lactose intolerant
Patients are exposed to CO in cars/boilers - Cotinine
A metabolite of nicotine that is eliminated from the body slower than nicotine
Usually detected in saliva but urine or blood can be used
Most accurate measure as it lasts for several days in the body
Does not differentiate between NRT and smoking
Cut-off is 13ng/ml
What are involved in pre-quit stage?
Build rapport Listen to client’s views Explain the role of services Explain the importance of the programme Explain how tobacco dependence develops Assess current and past smoking behaviour History of quit attempts Readiness and ability to quit Physiological and mental functioning Assess nicotine addiction Assess social support Assess contacts who smoke Attitudes to smoking and stopping Advise on environment restructuring Advise on changing routine Advise on the use of social support Prompt self recording Explain the importance of CO monitoring Facilitate medication choice Explain the importance of ‘not a puff’ rule Set a quit date Summarise information given
What are involved in quit date stage?
Prompt commitment Facilitate medication use Maximise motivation to quit Measure CO Advise on withdrawal symptoms Advise on weight gain Alcohol and caffeine Advise on avoiding cues Advise on restructuring social life Summarise
What are involved in post quit stage?
Progress since quit date Responding to clients who have smoked Rewarding post-quit abstinence Assess withdrawal symptoms Ask about medication use Provide reassurance Relapse prevention Respond to the CO reading Prompt review of goals Signpost further support on the last session
Explain the mechanism behind nicotine addiction.
Nicotine mimics acetylcholine
Nicotine attaches itself to an area of the brain called the ventral tegmental area
This activates the neurons to release dopamine in the nucleus accumbens that is important in developing and maintaining addiction
Give examples of situations when people crave for nicotine.
being with other smokers
drinking alcohol
during times when they would normally smoke
