Smoking cessation (OSCE)

Question 1

What should be offered first line for people stopping smoking?

Answer 1

Nicotine replacement therapy
OR
varenicline (partial nicotine agonist)
OR
bupropion (NDRI)
Never given in combination

Question 2

What approach should be taken when councelling patients to stop smoking?

Answer 2

5 As approach
Ask about:
-Type of smoking
-Frequency
-Duration
-Quitting history
-Effect of smoking on patients life
Advise to quit smoking
Assess willingness to quit:
-if willing help, if not use 5R's approach
Assist patient to quit:
-Pharmacological and behavioural methods
Arrange for follow up plan or referral

Question 3

What are the aspects of assisting a patient to give up smoking?

Answer 3

Ask for a commitment
Set a quitting date
Bahavioural methods:
-Smkoing diary
-Progressive restriction
-Avoid being around people smoking
-Avoid environment e.g. ashtrays
-Learn to do something that will distract your craving
Pharmacological methods:
-Nicrotine replacement therapies
-Drugs e.g. bupripion and varencline

Question 4

What are some of the forms of nicotine replacement therapy?

Answer 4

Pathches
gum
lozanges
Inhalational
Oral/Nasal spray

Question 5

If a patient is not willing to quit smoking what approach can you use?

Answer 5

5 Rs approach

• Risks - Medical, social, risk of fires
• Reward - benefits of smoking cessation
• Relevancy - focus on short term changes, tailor to patients condition
• Road blocks - withdrawl symptoms and weight gain
• Repitition - repeat the information and check understanding