Varenicline training

Question 1

What % of all deaths in Scotland is attributed to tobacco?

Answer 1

1/5 or 20%

Question 2

How many deaths per year does smoking cause?

Answer 2

10,000

Question 3

What % of adults in Scotland smoke?

Answer 3

16.3%

Question 4

In what 3 populations is smoking still might higher?

Answer 4

• poorer communities
• long-term mental health
• prisoners

Question 5

Smokers are __ times more likely to quit with support from pharmacy

Answer 5

4 times

Question 6

When might dual NRT therapy be used?

Answer 6

Smoker >20 cig/day

Question 7

When might dual NRT not be suitable?

Answer 7

Pregnancy or breastfeeding

Question 8

What is the MoA of varenicline?

Answer 8

Partial agonist at nicotinic receptors to prevent the high of smoking and also reduce the craving/withdrawal.

Question 9

Upon which receptor does varenicline act?

Answer 9

alpha-4-beta-2 nicotinic receptor.

Question 10

Does varenicline cause a release of dopamine?

Answer 10

Yes - but smaller than would be released from smoking.

Question 11

Name some instances where a GP would need to be informed when starting someone on varenicline?

Answer 11

epilepsy
severe renal disease
severe mental health/psychriatry problems.

Question 12

When should you stop smoking if you are starting varenicline?

Answer 12

About 1-2 weeks after starting varenicline

Question 13

When should you stop smoking if you are using NRT?

Answer 13

As soon as possible after starting first patch.

Question 14

What is the dosing titration schedule for varenicline?

Answer 14

days 1-3 = 0.5mg daily
days 4-7 = 0.5mg BD
day 8 till end of treatment = 1mg BD.

Question 15

What is the most common S/E with varenicline and how can this be combated in the first instance?

Answer 15

Nausea

Take tablets with some food.

Question 16

What to do if nausea with varenicline persists?

Answer 16

If nausea is not reducing - client can drop down to 0.5mg BD (half tab) for the rest of the course.

Question 17

What happens if a client has smoked at week 4?

Answer 17

End quit attempt and record.

If client wants to continue - new quit attempt must be started in the same pharmacy.

Question 18

What if the client has smoked between 1-5 cigarettes since the 4 week mark at week 12?

Answer 18

Congratulate them - record as successful quit attempt.

Question 19

What if the client has smoked >5 cigarettes since the 4-week mark at week 12?

Answer 19

Advise client this quit attempt has finished - discuss where they might have went wrong. Advise client to return when they are ready to try again.

Question 20

List some other S/E with varenicline?

Answer 20

Sleep disturbances,
headache,
appetite changes,
drop in mood initially.

Question 21

List some S/E of NRT?

Answer 21

Upset stomach,
Sleep disorders/abnormal dreams
Skin irritation

Question 22

What are some cautions to using NRT or varenicline?

Answer 22

History psychiatric illness,
CVD
Renal or hepatic impairment
Diabetes mellitus

Question 23

Which can be supplied in pregnancy/BF’ing?

Answer 23

NRT

Question 24

List 6 drugs that may require dose adjustment if a patient stops smoking?

Answer 24

clozapine
insulin
methadone
olanzapine
theophylline
warfarin

Question 25

In which patients should the dose of varenicline be reduced?

Answer 25

• Mod renal impairment
• Sev renal impairment
• Unable to tolerate S/E

Question 26

Which CYP enzymes are affected most by smoking status?

Answer 26

1A2