NRT (Nicotine replacement therapy)

Question 1

Symptoms?

Answer 1

• Brown staining of teeth fingers and fingernails.
• Shortness of breath.
• Wrinkled skin.
• Odour on their hair and clothing.
• Excessive smoking more than 10 per day.

Withdrawal symptoms from smoking cessation (ie, dizziness, nausea and headaches).

Lung disease (symptoms include smokers cough).

Within a day of stopping smoking:

• Changes in mood (ie, feeling down),
• Restlessness and lack of concentration,
• Sleeping difficulties
• Decreased heart rate
• Increased appetite

Question 2

Questions?

Answer 2

Have they used any nicotine replacement therapies before?

Have they tried to stop smoking before?

How many cigarettes have they smoked per day on average? How long have they been smoking for?

Ask about previous clinical history, such as:
Do they have liver/kidney problems?

Have they had a stroke/heart attack?

Ask them about pregnancy/breastfeeding if they’re female

Identifying the reason for stopping smoking can often be very important.

Find out if the patient knows of any existing treatment plans and if they have any preference for their treatment course.

If they have no preference then ask if they have problems sleeping, if they do then a 24 hour patch may not be a good option, and a 16 hour patch could be considered instead.

Question 3

Red flags?

Answer 3

Chest pain
Shortness of breath
Blood in the urine
Coughing up blood
Hoarseness
Pain/difficulty swallowing 
Unexplained weight loss.  

High blood pressure due to smoking.

Pregnant or breastfeeding women
Any patients with ulcers, liver disease or kidney disease

Question 4

Treatment?

Answer 4

(Find more specific treatment)

Gum

Lozenges

Sublingual tablets

Inhalator

Nasal spray

Oral Spray

Transdermal patch