Smoking Flashcards
(17 cards)
main cause of premature death + preventable illness in UK
smoking
Markers for addiction
- use despite knowledge of harmful consequences
- cravings during abstinence
- failure of attempts to stop
- withdrawal symptoms during abstinence
management of quitting/reducing smoking
- refer to NHS stop smoking services
- ask about triggers + habits
- nicotine free medications: e.g. varenicline, bupropion
- NRT: e.g. patches, gum, inhalers, lozenges
Management of quitting smoking in pregnancy
- first line: CBT, motivational interviewing + support from NHS Stop smoking services
- second line: NRT
- varenicline + bupropion are contraindicated
Pharmacological treatment of smoking
- Nicotine replacement therapy: short acting - gums, inhalers, lozenges - help with cravings |long acting - patches 16 or 24 hours
- nicotine free medications: varenicline (nicotine receptor antagonist) or bupropion (NA + dopamine reuptake inhibitor)
examples of nicotine free medications + MOA
when should they be started
- Varenicline: nicotine receptor partial agonist
- Bupropion: NA + dopmaine reuptake inhibitor, + nicotinic antagonist
- start 1 week before patient target date to stop
adverse effects of varenicline
- nausea
- headache
- insomnia
- abnormal dreams
contranidications of nicotine free medications
- pregnancy + breast feeding
- epilepsy (bupropion)
- caution in depression or self harm (varenicline)
Treatment of tobacco dependency
- screen for tobacco dependence
- advise on role of nicotine
- initiate combination NRT ASAP
- complete a referral to on site tobacco dependency advisor
- provide accurate + consistent information about vaping
- discuss, offer + prescribe nicotine analogue meds
Examples of tobacco related diseases
- lung cancer
- COPD
- asthma
- stroke
- vascular disease
- crohn’s diseases
- infection
- blindness
What withdrawal symptoms may be expected when someone stop smoking?
- irritability, frustration, anger
- difficulty concentrating
- increased appetite
- restlessness
- depressed mood
- insomnia
Management of smoking withdrawal symptoms
- reassurance that this is normal + first few days is the worst
- delay acting on craving, often it will pass
- stress management
- no judgement approach to relapse
Harm reduction approach for smoking
- stopping smoking but continuing to use NRT
- cutting down before stopping smoking, w/wo NRT
- smoking reduction w/wo NRT
- temporary abstinence, w/wo NRT
Follow up of quitting smoking
- 2 weeks after NRT
- 3-4 weeks after varenicline/bupropion
- measure CO levels 4 weeks after quitting - <10ppm suggests non smoker
- discuss how it is going
- withdrawal symptoms
- if returned to smoking, advise them to set another quit date, reassurance that most smokers need several attempts before they succeed
follow up after initating NRT
2 weeks
follow up after starting nicotine free medications - varenicline or bupropion
3-4 weeks
what can be measured to assess whether someone is a smoker or not?
when should this be done as follow up of quitting smoking?
what value indicates non smoker
CO levels
4 weeks after quitting
<10ppm - non smoker
