Smoking Cessation Flashcards
(26 cards)
What does quitting smoking reduce your risk of?
- lung cancer 🫁
- COPD 😷
- coronary vascular disease 🫀
What is the addicting component in smoking?
- nicotine - the harmful substances are the tar and the carcinogens, however the addicting nature of nicotine means the px intake of these harmful substances will increase bc they are constantly smoking bc of the addiction.
How does smoking harm the body?
- increased risk of heart attack 🫀 + stroke 🧠
- increased risk of lung cancer 🫁
- brittle bones - increased risk of OP in women 🦴
- can cause impotence in men 🥚
- premature aging b/w 10 - 20 yrs
- can make it harder to conceive 🤰🏾
What are the harms of smoking in pregnancy?
increases risk of complications such as
- premature birth
- low birth weight
- increased risk of miscarriage
- baby at increased risk of developing diabetes, problems with ENT, obesity, + resp conditions
What are the 4 major methods of quitting smoking - rank most to least effective
- local stop smoking services (involves behavioural support and stop smoking aids) ( 🥇 )
- using smoking cessation medication (ie varenicline, bupropion) ( 🥈 )
- using OTC NRT ie patches, gum, e - cigarettes ( 🥉 )
- willpower alone - least effective
What are the risks of stopping smoking - need to tell patient this aswell so they have an informed choice!!
- withdrawal effects (tachycardia, anxiety, shakes, cravings)
- it may suffer with cravings - essp if long term smoker, habit
Explain what ** “ask, advise and act” ** are in terms of Very Brief Advice?
- Ask- establish the patients smoking status (ie current, ex smoker, attempts to quit?
- Advise - if px does smoke, offer support, give them advice on the best way to stop smoking (combination of treatment, ie drugs or NRT and support).
- Act - the preferred route is the NHS stop smoking services - if the patient doesn’t want to take that route, offer them NRT to reduce withdrawal effects.
What is some practical advice we can offer to patients in regards to stopping smoking?
- 📆 set a date to stop smoking 🗓️
- 🫂 make sure they let their friends and family know they are quitting - they can support the patient
- ⚖️ make sure the patient knows the benefits and risks of quitting smoking - cost is withdrawal effects, benefits = reduced risk of lung cancer, MI, stroke, smokers cough
- 😷 smokers cough may be worse in the first few days but it just means the lungs are clearing themselves up.
- 🏃♀️ it would be good to try and incorporate exercise as-well - helps with motivation to a happier and healthier lifestyle but we can address this another time
What is the main indication for NRT?
NRT is nicotine replacement therapy - it helps patients deal with the cravings that come with stopping smoking. It is good for patients with nicotine dependance.
Rmb, its the nicotine that keeps patients addicted - so NRT offers low dose nicotine without all the harmful side effects of smoking ie tar,and carcinogens
NRT counselling.
- very good in helping patients to quit smoking - helps with cravings
- delivers nicotine which is absorbed much more slowly compared to smoking
- nb its not as effective in dealing with withdrawals of nicotine dependance (ie that you would need cigarettes to get that hit quickly)
- we usually rx the patch and another method of NRT in addition to this.
⚠️ all NRT are medicines - need to be discarded carefully !!! - they all have nicotine in them!!! - use a prolonged release preparation (ie a transdermal patch) and
an immediate relief NRT for best results
🩹 NRT patch counselling
🩹 It is a prolonged release preparation and can be applied for up to 16 - 24 hrs - it provides a background nicotine level however we can use immediate release preparations (ie gum, inhalator, nasal spray) for immediate relief when the patient gets the urge to smoke
✅ start on a strength that matches the amount of cigarettes that the patient smokes - we can taper this slowly over time.
😴 some patients report vivid dreams and nightmares - advice patient to remove the patch at night, or we can change to 16hr patch so they only wear it in the daytime
🩸 DO NOT place on BROKEN SKIN - increased absorption, and not suitable for px with skin disorders
🔁 patch should be applied on waking to dry, non - hairy skin, ie the trunk, or upper arm and held in position for 10 - 20 (s) to ensure adhesion. Place patch on a different area and avoid using the same site for several days
🌅 place patch on in the morning on waking to avoid getting vivid dreams (however in some px, 24hr patch may help them not have cravings for smoking in morning)
⏰ patients taking who are on the 16hr patch need to remember to remove the patch at night time.
Symptom of nicotine withdrawal
- 🤢 malaises
- 🤕 headache
- 😢 depression
- 😴 sleep disturbance
- 😷 cough
- 😠 irritability
- 😟 anxiety
- 🤤 increased appetite
😋 NRT gum counselling?
Requires a special type of chewing
- chew on one piece of gum until the flavour is STRONG then rest the gum between cheeks and ur gums until the flavour reduces. Repeat the process for abt 30 mins , after which the flavour typically reduces then can discard the gum.
🔥 initially, it may cause a burning sensation in the throat however this will reduce with increased usage
👵 It should NOT be used in px with false teeth
🥤 avoid drinking acidic drinks and food abt 15 mins prior to chewing the gum
⚠️ keep away from children and discard the gum wrapped up properly - may have traces of nicotine within it!!! (Rmb its still a medicine!)
SIDE EFFECTS INCLUDE
- 😬 anxiety, 💩 diarrhoea + GI disorders, sleep disorders 😴, mood altered, dyspepsia + burping 🔥
🚬 NRT inhalator counselling
✅ mimics the hand to mouth habit - however has replaceable cartridges and px can use a max of 6 cartridges /24hrs
🫁 its use requires more effort than smoking - deeper breaths advised
1 cigarette puff = same (n) nicotine as abt 8 - 10 puffs of the inhalator :) thus nicotine is absorbed in at a much slower rate making it less addictive and easier to stop smoking
SIDE EFFECTS
- weakness/lack of NRG 🥱, dry mouth 🏜️, 👃 flatulence, GI discomfort, hiccups, taste altered 👅, throat and nasal complaints
Other than patches, inhalators and gum, what are some alternative methods of NRT?
- lozenges 🍬
- nasal spray 👃 (prime spray and spray on outer corner of nose , leaning forwards - rmb to prime first).
- oral spray
- sublingual tablets
Name the two drug options we can prescribe to patients who want to stop smoking? (POM)
- Varenicline - nicotine receptor agonist
- Bupropion - SNRI
How does varenicline work to help patients in smoking cessation?
It is a (partial) nicotine receptor agonist - thus it binds to the nicotinic receptors instead of nicotine (ie when a px smokes) preventing the dopamine rush and stimulation they usually would get from smoking.
- 😑 thus when PX DO smoke its less satisfying for them
Varenicline counselling.
- MOA - partial nicotine receptor agonist, so when you do smoke it binds to the receptors instead of nicotine from cigarettes and so you dont feel as satisfied or stimulated from smoking
- ⏰ It should be started whilst the px is still smoking cigarettes - thus the quit date should be abt 1-2 weeks after starting the tablets
- ✅ more than DOUBLES chances of successfully quitting!
- more effective than bupropionshowever have similar efficacy to NRT
- 📅 typically a ** 3 month ** course - however px can request an additional 3 month supply
- 🥘 take with food to prevent common SE of nausea
- 😵💫 caution in px with MH problems - may induce psychosis - STOP and refer/escalate
How does bupropion help patients with smoking cessation?
- It reduces the urge to smoke and symptoms of nicotine withdrawal - it blocks the satisfaction that patients feel when they smoke
It is typically used in patients who cant use NRT or have failed to stop using NRT
Why is Bupropion more of a 2nd line option compared to Varenicline?
- it has more side effects and interactions associated with it
- ie risk of serotonin syndrome with other serotonergic drugs - ie alongside use with SSRIS
-
Why do we need to be careful about smoking cessation in patients taking CLOZAPINE (ie for schizofrenia).
⚠️ Nicotine is a liver enzyme INDUCER - thus causes drugs to be metabolised quicker
- cessation means there is a risk of accumulation and toxicity - ie in px taking CLOZAPINE (anti- psychotic - this can be very bad!) as cessation will INCREASE the (n) of clozapine the px is exposed to.
- px will need retitration to lower the dose (bc it may have been initially increased bc of the effects of nicotine)
Can pregnant and breastfeeding women still take NRT?
Yes - less nic excreted in breastmilk vs smoking the risk of smoking is far greater than NRT
Smoking cessation is an advanced care pharmacy service - what does this mean?
It is one of the 9 services a community pharmacy can choose to offer and be remunerated for.
Pharmacists can prescribe Varenicline and Cystisinicline under the PGD
