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GP and Public Health > Smoking Cessation > Flashcards

Smoking Cessation Flashcards

1
Q

What are the 3 tobacco indicators?

A

Adult smoking prevalence
Smoking prevalence amongst 15 year olds
Smoking status of mothers at time of delivery

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2
Q

Give an example of public health strategy to encourage smoking cessation.

A

“Healthy lives, Healthy people: A Tobacco control plan for England

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3
Q

What are the aims of the smoking cessation strategy?

A 
Stopping promotion of tobacco
Making Tobacco products less desirable
Effective regulation of tobacco products
Helping tobacco users to quit
Reducing exposure to second hand smoke
Effective communications for tobacco control
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4
Q

What are the impacts of smoking?

A

Greatest single cause of illness and premature death in UK
100,000 or 50% of smokers die from smoking-related disease
Tobacco and poverty are inextricably linked
Single biggest cause of inequality between the rich and the poor

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5
Q

What are the economic impacts of smoking?

A 
5.5% of total healthcare costs
Money spent on buying cigarettes
Loss of productivity from smoke breaks
Increased absenteeism from smoking-related illnesses
Cleaning up of cigarette butts
Loss of economic output from deaths
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6
Q

What are the associations between gender and smoking?

A

Teenage girls are more likely to smoke than teenage boys but there are more men smoking than women
Both genders find it equally difficult to stop smoking
Women are more likely than men to access stop smoking services
More women are concerned about weight gain when they stop smoking

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7
Q

What are the benefits of stopping smoking?

A
  1. Increased life expectancy
    +10 years if quit at 35 yrs old
    +3 years if quit at 65 yrs old
  2. Lung cancer risk stops increasing
  3. Heart disease risk decreases by 50% in the 1st year
  4. Rate of progression of COPD slows drastically once smoker stops
  5. Ex-smokers report being happier, having a greater lift and satisfaction than smokers
  6. An average smoker saves £1500 a year if they quit
  7. Smoking increases the rate of clearance of medications and an increased dosage is needed and upon stopping smoking, a reduced dose is needed
  8. Decreased risk of the following:
    Pre-eclampsia
    Morning sickness during pregnancy
    Ulcerative colitis
    Parkinson’s disease
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8
Q

What are the effects of smoking on conception?

A

Men- Reduces sperm count, makes sperm more immobile and higher incidence of impotence
Women- Hormonal changes that reduce likelihood of becoming pregnant
Smoking reduces the effectiveness of assisted reproductive devices

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9
Q

How does smoking affect pregnancy?

A
  1. Increases risk of miscarriage and stillbirth
  2. Babies are more likely to be born premature and have intrauterine growth restriction
  3. Babies born to mothers who smoke are twice as likely to die from sudden unexplained death in infancy
  4. Long term problems:
    Behavioural problems
    Learning difficulties
    Respiratory problems
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10
Q

What are the impacts of smoking on mental health?

A

High incidence among people who have anxiety and depression
Majority of people with mood disorders will be happier after stopping smoking
Stopping smoking will not worsen their mood disorders
No evidence that smoking helps with psychotic symptoms

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11
Q

Facts on nicotine

A

On average, smokers get up to 1mg of nicotine with each cigarette, and can get up to 6mg if smoked really hard
Nicotine is absorbed into the blood rapidly in the lungs and reaches the brain in seconds

Nicotine is excreted rapidly and has a half-life of about 90-120 mins

Long term smoking causes the brain to adapt to the high levels and creates an abnormally low dopamine level when smoking is stopped

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12
Q

Give examples of nicotine withdrawal symptoms.

A 
Depression
Irritability
Restlessness
Difficulty concentrating
Increased appetite
Coughing
Constipation
Weight gain
Mouth ulcers
Light headedness (usually <48hrs) 
Waking at night (usually <1wk)
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13
Q

Facts on nicotine replacement therapy

A

Nicotine is delivered without the harmful substances of the rest of the cigarette
The problem is that smokers do not use enough of it for long enough
Using 2 or more methods for nicotine replacement works best. Patch for basal nicotine and intermittent nicotine as and when needed
Use NRT 2 weeks before stopping smoking and for at least 8-12 weeks
The higher dose of each NRT is used for the normal nicotine amount absorbed when smoking

During pregnancy
NRT during pregnancy can cause the NRT to reach the baby
Intermittent NRT should be used rather than the constant flow NRT (lozenges)
Liqourice-flavoured nicotine gum (Nicotinell) is contraindicated in pregnancy

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14
Q

Facts on nicotine transdermal patch

A
  1. The patches deliver half the nicotine they would normally get from smoking
  2. Side effects
    Skin reaction (5%)
    Burning sensation at the site. Change site location to prevent this
    Wakefulness/vivid dreams at night. Use the 16hr patch instead and another form of NRT in case they wake up during the night
  3. Contraindications
    Hypersensitivity to the patch or any component of it
    Children under 12
  4. Prescription
    10mg and 25mg
    16hr and 24hr patches
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15
Q

Facts on oral nicotine products

A
  1. The nicotine are absorbed through the buccal mucosa
  2. Chewing gum
    Needs to be chewed until there is hot peppery taste and then placed against the cheek
    Less than half of the nicotine dose is absorbed
    Side effects become less severe with use
    Side effects- Burning mouth, Indigestion, hiccups, jaw ache
    Contraindications- Hypersensitivity to any component of the gum
    Prescription- 2mg and 4mg
  3. Lozenges
    Half the nicotine dose is absorbed
    Side effects become less severe with use
    The taste can be unpleasant at first, but can get used to it
    Side effects- Burning mouth, indigestion, hiccups, heartburn (when swallowed)
    Contraindications- Hypersensitivity to any component and children under 12
    Prescription- Normal (1mg, 2mg, 4mg) and mini lozenge (1.5mg, 4mg)
  4. Microtabs
    Should be placed under the tongue where it can be absorbed
    Half the nicotine dose is absorbed
    Side effects become less severe with use
    The taste can be unpleasant at first, but can get used to it
    Side effects- Burning mouth, indigestion, hiccups, heartburn (when swallowed)
    Contraindications- Hypersensitivity to any component
    Prescription- 2mg
  5. Mouth sprays
    Side effects become less severe with use
    Side effects- Indigestion, hiccups, heartburn (when swallowed), headache, nausea, taste distortion, irritation to the mouth and throat for the first few days
    Contraindications- Hypersensitivity to any component, children under 12
    Prescription- 2mg. Recommended 1-2 sprays every 30-60 mins. Max 4 sprays/hr, 64 sprays/day
  6. Inhalator
    Some people get a sore throat or find that the nicotine taste is unpleasant
    Side effects- Indigestion, hiccups, heartburn (when swallowed), coughing,
    Contraindications- Hypersensitivity to any component, children under 12
  7. Strips
    Strips are placed on the tongue and allowed to dissolve
    Many find that this tastes much better than the other forms of NRT
    Side effects- Nausea, indigestion, heartburn, stomach discomfort, mouth discomfort
    Contraindications- Hypersensitivity to any component, children under 12
    Prescription- 2.5mg. Recommended 1 film every 1-2 hrs, up to 15 a day
  8. Nasal spray
    Nicotine is absorbed through the nasal mucosa and is absorbed faster than any other type of NRT
    Side effects become less severe with use
    Side effects- Sneezing, coughing, watery eyes, burning and itching sensation in the nose
    Contraindications- Hypersensitivity to any component, children under 12
    Prescription- Every hr
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16
Q

Facts on Varenicline (Champix)

A
  1. Mechanism
    Nicotinic acetylcholine receptor partial agonist
    Results in dopamine release similar to that when nicotine from smoking releases dopamine
    The nicotinic receptors are blocked and further smoking does not have an effect on dopamine release and they do not feel satisfied
  2. Side effects
    Nausea, headache, difficulty sleeping (insomnia), abnormal dreams
    Side effects are less severe with time
    Nausea can be reduced when the medication is taken with food
3. Contraindications
Allergy
Children under 12
Pregnancy
Breastfeeding
  1. Prescription
    Start 1 week before stopping smoking and duration for 3 months
    1mg BD
17
Q

Facts on Bupropion (Zyban)

A
  1. Mechanism
    An atypical antidepressant found to help with smoking
    Unclear mechanism but thought to inhibit neuronal uptake of dopamine and noradrenaline
    Reduces severity of withdrawal symptoms and reduces desire to smoke
  2. Side effects
    Dry mouth, insomnia, headache, low risk of seizures, urticaria
  3. Contraindications
    History of seizures, abrupt alcohol/sedative withdrawal, irreversible monoamine oxidase inhibitors, bulimia, anorexia, severe hepatic cirrhosis
  4. Prescription
    150mg OD for 6/7, then BD with at least 8 hrs between
    Start 1 wk before stopping smoking and continue for 120 tablets
18
Q

Facts on E-cigarettes

A

Effectiveness and quality of e-cigarettes are unknown until it is licensed
It is not available on the NHS
People who want to stop smoking can be encouraged to do so with e-cigarettes but should be supported

19
Q

Who are the groups of smokers who need additional support in stopping smoking?

A

Young smoker
Smoke first thing in the morning/interrupt their sleep to smoke
Lives with people who smoke
Come from a low paid manual job or are unemployed
Have a mental health problem/illness
Are drug/alcohol dependent

20
Q

What are the biomarkers of smoking?

A
  1. Expired CO
    Good to detect amount of smoke for the day, not the day before
    Cut-off is 10ppm
    Readings can be inaccurate if patients are lactose intolerant
    Patients are exposed to CO in cars/boilers
  2. Cotinine
    A metabolite of nicotine that is eliminated from the body slower than nicotine
    Usually detected in saliva but urine or blood can be used
    Most accurate measure as it lasts for several days in the body
    Does not differentiate between NRT and smoking
    Cut-off is 13ng/ml
21
Q

What are involved in pre-quit stage?

A 
Build rapport
Listen to client’s views
Explain the role of services
Explain the importance of the programme
Explain how tobacco dependence develops
Assess current and past smoking behaviour
History of quit attempts
Readiness and ability to quit
Physiological and mental functioning
Assess nicotine addiction
Assess social support
Assess contacts who smoke
Attitudes to smoking and stopping
Advise on environment restructuring 
Advise on changing routine
Advise on the use of social support
Prompt self recording
Explain the importance of CO monitoring
Facilitate medication choice
Explain the importance of ‘not a puff’ rule
Set a quit date
Summarise information given
22
Q

What are involved in quit date stage?

A 
Prompt commitment
Facilitate medication use
Maximise motivation to quit
Measure CO
Advise on withdrawal symptoms
Advise on weight gain
Alcohol and caffeine
Advise on avoiding cues
Advise on restructuring social life
Summarise
23
Q

What are involved in post quit stage?

A 
Progress since quit date
Responding to clients who have smoked
Rewarding post-quit abstinence
Assess withdrawal symptoms
Ask about medication use
Provide reassurance
Relapse prevention
Respond to the CO reading
Prompt review of goals
Signpost further support on the last session
24
Q

Explain the mechanism behind nicotine addiction.

A

Nicotine mimics acetylcholine
Nicotine attaches itself to an area of the brain called the ventral tegmental area
This activates the neurons to release dopamine in the nucleus accumbens that is important in developing and maintaining addiction

25
Q

Give examples of situations when people crave for nicotine.

A

being with other smokers
drinking alcohol
during times when they would normally smoke

GP and Public Health (23 decks)

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