Smoking Cessation

Question 1

What does a cigarette consist of?

Answer 1

Filler, filter, tobacco, additives, paper

Question 2

Cig smoke contains > how many known carcinogens?

Answer 2

40

e.g. nicotine, tar, arsenic, hydrogen cyanide

Question 3

What is the average amount of life lost by a smoker?

Answer 3

7.5 years

Question 4

What cancer is related most to smoking? What other cancers are also related to smoking?

Answer 4

Lung

Upper resp, bladder, pancreas, oesophagus, kidney

Question 5

What endocrine condition is associated with smoking?

Answer 5

T2DM

Question 6

What MSK condition is associated with smoking?

Answer 6

Osteoporosis

Question 7

What dermatological condition is associated with smoking?

Answer 7

Psoriasis

Question 8

What ophthalmological condition is associated with smoking?

Answer 8

Macular degeneration

Question 9

What GI conditions are associated with smoking?

Answer 9

Peptic ulcers

Crohn’s disease

Question 10

What effects does smoking have on the unborn foetus?

Answer 10

1/3 increased risk of miscarriage, stillbirth, neonatal death

Question 11

What is the effect of second hand smoke on children?

Answer 11

More likely to have - respiratory infections, bronchitis, bronchiolitis, pneumonia, cot death, otitis media

Question 12

What are the health benefits of smoking cessation?

Answer 12

Live longer (7.5 years)
Reduces CV disease
Reduces risk of lung cancer (to only slighter higher than that of a non-smoker)

Question 13

What laws were introduced to protect kids from passive smoking?

Answer 13

Can't sell to u18
Can't smoke in car with kids in it
No proxy purchase
No vending machines
Standardised packaging - warning + pictures
Ban on distinguishable flavours
Smoking in public places band

Question 14

What should patients trying to quit smoking be offered?

Answer 14

NRT (nicotine replacement therapy), varenicline or bupropion
Give prescription until 2 weeks after target stop date (2 weeks of NRT or 3-4 weeks of varenicline/bupropion)

Question 15

If unsuccessful with NRT/varenicline/bupropion should you prescribe another course?

Answer 15

No not for 6 months unless special circumstances

Question 16

What AEs are associated with NRT?

Answer 16

Nausea, vomiting
Headache
Flu like symptoms

Question 17

What do NICE recommend for NRT?

Answer 17

Combination of nicotine patches and another form of NRT (gum, inhalator, lozenge, nasal spray) for those with a high dependence/failed single NRT before

Question 18

What kind of drug is varenicline?

Answer 18

A nicotinic receptor partial agonist

Question 19

When should you start varenicline?

Answer 19

1 week before target stop date

Question 20

What is the recommended course of treatment of varenicline?

Answer 20

12 weeks

Question 21

What are common AEs of varenicline?

Answer 21

Nausea
Headache
Insomnia
Abnormal dreams

Question 22

Who should varenicline be used in caution in?

Answer 22

Those with hx of depression/self harm

Question 23

When is varenicline CI?

Answer 23

Pregnancy

Breast feeding

Question 24

Which of bupropion and varenicline is more effecitve?

Answer 24

Varenicline

Question 25

What kind of drug is bupropion?

Answer 25

NE and dopamine reuptake inhibitor and nicotonic antagonist

Question 26

What is there a small risk of when taking bupropion?

Answer 26

Seizures

Question 27

When is bupropion CI?

Answer 27

Epilepsy
Pregnancy
Breast feeding

Question 28

What did NICE recommend in 2010 about pregnant woman and smoking?

Answer 28

Test all pregnant women for smoking using CO detectors

All those who smoke/have stopped smoking in the last 2 weeks or those with a CO reading of 7ppm or above should be referred to NHS Stop Smoking Services

Question 29

What is the first line smoking cessation treatment for pregnant women?

Answer 29

CBT, motivational interviewing, structured self-help and support from NHS Stop Smoking Services
Mixed evidence for NRT