Varenicline training Flashcards
(26 cards)
What % of all deaths in Scotland is attributed to tobacco?
1/5 or 20%
How many deaths per year does smoking cause?
10,000
What % of adults in Scotland smoke?
16.3%
In what 3 populations is smoking still might higher?
- poorer communities
- long-term mental health
- prisoners
Smokers are __ times more likely to quit with support from pharmacy
4 times
When might dual NRT therapy be used?
Smoker >20 cig/day
When might dual NRT not be suitable?
Pregnancy or breastfeeding
What is the MoA of varenicline?
Partial agonist at nicotinic receptors to prevent the high of smoking and also reduce the craving/withdrawal.
Upon which receptor does varenicline act?
alpha-4-beta-2 nicotinic receptor.
Does varenicline cause a release of dopamine?
Yes - but smaller than would be released from smoking.
Name some instances where a GP would need to be informed when starting someone on varenicline?
epilepsy
severe renal disease
severe mental health/psychriatry problems.
When should you stop smoking if you are starting varenicline?
About 1-2 weeks after starting varenicline
When should you stop smoking if you are using NRT?
As soon as possible after starting first patch.
What is the dosing titration schedule for varenicline?
days 1-3 = 0.5mg daily
days 4-7 = 0.5mg BD
day 8 till end of treatment = 1mg BD.
What is the most common S/E with varenicline and how can this be combated in the first instance?
Nausea
Take tablets with some food.
What to do if nausea with varenicline persists?
If nausea is not reducing - client can drop down to 0.5mg BD (half tab) for the rest of the course.
What happens if a client has smoked at week 4?
End quit attempt and record.
If client wants to continue - new quit attempt must be started in the same pharmacy.
What if the client has smoked between 1-5 cigarettes since the 4 week mark at week 12?
Congratulate them - record as successful quit attempt.
What if the client has smoked >5 cigarettes since the 4-week mark at week 12?
Advise client this quit attempt has finished - discuss where they might have went wrong. Advise client to return when they are ready to try again.
List some other S/E with varenicline?
Sleep disturbances,
headache,
appetite changes,
drop in mood initially.
List some S/E of NRT?
Upset stomach,
Sleep disorders/abnormal dreams
Skin irritation
What are some cautions to using NRT or varenicline?
History psychiatric illness,
CVD
Renal or hepatic impairment
Diabetes mellitus
Which can be supplied in pregnancy/BF’ing?
NRT
List 6 drugs that may require dose adjustment if a patient stops smoking?
clozapine insulin methadone olanzapine theophylline warfarin
