Responding to Symptoms - Smoking Cessation

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  • Created by: LBCW0502
  • Created on: 31-01-19 17:10
Describe features of the nicotine patch (1)
Self-adhesive, transdermal delivery system which delivers a controlled amount of nicotine. 16 hour patch worn during waking hours. Applied in the morning and removed at bedtime. Convenient, discreet and easy to use
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Describe features of the nicotine patch (2)
Alternate application sites to reduce irritation of skin and avoid chest area
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Describe features of the nicotine patch (3)
Apply to clean, dry hairless area of skin. Different strengths, step down programme (25 mg, 15 mg, 10 mg over 12 weeks).
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Describe features of the nicotine mouth spray (1)
Effective NRT product used when cigarettes would have been smoked or if cravings emerge. Allows rapid delivery and uptake of nicotine into the body. Effective as mist (different flavours)
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Describe features of the nicotine mouth spray (2)
Point spray nozzle towards open mouth holding it as close as possible. Press top of dispenser to release one spray into the mouth, avoid lips. Avoid getting spray down the throat, don't inhale while spraying
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Describe features of the nicotine mouth spray (3)
For best results, don't swallow for a few seconds after spraying. Use 1-2 sprays when cigarettes normally work have been smoked or if cravings emerge. Relieves cravings in 30 seconds
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Describe features of nicotine gum (1)
Nicotine bound to ion exchange resin. Chewing releases nicotine which is absorbed through the lining of the mouth. Strengths (2 mg, 4 mg, 6 mg) to suit low/high dependent smokers. Chewed regularly to prevent cravings and withdrawal symptoms
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Describe features of nicotine gum (2)
Chewing means patients can actively fight back against cravings. Maximum 15 pieces a day (may not be suitable for elderly patients). Chew/rest technique (release taste, rest in gum/cheek)
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Describe features of nicotine inhalator (1)
Mouthpiece and replaceable cartridge containing a plug impregnated with nicotine. Nicotine via oral inhalation (absorbed via mouth lining). Inhaled either by deep or shallow puffing. Format which addresses behavioural/pharmacological dependence
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Describe features of nicotine inhalator (2)
Maximum of 6 cartridges a day. Each cartridge lasts for 40 minutes (depending on depth of puffs)
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Describe features of nicotine sublingual tablet
2 mg of nicotine, suitable for both low and high dependent smokers. Placed under tongue, slowly disintegrates within 30 mins. Depending on smoking habit, 1-2 tablets every hour. Maximum dose of 40 mg/day
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Describe features of nicotine lozenge
Round lozenge containing nicotine, 1/2/4 mg strengths for low and high dependent smokers available. Should be placed in mouth and allowed to dissolve - absorbed through mouth lining, periodically move from one side of the mouth to the other
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Describe features of the nicotine nasal spray (1)
Initial dose of 1 spray in each nostril up to twice an hour to relieve cravings (maximum of 64 sprays/day). Used as required for 8 weeks, subject to maximum, after this period usage is reduced over the following 4 weeks, 3 month treatment
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Describe features of the nicotine nasal spray (2)
One bottle delivers 100 doses (200 sprays). Pump primed, spray tip into nostril, point upwards towards back of nose, press nasal spray
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Describe features of combination NRT (1)
Use of nicotine patch + flexible format (e.g. mouth spray, gum, lozenge). Nicotine patch provides continuous nicotine levels through the day to relieve background withdrawal. Flexible format to relieve breakthrough cravings whenever they strike
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Describe features of combination NRT (2)
Combination NRT is more effective in helping smokers to quit compared to single NRT (nicotine plasma curve is bell shaped instead of having constant fluctuations/short half life)
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Why is it so hard to quit smoking?
Pleasure, behavioural aspects, environmental triggers
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Give examples of campaigns for smoking cessation
National no smoking day campaign. Stoptober. Passive inhalation and smoking ban
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What do the NICE guidelines state about brief interventions?
Ask about smoking status every year. Provide information within 30s e.g. ask about smoking status, offer verbal/written information, provide options, signposting/referral
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Describe features of behavioural support
One to one or closed and rolling groups. Group-based support using closed group format - whole group starts together and has same quit date, highest success rates of all forms of behavioural support. Rolling groups - people join different stages
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Give examples of smoking cessation services
Local stop smoking service. Smokefree national helpline. Quit kit support pack. Online support. Social networks. Complementary health e.g. acupuncture
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Describe features of pharmacy stop smoking services (1)
Pharmacy enhanced service, locally commissioned. Patient referred by GP/self refer. Structural approach, different levels of support, some services provide NRT/POM under PGD
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Describe features of pharmacy stop smoking services (2)
Smokers after to set a quit date then return once a week to discuss progress. Pharmacist paid an extra fee for carrying out this service
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Describe features of pharmacy stop smoking services - preparation
Private one-to-one consultation, telephone or face to face, group support, locally commissioned enhanced service. Identify smoking patterns and triggers, reasons for cutting down or stopping. Concerns. Previous attempts (relapse not failed)
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Describe features of pharmacy stop smoking services - getting started
Personal action plan, quit date, levels of support (behavioural/pharmacological), NRT, POM/GP referral, progress diary, level of support (face to face/phone/frequency)
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Describe features of pharmacy stop smoking services - staying on track
Journey so far, CO monitoring, health benefits, other benefits (food, money, smell), NRT exchange, side effects, weight gain. Reaching goals (rewards, sports, healthy eating)
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Describe features of pharmacy stop smoking services - supportive advice
Person centred, withdrawal symptoms, choices, moods, avoid caffeine/alcohol, peer pressure, patience
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Describe features of varenicline (champix) (1)
POM, NICE guidelines, recommended to help smokers who have said they want to stop smoking, used only as part of a programme that includes advice from healthcare professional or other types of support
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Describe features of varenicline (champix) (2)
Selective nicotine-receptor partial agonist. Alleviates symptoms of craving and withdrawal. Reduces reward and reinforcing effects. 0.5 mg and 1 mg tablets (successful treatment- easy to understand dosing)
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What are the side effects of varenicline (champix)?
GI, nausea, appetite changes, dry mouth, headache, sleep disorders, vivid dreams, thirst, weight gain, hypertension, chest pains, AF, panic attacks, hallucinations (rare - suicidal, MI, irrational behaviour, diabetes), yellow card warning
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What are the contraindications of varenicline (champix)?
<18 years old. Pregnancy, breast-feeding, not to be used with other NRT or in severe renal impairment. Caution - epilepsy, CVD risk, history of depression
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Describe features of bupropion hydrochloride (Zyban) (1)
Originally antidepressant. For 18+ years. Start taking 1-2 weeks before target stop date (still smoking). Initial dose of 150 mg OD for 6 days, increasing on day 7 to 150 mg BD. Interval of 8 hrs between doses
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Describe features of bupropion hydrochloride (Zyban) (2)
Maximum single dose should not exceed 150 mg and maximum total daily dose must not exceed 300 mg. Treatment for 7 to 9 weeks. Discontinue at 7 weeks if no improvement. Swallow hole (not crushed - risk of ADRs)
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What are the side effects of bupropion hydrochloride (Zyban)?
Insomnia (avoid bedtime), GI, taste changes, agitation, hypertension, chest pain, tachycardia, hepatitis, jaundice, paranoid, suicidal ideation, aggression
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What are the contraindications of bupropion hydrochloride (Zyban)?
<18 years old, acute alcohol, BDZ withdrawal, seizures, bipolar, eating disorders, hepatic cirrhosis, CNS tumours, other forms of NRT. Avoid in pregnancy and breast-feeding
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Describe features of e-cigarettes
Now regulated, 18+ yrs, plain packaging with health warning, NICE guidelines (alternative to cigarettes)
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Describe features of smoking and concomitant medication
Smoking increases metabolism of some medicines, stimulating CYP1A2. Smoking cessation may require dosage adjustments (reduction) of drugs: theophylline, ropinirole, clonazapine, olanzapine, chrompromazine, haloperidol (monitor/pregnancy)
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Card 2

Front

Describe features of the nicotine patch (2)

Back

Alternate application sites to reduce irritation of skin and avoid chest area

Card 3

Front

Describe features of the nicotine patch (3)

Back

Preview of the front of card 3

Card 4

Front

Describe features of the nicotine mouth spray (1)

Back

Preview of the front of card 4

Card 5

Front

Describe features of the nicotine mouth spray (2)

Back

Preview of the front of card 5
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