Can you identify the pharmacotherapy option that works for your patient? Learn which type will be the most effective for your patient in their smoking cessation plan.
In this episode we’re going to look at the first line agents for smoking cessation and we’re going to look at the steps for decision making as well i’m john shafts key a clinical pharmacist for the last 40 years currently clinical instructor at the university of british columbia i have won several awards both provincially and federally on innovation and as well an
Award for agent of change from the university of british columbia this is series 2 episode 2 looking at the effective algorithm for smoking cessation what’s considered first-line would be the nicotine replacement therapy varenicline and bupropion however we have to go through a decision-making process in this algorithm we’re going to look at the different steps that
We take to help you help the patient make a decision on what to do to set them up for success the first thing i do is i ask the patient if they smoke then i get into a conversation with them if they say yes advise if they say yes to smoking i will simply say you know when you are ready to discuss either reducing or quitting i’m here to help you i don’t give them any
Lectures i just leave it at that and usually if there’s any interest at all that’s when they approach me and makes it better for success in the long run the next step i do is motivational interviewing what i talk about is the some of the benefits of quitting i talked about the 43,000 canadians a year that died from cigarette smoking i talked about the health risks
And then i talked about how much it costs currently if you’re a smoker in canada with twenty cigarette a day habit you’re looking at approximately thirty six hundred dollars that is spent translates into roughly five thousand dollars pre tap what happens when patients quit smoking smokers who successfully make it one week without smoking are 9 times as likely to
Be successful after one year of quitting smoking your lungs will have experienced dramatic health improvements in terms of capacity and functioning in 3 years after quitting smoking the risk of a heart attack has declined to that of a nonsmoker and five years after patient stop smoking their risk of death from lung cancer has dropped by half compared to when they
Smoked at the decade mark their risk of dying due to lung cancer has decreased to that of a nonsmoker and at the 15-year mark the risk for heart attack and stroke has decreased to equal that of a person who has never smoked before the next thing i do is i simply ask the patient imagine what it would be like if you don’t smoke what would it look like i then just get
Into general discussion with the patient and i find out where their importance is in the smoking is it such as our example in the previous episode where the lady wanted to look better but she also i found out didn’t want to smoke in front of her children anymore or if they need to spend less money on cigarettes and more on themselves education savings retirement
Whatever it is so i always find out why they really want to quit and i feel that is the nugget to keep bringing them back when they’re coming up with challenges one of the aspects that it’s also important when you’re talking to the patient is find out what they believe their roadblocks are we should always look and remind them that there will be challenges and try
To set them up for success by learning how to handle those challenges but you must find out what they believe their roadblocks could be it could be fear of failure it could be weight gain and that’s a huge one especially for women it could be that they would lose their friends or feel they would lose their friends that they would have to change their lifestyle
And they’re not very good with change whatever that roadblock is please address it and discuss it with them and set it up for their success i look at pharmaco therapy and counseling as a very important aspect of all this i just asked two simple questions how many cigarettes do you smoke a day and that indicates obviously if they’re smoking 10 that probably the
Process will be a lot simpler than if they’re smoking 40 at the same time when is the first cigarette that they crave in the morning the sooner it is to waking up the more i know there will be a challenge and how much support they’ll need reduce to quit that’s becoming more and more in vogue and there’s reasons for it because it is more successful it gets over
The roadblock of fear with reduced to quit unfortunately a lot of the provincial plans look for a 12-week course of treatment and leave it at that that almost sets people up for failure it’s usually a lot longer i will actually go as long as a year from the start to when you can consider that there through the process and hopefully our reformed smoker so i might
Even have them reduce by just simply eliminating some cigarettes over the first three months or even six months and it’s not initiate therapy till a certain time or just start to add in short-acting nicotine replacement therapy gum for example and as always i use my checklist the worst thing you can do for time wasting is to forget to get a piece of information
Or tell somebody something and then have to contact them later it just is a waste of time the checklist i use is provide guidance on using medication or a device make sure that’s done thoroughly discuss potential for changes in mood related to quitting smoking they may get grumpy inform them how they should tell their friends and family to give them support and cut
Them a little bit of slack advise patients on how to prepare for their start date whether they’re reducing or stopping to quit and it’s really important to do that and to think it through carefully with them by doing it once so much easier discuss smoking routine and triggers and identify strategies for managing cravings the two most common ones are getting into
The car and drinking coffee what can they do differently to break that cycle remind patients that they will need to reduce their caffeine intake by 50% if they consume more than 5 cups per day because of course with cigarette smoking it breaks down the caffeine in the body so they can drink more now if they drink 5 cups or more they could be a little jittery as
They’re getting off their cigarettes and then current medication doses may need to be adjusted once the patient becomes smoke-free and that could be with insulin or warfarin people on methadone clozapine all those things interact with cigarettes and need to be adjusted and monitored appropriately now i would like to mention that there are two first-line treatments
We’re going to briefly touch on varenicline and bupropion both have their dosing schedules their advantages and their disadvantages what i’d like you to do for further information is go to pharmacist for a smoke-free canada or click on the link below in our next episode we’re going to talk about nicotine replacement therapy you
Transcribed from video
Smoking Cessation: Effective Pharmacotherapy | Series 2 | Episode 2 By Pharmacedure
