Lecture 41: Nicotine and smoking cessation

Which groups have higher smoking rates in the UK?

Marginalized groups including people with mental health conditions, low income, unemployment, homelessness, contact with the criminal justice system, and those in social housing

What are the three steps of very brief advice (VBA)?

Ask - ask if patients smoke

Advise - give personalised advice

Act - offer referral to local stop smoking services

What are some pharmacological interventions for smoking cessation?

Nicotine replacement therapy (NRT) - patches, gums, inhalers, sublingual tablets, nasal/mouth sprays

Prescription meds - bupropion and varenicline

E-cigarettes - long term efficacy and safety remains uncertain

What do e-cigarettes do and why are they considered less harmful than smoking?

Heat liquid containing nicotine and flavourings to create inhalable vapor

They do not burn tobacco and expose users to fewer toxins

Who specifically should avoid vaping?

Non-smokers and individuals under 18

What are some motivational questions for quitting?

Why: Understanding personal motivations can strengthen resolve to quit smoking

What: Consider the differences quitting will make in life, including potential gains and losses

How: Reflect on the emotional benefits of being a non-smoker and the positive impact on loved ones

Who: Identify who will benefit from your success and who will be most supportive

When: Anticipate challenges and milestones in the quitting process

How does tobacco smoke affect drug metabolism and what specific drugs are most affected?

It induces drug-metabolizing enzymes, reducing plasma levels of certain medications

Clozapine, fluphenazine, many antidepressants

What may need adjusting after a person quits smoking?

Medication doses—typically reduced due to slower metabolism

What are some safety recommendations for those smoking?

Licensed nicotine replacement therapy preferred over e-cigs

Pregnant women should avoid liquorice-flavoured vape liquids due to risks with liquorice roots

Avoid second hand exposure to smoke

What is a structured smoking cessation programme?

Step 1: Preparation: Set a quit date and prepare to stop smoking.

Step 2: Initial Phase: Use nicotine replacement therapy (NRT) for up to 8 weeks to manage cravings

Step 3: Gradual Reduction: Reduce NRT usage over the next two weeks, aiming to halve daily intake of sprays

Step 4: Final Phase: Eliminate NRT completely over the following two weeks