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TRANSCRIPT
Module 9
Quitting Smoking
Contents Smoking 63
Risks of smoking 64
Benefits of quitting 65
Withdrawal 66
Treatments to help quit smoking 70
Supporting patients who want to quit 71
Case study 72
Case study 76
Test your knowledge 80
of chronic respiratory disease
±42%
of lung cancer deaths
±71%
of cardiovascular disease
±10%
SMOKINGAcross the globe, the use of tobacco is the second leading risk factor for death, after high blood pressure1a, while smoking cigarettes is the most harmful form of tobacco use2a.
Globally, tobacco smoking is
responsible for1b
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Module 9 Quitting Smoking
RISKS OF SMOKING
BENEFITS OF QUITTING
Smoking tobacco is harmful to almost every organ in the human body2a. Nicotine may be the main addictive component of tobacco products, but it is the other toxins and carcinogens in tobacco smoke that are responsible for the negative effects on health2b.
There are plenty of practical advantages when it comes to quitting, including physical, mental and financial benefits. Motivate your patients by discussing the health benefits and encouraging them to track their progress.
Time Period Positive Effect4
20 minutes Pulse rate returns to normal
8 hoursNicotine and carbon monoxide levels in blood reduce by half
Oxygen levels return to normal
48 hours
Carbon monoxide and nicotine are eliminated from the body
Lungs start to clear mucus and other smoking debris
Sense of taste and smell improve
72 hoursBreathing becomes easier
Energy levels increase
2 – 12 weeks Circulation improves
3 – 9 monthsLung function increases by up to 10% – as a result coughs, wheezing and breathing problems improve
1 yearRisk of heart disease falls by approximately 50% compared to a person who continues smoking
10 yearsRisk of lung cancer falls by approximately 50% compared to a person who continues smoking
15 yearsHeart attack risk is reduced to the same as a person who has never smoked
SMOKING ADDICTION Nicotine, the key ingredient in commercial tobacco products, causes smoking dependency2c.
Cravings can begin within days of the first cigarette2d. Nicotine stimulates the brain’s dopamine reward system2e. Dopamine is a chemical or neurotransmitter which is associated with feelings of pleasure3. It is a need for this enjoyment that keeps smokers addicted.
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Module 9 Quitting Smoking
Abstinence in the first week is key to long-term quitting
success5
COMMON WITHDRAWAL
SYMPTOMS6
REDUCED CONCENTRATION
A reduction in concentration
DEPRESSION
Usually mild, but can be major
RESTLESSNESS
Inability to rest or relax
ANXIETY
Feeling frightened, nervous, or panicky
STRONG CRAVINGS
Strong cravings for cigarettes
GI DISTURBANCES
Gastrointestinal disturbances
SLEEP DISTURBANCES
Initiating & maintaining sleep
WEIGHT GAIN
Weight gain as a result of increased appetite
INSOMNIA
Inability to sleep
IRRITABILITY
Irritability, anger or frustration
HUNGER
Food cravings
HEADACHES
Usually mild headaches & dizziness
First week abstainers are to still be abstinent at week 52 than those who smoke during the first week (<0.001)5
9x more likely
VS
Disclaimer: As per the Medicines and Related Substances Act, 1965, Section 22A(4) and (5), S1 and S2 product recommendations can only be made by a pharmacist, pharmacist intern or a pharmacist’s assistant acting under the personal supervision of a pharmacist.
First week abstainers are 9x more likely to still be abstinent at week 52 than those who smoke during the first week (<0.001). At week 1, the new NICORETTE® Invisi 25mg Patch significantly reduced nicotine adverse mood withdrawal symptom score by 79% vs. placebo (0.26 patch vs.1.23 placebo; p<0.001).5
WITHDRAWAL
DID YOU KNOW? The first few days are the hardest.
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Module 9 Quitting Smoking
• Relapse most frequently occurs within the first few days of a quit attempt when withdrawal symptoms are the greatest7. Over 75% of unaided quitters relapse within the first week8.
• Evidence suggests that smoking cessation interventions should focus on early relapse prevention7.
67% 76% 78% 81%
33% 24% 22% 19%
Relapse
Complete abstinence
Relapse pattern in smokers who quit unaided (n=630)8
Time post-cessation
% S
mo
kers
wh
o m
ake
an u
nai
ded
q
uit
att
emp
t o
n d
ay 0
0
20
40
60
80
100
2 days 7 days 14 days 1 month
Smokers need the most support in the initial stages
of their quit attempt
Comparative levels of efficacy in treatments for controlling
withdrawal symptoms
423 (p<0.001)
393 (p<0.001)
317 (p=0.02)
249 (p=0.022)
Adverse mood withdrawal symptoms in abstinent subjects5
Weeks after start of treatment
Ad
vers
e m
oo
d s
core
Placebo
15mg
25mg
0.5
0.5
1.0
1.5
0
01 23 43 67 8
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Module 9 Quitting Smoking
TREATMENTS TO HELP QUIT SMOKING
Tips for patients who want to stop smoking
Effective treatments for quitting smoking include:
People who recognise or are aware of their smoking cues can modify their behaviour.
Some tips for kicking the habit include:
• Hide matches, lighters and ashtrays12
• Designating the home a non-smoking area12
• Asking friends and colleagues who smoke to avoid smoking around you12
• Avoiding places where people smoke12
• Taking a walk instead of having a coffee break10c
• Eating candy or chewing a toothpick or gum instead of smoking10c
• Avoiding alcohol, which can temporarily reduce a person’s resolve10c
People can change the habits that encourage smoking during everyday activities.
Common triggers include10c:
• Telephone conversations
• Coffee breaks
• Meals
• Sexual activity
• Boredom
• Traffic problems
SUPPORTING PATIENTS WHO WANT TO QUIT
Even when smokers know the health risks, it is hard to overcome the powerful withdrawal symptoms6b. It can be beneficial to warn your customers about these withdrawal symptoms, but to also assure them that6a:
• Symptoms are worst in the first week – the time when most people relapse
• The majority of the withdrawal symptoms subside within 2 weeks
Remedy Availability Effect
Nicotine replacement therapy (NRT) products, such as Nicorette®10a
NRTs are available over the counter in a variety of forms, including chewing gum, lozenge, patch, nasal spray and inhaler
Nicotine replacement therapy (NRT) supplies the body with lower levels of nicotine than in cigarettes, but enough to help relieve cravings and withdrawal symptoms. The aim is to gradually reduce the level of nicotine until the smoker no longer needs it
Supportive counselling10b
Take up therapy or join a counselling group
Counselling helps modify behaviour and emotional reactions
Disclaimer: As per the Medicines and Related Substances Act, 1965, Section 22A(4) and (5), S1 and S2 product recommendations can only be made by a pharmacist, pharmacist intern or a pharmacist’s assistant acting under the personal supervision of a pharmacist.
DID YOU KNOW? Quitting cold turkey (completely) is better than gradually cutting down, as people who smoke fewer cigarettes may unconsciously inhale more deeply to attain the same nicotine levels10c.
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Module 9 Quitting Smoking
Ask the following questions
• How much do you smoke?
• Have you tried to stop smoking before?
• How did you go about quitting?
• Did you experience any symptoms when you tried to quit?
• How serious are your cravings when you don’t smoke?
CASE STUDYDebbie, 50, Landscape Designer
• Debbie has come to the pharmacy to ask for advice.
• She tells you that she smokes and finds that she is getting sick more often than she used to.
• She would like to know which OTC product she can use to help her quit.
Debbie tells you that she smokes 5 cigarettes a day. She used to smoke 10. She has tried to stop smoking before on her own without any help, but she could not manage to stop for longer than 48 hours. She has, however, cut down on her smoking over time. When she tried to stop completely she was very irritable and suffered from headaches.
TOP TIPS TO HELP YOUR PATIENTS QUIT • Set a quit date:
Suggest that your patient set a quit date to focus on. It’s not recommended to quit during a stressful time10e.
• Start an exercise programme: Weight gain is a major concern when trying to quit smoking – especially for women. An exercise regime will help prevent weight gain and can reduce the craving for nicotine10f.
• Keep healthy snacks at hand: Suggest that your patient keep wholesome snacks, like fruit, nuts and vegetable sticks within easy reach, and avoid processed foods that are high in fat or sugar13.
Disclaimer: As per the Medicines and Related Substances Act, 1965, Section 22A(4) and (5), S1 and S2 product recommendations can only be made by a pharmacist, pharmacist intern or a pharmacist’s assistant acting under the personal supervision of a pharmacist.
Disclaimer: As per the Medicines and Related Substances Act, 1965, Section 22A(4) and (5), S1 and S2 product recommendations can only be made by a pharmacist, pharmacist intern or a pharmacist’s assistant acting under the personal supervision of a pharmacist.
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Module 9 Quitting Smoking
Disclaimer: As per the Medicines and Related Substances Act, 1965, Section 22A(4) and (5), S1 and S2 product recommendations can only be made by a pharmacist, pharmacist intern or a pharmacist’s assistant acting under the personal supervision of a pharmacist.
Dosage: Nicorette® Gum• Chew 1 gum at a time.
• Stop smoking completely to increase the chances of success.
• Number of pieces chewed per day will depend on cravings.
• Use 10 – 12 pieces, but not more than 15 pieces in a 24 hour period.
• As the urge to smoke becomes infrequent reduce the number of pieces of gum chewed to 3 – 6 pieces per day.
• Smoking cessation may be achieved within 2 – 3 months.
• Treatment should not exceed 3 months.
• Starts to work from the 1st chew14 and fights cravings for up to 2 hours.
• 10 – 12 pieces of gum daily for up to 3 months. (Depends on smoking patterns.)
Disclaimer: As per the Medicines and Related Substances Act, 1965, Section 22A(4) and (5), S1 and S2 product recommendations can only be made by a pharmacist, pharmacist intern or a pharmacist’s assistant acting under the personal supervision of a pharmacist.
Treatment Since Debbie is struggling to stop smoking you can recommend the following Nicorette® products:
Please note: Nicorette® Gum is available in 2 flavours: freshfruit and freshmint.
Advise Debbie to choose between the two products depending on her cravings.
Nicorette® 2 mg (low dependency)For the active control over nicotine cravings, and flexible, on-demand dosing when needed.
Nicorette® 4 mg (high dependency)For the active control over nicotine cravings, and flexible, on-demand dosing when needed.
2
1
1
DID YOU
KNOW? Most smokers would like to stop smoking, and while each year
about half try to quit only about 6% manage
to. Medications, such as NRT, can,
however, help in many cases.11
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Module 9 Quitting Smoking
Ask the following questions
• How much do you smoke?
• How long have you been smoking?
• Have you tried to stop smoking before?
• How did you go about quitting?
• How serious are your cravings when you don’t smoke?
CASE STUDYBlake, 31, Head of Strategy
• Blake has come to the pharmacy to ask for advice.
• He would like to know which OTC product he can use to help him quit.
Blake tells you that he smokes at least a pack of cigarettes a day - and has been doing so for years. He has tried to stop smoking before on his own without any help.
When he tried to stop completely he struggled with nicotine cravings.
Disclaimer: As per the Medicines and Related Substances Act, 1965, Section 22A(4) and (5), S1 and S2 product recommendations can only be made by a pharmacist, pharmacist intern or a pharmacist’s assistant acting under the personal supervision of a pharmacist.
Disclaimer: As per the Medicines and Related Substances Act, 1965, Section 22A(4) and (5), S1 and S2 product recommendations can only be made by a pharmacist, pharmacist intern or a pharmacist’s assistant acting under the personal supervision of a pharmacist.
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Module 9 Quitting Smoking
12-WEEK PROGRAMME
For patients who smoke 10 or more cigarettes a day start with 25 mg
12-WEEK PROGRAMME
For patients who smoke less than 10 cigarettes a day start with 15 mg
Disclaimer: As per the Medicines and Related Substances Act, 1965, Section 22A(4) and (5), S1 and S2 product recommendations can only be made by a pharmacist, pharmacist intern or a pharmacist’s assistant acting under the personal supervision of a pharmacist.
Disclaimer: As per the Medicines and Related Substances Act, 1965, Section 22A(4) and (5), S1 and S2 product recommendations can only be made by a pharmacist, pharmacist intern or a pharmacist’s assistant acting under the personal supervision of a pharmacist.
Treatment Since Blake is struggling to stop smoking you can recommend the following Nicorette® product:
Nicorette® Transdermal Patch 25 mg (for 8 weeks)For the active control over nicotine cravings, and flexible, on-demand dosing when needed. In terms of Blake’s working life, the new patches are discreet and convenient. They can be applied and forgotten, allowing him to attend meetings or visit clients without having to chew gum to offset his cravings.
1
Dosage• 1 Nicorette® Transdermal Patch 25 mg lasts
up to 16 hours.
• Wear one patch at a time.
• Stop smoking completely to increase the chances of success.
• One patch a day.
• Applied in the morning.
• A quit attempt should be made as soon as the smoker feels ready.
Support Program
The new Nicorette® Transdermal Patch 25 mg
Nicorette® now offers 3 new Transdermal Patches - available in 3 strengths to successfully complement support programs based on the level of smoker trying to quit.
25 mg 8 weeks
15 mg 2 weeks
15 mg 8 weeks
10 mg 2 weeks
10 mg 4 weeks
1
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Module 9 Quitting Smoking
Product Portfolio
QUITTING SMOKING
WHY CHOOSE NICORETTE®Nicorette Transdermal Patches is a nicotine replacement therapy (NRT) range that offers a convenient way to make nicotine bio-available. Nicorette is also available in a gum range to relieve cravings and helps you stop smoking.
Nicorette® Transdermal Patch 10 mg
Nicorette® Transdermal Patch 15 mg
Nicorette® Transdermal Patch 25 mg
Nicorette® Gum 2 mg
Nicorette® Gum 4 mg
Disclaimer: As per the Medicines and Related Substances Act, 1965, Section 22A(4) and (5), S1 and S2 product recommendations can only be made by a pharmacist, pharmacist intern or a pharmacist’s assistant acting under the personal supervision of a pharmacist.
Nicotine addiction Nicotine addiction
30's, 105's 30's, 105's
• Active control over cravings
• Flexible, on-demand dosing when needed
• Gum available in palatable flavours: Freshfruit and Freshmint
• Available in 2 mg and 4 mg formats for low and high dependency smokers
• Smoking cessation may be achieved within 2 – 3 months
Nicotine-resin complex 20 % 20,0 mg equivalent to 4 mg nicotine
Nicotine-resin complex 20 % 10,0 mg equivalent to 2 mg nicotine
Nicotine addiction Nicotine addiction Nicotine addiction
7 patches 7 patches 7 patches
• Active control over cravings
• Flexible, on-demand dosing when needed
• Smoking cessation may be achieved within 2 – 3 months
Transdermal delivery system releasing 25 mg of nicotine respectively over 16 hours
Transdermal delivery system releasing 15 mg of nicotine respectively over 16 hours
Transdermal delivery system releasing 10 mg of nicotine respectively over 16 hours
Ind
icat
ion
US
PA
ctiv
e In
gre
die
nts
Siz
e
Disclaimer: As per the Medicines and Related Substances Act, 1965, Section 22A(4) and (5), S1 and S2 product recommendations can only be made by a pharmacist, pharmacist intern or a pharmacist’s assistant acting under the personal supervision of a pharmacist.
Nicorette® 25 mg Transdermal Patch
Nicorette® 2 mg Gum
Nicorette® 15 mg Transdermal Patch
Nicorette® 4 mg Gum
Nicorette® 10 mg Transdermal Patch
Starts to workfrom the
1st chew14Lasts up to16 hours
S0 Nicorette® Gum Freshmint 4 mg: Reg.No.: A40/34/0523.
NICORETTE® is sugar free.
NICORETTE® is indicated as a temporary aid to the cigarette smoker seeking to give up his or her smoking habit while participating in a behavioural modification programme under professional supervision. The efficacy of NICORETTE® use without concomitant participation in a behavioural modification programme has not been established. The benefits of NICORETTE® use beyond 3 months have not been demonstrated.
S0 Nicorette® Gum Freshfruit 2 mg: Reg.No.: A40/34/0565.
S0 Nicorette® Gum Freshmint 2 mg: Reg.No.: A40/34/0520.
S0 Nicorette® Gum Freshfruit 4 mg: Reg.No.: A40/34/0566.
S1 Nicorette Transdermal Patch 25 mg – 45/32.16/0954
S1 Nicorette Transdermal Patch 15 mg – 45/32.16/0953
S1 Nicorette Transdermal Patch 10 mg – 45/32.16/0952
Disclaimer: As per the Medicines and Related Substances Act, 1965, Section 22A(4) and (5), S1 and S2 product recommendations can only be made by a pharmacist, pharmacist intern or a pharmacist’s assistant acting under the personal supervision of a pharmacist.
References 1. World Health Organization. Global Health Risks: Mortality and Burden of Disease Attributable to Selected Major Risks Global Health
Risks. Available at www.who.int/healthinfo/global_burden_disease/GlobalHealthRisks_report_full.pdf. pp. v, 11, 21. Accessed on 17 January 2018.
2. Prochaska, J. (2018). Tobacco. [online] Merck Manual. Available at: https://www.merckmanuals.com Accessed on 6 Aug. 2019.
3. ASH Fact Sheet. Nicotine and addiction. Available at ash.org.uk/files/documents/ASH_114.pdf. Accessed on 18 January 2018.
4. NHS Smokefree (UK). Adapted from ‘What happens when you quit?’ Available at www.nhs.uk/smokefree/why-quit/what-happens-when-you-quit#ow7IKbWJt4XTfImP.97. Accessed on 18 January 2018.
5. Tønnesen P et al. Higher dosage nicotine patches increase one-year smoking cessation rates: results from the European CEASE trial. Eur Resp J 1999;13:238-246
6. Porter RS (Ed). Tobacco Use: Smoking Cessation. The Merck Manual of Diagnosis and Therapy. Available at www.merckmanuals.com/professional/special-subjects/tobacco-use/smoking-cessation. Accessed on 18 January 2018.
7. Hughes JR et al. Shape of the relapse curve and long-term abstinence among untreated smokers. Addiction 2004;99:29–38.
8. Hughes JR et al. Smoking cessation among self-quitters. Health Psychol 1992;11:331–334.
9. Henningfield JE. Nicotine medications for smoking cessation. N Engl J Med 1995;333:1196–1203
10. Porter RS (Ed). Tobacco Use: Smoking Cessation. The Merck Manual Home Health Handbook. Available at www.merckmanuals.com/home/special-subjects/tobacco-use/smoking-cessation. Accessed on 18 January 2018.
11. National Institute of Drug Abuse. Tobacco/Nicotine. Available at www.drugabuse.gov/publications/research-reports/tobacco/nicotine-addictive. Accessed on 18 January 2018.
12. WebMD. Smoking during pregnancy. Available at www.webmd.com/baby/smoking-during-pregnancy. Accessed on 18 January 2018.
13. Better Health Channel. Quitting smoking and managing weight. Available at www.betterhealth.vic.gov.au/health/healthyliving/smoking-and-weight. Accessed on 18 January 2018.
14. Data on file.
1 Which one of the following is the main addictive component of cigarettes?
a Tobacco
b Nicotine
c Dopamine
d Carcinogens
2 Which one of the following statements about Nicorette® is untrue?
a It offers active control over cravings
b It offers a flexible, on-demand dosing of nicotine when needed
c It is available in 6 mg and 8 mg formats for low and high dependency smokers
d With Nicorette® smoking cessation may be achieved within 2 – 3 months
3 Which of the following is not an effective treatment for quitting smoking?
a Nicotine replacement therapy
b Varenicline
c Supportive counselling
d Regular coffee breaks
4 In the first 20 minutes after quitting smoking what benefit can be observed?
a Heart attack risk is reduced
b Nicotine cravings are noticeably less
c Sense of smelling becomes clearer
d Pulse rate returns to normal
TEST YOUR KNOWLEDGE
You’ve reached the end of the module. You can test your knowledge right away while the info is fresh, or you can complete the full Class Test in one go once you reach the end of this Study Pack. See the back page of the booklet for more details on how to complete and submit your test.
Below are the questions from the Class Test that apply to the module you just finished. The full Class Test appears on the fax sheet included separately.
Disclaimer: As per the Medicines and Related Substances Act, 1965, Section 22A(4) and (5), S1 and S2 product recommendations can only be made by a pharmacist, pharmacist intern or a pharmacist’s assistant acting under the personal supervision of a pharmacist.
Disclaimer: As per the Medicines and Related Substances Act, 1965, Section 22A(4) and (5), S1 and S2 product recommendations can only be made by a pharmacist, pharmacist intern or a pharmacist’s assistant acting under the personal supervision of a pharmacist.
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Module 9 Quitting Smoking