role of hospital pharmacist in managment smoking cessation

8/3/2019 Role of Hospital Pharmacist in Managment Smoking Cessation

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Sinai universityfaculty of pharmacy

pharmaceutics departmentRole of hospital pharmacist in

management of smoking cessation

Prof.DR: Mohamed Muostafa

Name:mohammed hamdy mohammed salimID:0701125


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Smoking

According to the World Health Organization(WHO), smoking cigarettes remains the leadingcause of preventable death worldwide and isestimated to kill more than 5 million peopleevery year.

A pharmacist-initiated and -managed smoking

cessation program promotes the importance ofsmoking cessation to both patients and healthcare professionals.


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Role of hospital pharmacists in smoking cessation service:

1-They play an important role in educatingtheir patients about the health effects ofsmoking, and in the process canencourage them to quit.

2- Pharmacists conducted an initial face-to-face assessment and follow-up (face-to-face or by telephone).


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3- Explain the treatment that can help

smoker to quit.

4- Arrange an appropriate date to quit:

Advise the client to smoke as normal up to the quitdate.

Advise that cutting down does not work.

Explain that the goal from the quit date onwards isnot to have a single puff .


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5- Explain the withdrawal symptoms

Explain that many smokers experience a range ofdifferent symptoms when they stop.

Reassure the client that most symptoms last, onaverage, between two and four weeks, and willbecome less severe and less frequent the longerthey go without a single puff.

Explain that medication (NRT or bupropion) will helpreduce the severity of withdrawal symptoms.


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6- Assess the level of tobacco dependence:

The number of cigarettes smoked per day is not astrong indicator of how dependent a smoker is.

If a person smokes within 30 minutes of waking, theyare a highly dependent smoker.

7- Measure the carbon monoxide level inexpired breath.


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8- Discuss medication and arrange a supply:

Nicotine Replacement Therapy (NRT)-Patch (OTC)-Gum (OTC)

-Lozenge (OTC)-Oral Inhaler (Rx)-Nasal Spray (Rx)

Non-Nicotine Medications-Varenicline (Chantix, Rx)-Bupropion Hydrochloride (Rx)


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If bupropion is the product of choice, they need tostart this a week before quitting (initial response from

1-2 week).

If NRT is the product of choice, discuss the sixdifferent types and offer advice on which product

might be most suitable.

Explain that the client will start NRT on the quitdate,and show them how to use it.

Patients should be given accurate expectations (nomagic bullet).


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9- Offer advice on preparing to stop: Suggest that, by the quit date, all cigarettes,

lighters and ashtrays are cleared out of the house.

Ask the client to consider which cigarettes aregoing to be missed most (eg first one in themorning) and how they might be able to deal withthese.

Offer strategies on how to cope with urges tosmoke.

Suggest that they tell all their friends, family andcolleagues (especially those who smoke) abouttheir quit attempt, and ask for their support.


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10-Explain beneficial health changes on stoppingsmoking:

Time since quitting Beneficial health changes

20 minutes Blood pressure and pulse rate return to normal

8 hours Nicotine and carbon monoxide levels in blood

reduce by half, oxygen levels return to normal

72 hours Breathing becomes easier. Bronchial tubes begin torelax and energy levels increase

1 year Risk of a heart attack falls to about half that of asmoker

15 years Risk of heart attack falls to the same as someonewho has never smoked


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Ask Assess Advise Assist Arrange

Establishpatientssmokingstatus

Determineamountsmoked andreadiness toquit

Informationandmotivationalinterviewing

Developa quitplan

Arrangefollow upand quit

date

Pharmacists primarily helped patients referred to the

program by using assist and arrange strategies.


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Example: the University of Iowa Hospitals in USA

1-Patients were counseled on the risks and benefits ofnicotine replacement therapy, bupropion and vareniclineat the first clinic session.

2-They were then telephoned by the clinical pharmacistbefore the second clinic meeting to discuss whichtherapy would be best suited forthem.

3-The clinical pharmacist reviewed the patient s electronicmedical record for contraindications or precautions fortherapy.


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4- If the patient wished to use smoking cessationpharmacotherapy, the clinical pharmacist

formulated a recommendation and presentedit to the patient s primary care provider for approval.

5- Doses for smoking cessatio pharmacotherapy

aligned with each product sprescribinginformation.


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Result:

The pharmacist-managed Smoking CessationGroup Clinic successfully aided approximatelyhalf its participants quit smoking at 3 and 6months.

smoking cessation group program that withoutpharmacist found 42% and 26% at 3 and 6months respectively.

role of hospital pharmacist in managment smoking cessation

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