Nicotine Addiction

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Nicotine Addiction Smoking Cessation Medication
s that can help how to manage medications
during cessation
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Whats in a cigarette?
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Some MYTHS About Nicotine NRT

• Nicotine is carcinogenic
• Nicotine causes the adverse health effects and
  diseases related to smoking
• Nicotine causes yellow stains on fingers and
  teeth
• NRT is more harmful than smoking because of
  nicotines addictive nature
• NRT substitutes one addiction for another
• NRT results in weight gain
• People with mental illness cant successfully
  stop smoking
• You cant stop smoking when youre taking
  medication for a mental illness

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The Truth About Nicotine Addiction
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Gotta Break The Cycle!
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(No Transcript)
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Nicotine Withdrawal Symptoms
1. Jarvis MJ. BMJ 2004 328277-279.
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Unaided QuittingRelapse Curve
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Medication Support is BEST
Aveyard West, BMJ, 335, 2007
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Pharmacotherapies

• Most common treatments
• Nicotine Replacement Therapy (patches, gum,
  lozenges, Microtab)
• Bupropion
• Nortriptyline
• Varenicline
• All reduce the severity of urges to smoke
• No clear evidence that one form of nicotine
  replacement is more effective than others

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The Truth About NRT

• Not a magic cure, effort needed
• Provides nicotine smokers miss, but more slowly
  and less of it than cigarettes
• Does not mimic cigarette effects, but takes the
  edge off the discomfort
• NRT oral product can be unpleasant initially,
  must persevere to benefit
• Delays weight gain
• Reduces relapse

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Using NRT

• Time to first cigarette is important!
• lt30 minutes
• ? tobacco dependence
• More NRT (e.g. full strength patch and PRN)
• gt30 minutes
• ? tobacco dependence
• Less NRT
• Combination strategies are effective safe

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Higher Dose Products Are Better For More
Dependent Smokers

• Nicotine gum 4mg vs. 2mg
• 4mg much more likely to be effective for highly
  dependent smokers
• Nicotine lozenge 4mg vs. 2mg
• 18 quit vs. 10 in 2mg group
• 15 quit vs. 6 in 4mg group
• Nasal spray much better than placebo for highly
  dependent smokers

Silagy, C., et al., Nicotine replacement therapy
for smoking cessation. Cochrane Database Syst
Rev, 2004(3)
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Cut Down To Quit

• Using NRT to help reduce consumption for 6-8
  weeks prior to quitting might increase quit rates
• It may be helpful for smokers who have tried many
  times before?

Shiffman, S., Ferguson, S. G. Strahs, K. R.
(2009) Quitting by gradual smoking reduction
using nicotine gum a randomized controlled
trial, Am J Prev Med, 36, 96-104
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Temporary Abstinence

• Abstinence from smoking results in withdrawal
  symptoms
• NRT is effective for symptom relief and so should
  be recommended regardless of desire to stop long
  term

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Reasons for NRT Failure

• Unrealistic expectations
• Incorrect use
• Not used for long enough
• Nicotine is often seen as the dangerous element
  in cigarette smoke
• Safety concerns can be a barrier to use

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Tobacco Smoke and Medications
Speeds up CYP1A2 Liver enzyme
Increased clearance of drugs Metabolised by CYP1A2
Tobacco smoke
Smoking means higher doses of some antipsychotic
medications might be needed
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Smoking Can Be Important
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Have I done what I said Id do?

• Nicotine is carcinogenic
• Nicotine causes the adverse health effects and
  diseases related to smoking
• Nicotine causes yellow stains on fingers and
  teeth
• NRT is more harmful than smoking because of
  nicotines addictive nature
• NRT substitutes one addiction for another
• NRT results in weight gain
• People with mental illness cant successfully
  stop smoking
• You cant stop smoking when youre taking
  medication for a mental illness

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Any Questions?

• nikki.holmes_at_waitematadhb.govt.nz
• mark.wallacebell_at_googlemail.com