Disclaimers. Smoking and Smoking Cessation. Worldwide. Objectives. Statistics at Home. Smoking Epidemic 16/10/2017
|
|
- Brook Black
- 6 years ago
- Views:
Transcription
1 Disclaimers Smoking and Smoking Cessation Dr. Janneke Gradstein CCFP(EM) Yarmouth, NS Received CHA Funding 6 th Annual Ottawa Conference: State of the Art Clinical Approaches to smoking cessation. References Disease Interrupted: Tobacco Reduction and Cessation by Els et al The Ottawa Model for Smoking Cessation (workshop materials) The Tobacco Atlas 4 th edition by Eriksen et al Canadian Action Network for the Advancement, Dissemination and Adoption of Practice-informed Tobacco Treatment (CAN-ADAPTT) Free-NS-Strategy.pdf Objectives Where smoking has been and where it s going Money and profit in industry and government HOW TO HELP PEOPLE QUIT! Worldwide 1 billion male smokers 250 million female smokers Rates overall decreasing in richer nations Rates climbing rapidly in poorer nations Smoking Epidemic Develops over 100 years Staggered start times Wealthier nations got a head start Stages I - IV Statistics at Home Canada, 2012 Smokers over age 15: 16% Smoked in pregnancy ages 25-44: 4.8% Smoked in pregnancy ages 20-24: 22.8% In Nova Scotia, 2011 Smoked in pregnancy (all ages): 21.3% 1
2 Economic Analysis: USA Value of cigarette sales: 71 billion$ per year Total cost of smoking: 193 billion$ per year Economic Analysis: Nova Scotia Government tobacco revenue (2011): $213.1 million / year Health Care costs: Direct: $170 million/ year Indirect: $760 million / year Total Government cost $950 million/year Source: Health Impact World Health Organization: Tobacco is the leading cause of preventable death and disease worldwide. Quitting Smoking and Life Expectancy Added life expectancy with smoking cessation: Age 35 8 years Age 65 2 years Health Canada: Tobacco smoking is the single most preventable cause of disease, disability and premature death in Canada. Am J Public Health. 2002;92: (Cancer Prevention Study II, American Census Data 1990) Smoking and Post-op Complications Post-op wound infection 12% in smokers 2% in never smokers (p<0.05) Ann Surg. Jul 2003; 238(1): 1 5 Smoking cessation pre-operatively lowers surgical complications by 41% Am J of Medicine 2011; 124(2): Smoking and Post-op Complications Odds ratios for major surgical complications in smokers 30 Day Mortality: 1.3 ( ) Myocardial infarction: 2.09 ( Cardiac Arrest: 1.87 ( ) Stroke: 1.53 ( ) Pneumonia: 1.8 ( ) Anesthesiology 2011;114(4):
3 Addiction to Tobacco Addiction to Tobacco Addiction means continued smoking IN SPITE of knowing the harm! There are degrees of addiction AND dependence 50% of Canadian smokers tried to quit last year. 2/3 of those who tried to quit, tried more than once Addiction to Tobacco Approximately 60% of all Canadian smokers intend to quit in the NEXT 6 MONTHS. Addiction to Tobacco Approximately 25% of all Canadian smokers intend to quit THIS MONTH. What can you do? The single, most powerful, preventative intervention in clinical practice. Woolf SH. JAMA 1999; 282(24): What can you do? 1. Influence public policy 2. Counsel patients to quit Inpatients Clinic patients ER patients OB patients Surgical patients 3. Prescribe pharmacotherapy 3
4 Public policy and smoking cessation What constitutes counselling? LIMITING ADVERTISMENTS PRODUCT LABELLING BAN PRODUCT PLACEMENT SMOKE-FREE ZONES TAXATION PUBLIC EDUCATION MENTION the role of smoking in their health ASK I know it s so challenging, but if there s anything I can do to help OFFER pharmacotherapy INFORM people about programming: addictions services, pharmacies, smokershelpline, ONLINE, APPS! Explore quitting history and help make plans What constitutes counselling Don t forget maintenance counselling!! - follow up after quit - consider checking in (get staff to call?) - make a stressful event kit Quit rates - Impact of Counselling MOST people quit unassisted. BUT 6-12 month quit rates for physician advice <3 minutes: OR 1.3 ( ) 3-10 minutes: OR 1.6 ( ) >10 minutes: OR 2.3 ( ) Fiore MC, Jaen CR, Baker TB, Bailey, WC, Benowitz, NL, Curry, SJ, et al. treating tobacco use and dependence: 2008 update. Clinical practice guideline. Rockville MD: U.S. Department of Health and Human Services. Quit Rates Impact of Pharmacotherapy Nicotine Replacement Therapy vs Placebo OR 1.6 Combined NRT vs Placebo OR 3.0 Cochrane Database Syst rev; 2008 Bupropion vs Placebo OR RCTs of combined 8000 patients Varenicline vs Placebo OR 3.0 JAMA. 2006; 296(1): Quit Rates: Readiness to Quit Helps but is NOT necessary for long-term success! Can change at a moment s notice For example: hospitalization doc: When did you quit smoking? patient: Today 4
5 Hospital Policy: The Ottawa Model Inpatient smoking cessation programs 6 month smoking abstinence Control group: 18.3% Intervention group: 29.4% OR 1.71 ( P=0.02) Nicotine Tob Res Jan; 12(1): 11-8 Hospital Policy: The Ottawa Model 1. Identification of smoking status 2. Bedside counselling (RT or RN) 3. Pharmacotherapy Nicotine withdrawal order set Smoking cessation order set 4. Automated Follow-up 5. Follow-up counselling Hospital Policy: The Ottawa Model Readmission (all cause): 30 days 13.3% 7.1% ARR 6.1% (CI 2.9% to 9.3% p<0.001) 2 years % ARR 11.6% (CI 6.5% to 16.8% p<0.001) Mortality (all cause): 2 years 15.1% 7.9% ARR 7.3% (CI 3.9% to 10.7% p<0.001) Mullen KA, Manuel DG, Hawken SJ, et al Effectiveness of a hospital-initiated smoking cessation programme: 2-year health and healthcare outcomes Tobacco Control 2017;26: Pharmacotherapy Nicotine patch Nicotine gum Nicotine lozenge Nicotine inhaler Nicotine mouth spray Bupropion (SR) (Zyban) Varenicline (Champix) Degree of Nicotine Dependence Influences likelihood of successful quit Informs intensity of intervention Changes type and amount of pharmacotherapy Can be measured with the Fagerström Test for Nicotine Dependence Fagerström Test for Nicotine Dependence 1. How many cigarettes per day do you usually smoke? 2. How soon after you wake do you smoke your first cigarette? <5 min 6-30 min >30 min 3. Do you find it difficult to stop smoking in non-smoking areas? 4. Which cigarette would you hate most to give up? The first 1 of the morning Other 5. Do you smoke more frequently in the first hours after waking up than during the rest of the day? 6. Does your smoking make you so ill that you are in bed most of the day? 5
6 Fagerström Test for Nicotine Dependence 1. How many cigarettes per day do you usually smoke? 2. How soon after you wake do you smoke your first cigarette? <5 min 6-30 min >30 min 3. Do you find it difficult to stop smoking in non-smoking areas? 4. Which cigarette would you hate most to give up? The first 1 of the morning Other 5. Do you smoker more frequently in the first hours after waking up than during the rest of the day? 6. Does your smoking make you so ill that you are in bed most of the day? Nicotine Replacement Therapy slower onset than cigarettes More stable plasma levels of nicotine 50% lower blood nicotine levels than smoking. Nicotine Replacement Therapy Concurrent smoking NOT contraindicated! Addiction potential is mild Much safer than smoking in cardiovascular diseases pulmonary diseases Pregnancy NOT a carcinogen Physiological effects on vital signs and perfusion significantly less than those of withdrawal Nicotine Patch 16 or 24 hour delivery formats Benefit of 16 hour format: less insomnia Benefit of 24 hour format: morning cravings Nicotine Patch Traditionally 1ppd: use 21mg patches for 6 weeks, 14mg patches for 2 weeks, 7mg patches for 2 weeks Reality do whatever works for you (multiple patches, longer courses) If relapse occurs, continue or resume the patch Nicotine Patch Onset slow, time to maximal effect 6 hours Dosing <10 cigarettes = 7mg = 14mg >20 = 21mg >30 = 21mg + 7mg > 40 = 21mg + 21mg A pack of cigarettes is 20 or 25 cigarettes 6
7 Nicotine Patch Nicotine Patch Dose titration If usually smokes <30 min from waking, add 7mg If cravings are still high Add a short acting NRT Increase patch by 7mg increments Side effects: itching, burning, insomnia, chest pain and arrhythmias, dyspepsia Cost: approximately 25$ for 7 patches, any strength (ie $100 a month) Nicotine Gum Dosing 2 and 4mg strengths available Use 4mg if smoke <30min after waking pieces/day After 6 weeks taper (or not) Onset of action: 30 minutes Nicotine Gum Technique matters! Chew 1-2x then park 1 minute 1 piece lasts 30 minutes Chew every 1-2 hours NOT EFFECTIVE IN ACIDIC ENVIRONOMENT No food or drink 30 minutes before Won t work if swallowed Nicotine Gum Side effects: light-headedness, nausea, chest pain, arrhythmias Caution: Dentures and fillings, TMJ dysfunction Cost: approximately 40$ for 105 (120$ a month for 10 a day) Nicotine lozenge/pastilles Side effects: light-headedness, nausea, chest pain, arrhythmias OK for dentures or TMJ dysfunction Technique: Allow to dissolve slowly and switch sides NOT EFFECTIVE IN ACIDIC ENVIRONOMENT No food or drink 30 minutes before Won t work if swallowed 7
8 Nicotine lozenge/pastilles Dosing 1,2 and 4mg lozenges Use 1-2 lozenges 8-15 times per day use for 6 months then taper (or not) Onset 30 minutes Cost: 40$ for 88 (136$ per month for 10 a day) Nicotine Inhaler Does NOT work below 10 degrees celcius absorbed through the oral mucosa Onset 30 minutes 6-12 cartridges a day (4mg/cartridge) Nicotine Inhaler Side Effects: headache, nausea, burning, tingling of mouth, chest pain, arrhythmias, salivation, dyspepsia Technique works better if rinse mouth first Place mouthpiece in mouth and inhale deeply Inhale multiple times over 5-20 minutes Nicotine Inhaler Dosing 20 inhalations = 1mg nicotine = 1 cigarette Usually 6-12 cartridges are used per day for 3 months, then reduced gradually (or not) Cost 11$ for 6 cartridges (330$ a month for 6/day) Nicotine Mouth Spray Absorbed via oral mucosa Onset 10 minutes (or sooner) Dose: 1 spray = 1mg nicotine = 1 cigarette (good for impatient people) Cost: 42$ per bottle (150 sprays) Nicotine Mouth Spray Technique Spray into mouth Avoid inhaling Avoid swallowing for a few seconds after spray Technique works better if rinse mouth first Place mouthpiece in mouth and inhale deeply Inhale multiple times over 5-20 minutes 8
9 Nicotine Inhaler and Mouth Spray hand-mouth habit? Bupropion SR Synthesized in 1968 oldest smoking cessation drug we have. Mechanism of action Unknown Low abuse potential? Bupropion SR Positive side effects: less weight gain, less depression Negative side effects: insomnia,headache, dry mouth, nausea, anxiety, rash risk of seizures 1:1000 Contraindicated if risk factors for seizure! Bupropion SR Interactions Inhibits CYP 450 (2B6) Check CNS and cardiac drugs Metabolism potentiated by anticonvulsants Metabolism slowed by antiretrovirals Bupropion SR Varenicline Dosing: Bupropion SR 150mg OD x3d then BID x 12 weeks Consider extending up to 12 months Quit 8 days later Coverage: may be covered as Bupropion SR Cost: $28/month as Buproprion Entered human clinical trials in 1999 partial agonist of the α 4 β 2 nicotinic acetylcholine receptor mesolimbic system Agonist effect in brain BUT blocks the effects of nicotine in the brain Does NOT block the effects of nicotine on the rest of the body 9
10 Varenicline Minimal drug interactions Side effects Nausea Insomnia Abnormal dreams Neuropsychiatric events - no Cardiovascular events no Needs to be taken with food Dosing: Varenicline Usual 0.5mg OD x 3 days, then 0.5mg BID x 4 days, then 1.0mg BID x 12+ weeks Start 8 35 days before quit date Titrate! Varenicline Cost 1 month supply $ Half strength $ week supply $360 A word about caffeine Smoking potentiates caffeine metabolism After cessation caffeine levels may double or triple! Caffeine toxicity mimics and worsens cravings NRT does not prevent this! A word about e-cigarettes Not regulated Produced by the tobacco industry Proceed with caution Population health impact Gateway to smoking Teen smoking initiation RE-Normalization of smoking after HUGE antismoking public health efforts Surgical patients Cardiac patients Obstetrical patients Psychiatric patients Special populations 10
11 Thank you! 11
Smoking Cessation: Treating Tobacco Dependence
Smoking Cessation: Treating Tobacco Dependence Pat Folan, RN Center for Tobacco Control Pulmonary Medicine NS-LIJ Health System NYS DOH Tobacco Control Program Treating Tobacco Dependence Center for Tobacco
More informationTobacco Dependence Screening and Treatment in Behavioral Health Settings. Prescribing
Tobacco Dependence Screening and Treatment in Behavioral Health Settings Prescribing GOAL To build the capacity of prescribing clinicians in behavioral health settings to integrate best practices for prescribing
More informationPharmacotherapy Summary for the Treatment of Nicotine Withdrawal and Nicotine Dependence 1
Pharmacotherapy Summary for the Treatment of Nicotine Withdrawal and Nicotine Dependence 1 Compiled by: TOP, in collaboration with Dr. Charl Els and Mr. Ron Pohar: TRaC II (Alberta Medical Association/Primary
More informationSMOKING CESSATION WORKSHOP. Dr Mark Palayew December
SMOKING CESSATION WORKSHOP Dr Mark Palayew December 5 2016 Conflicts of Interest None Case 1 Mr. T is a 55 year old smoker 2 packs/day He has been smoking continuously since age 16 When he wakes up at
More informationAn Evolving Perspective on Smoking Cessation Therapies
An Evolving Perspective on Smoking Cessation Therapies Andrew Pipe, CM, MD Chief, Division of Prevention & Rehabilitation University of Ottawa Heart Institute Faculty/Presenter Disclosure Andrew Pipe,
More informationPharmacologic Therapy for Tobacco Use & Dependence
Pharmacologic Therapy for Tobacco Use & Dependence Thomas Gauvin, MA, TTS Mayo Clinic Nicotine Dependence Center Rochester, MN 2013 MFMER slide-1 Learning Objectives Understand the 7 first line medications
More informationMy Mask. I keep it all inside. Because I d rather. The pain destroy me. Than everyone else. Anon.
My Mask KL I keep it all inside Because I d rather The pain destroy me Than everyone else. Anon. 43 K. N. Roy Chengappa, M.D., FRCPC Professor of Psychiatry, University of Pittsburgh School of Medicine,
More informationBest Practice for Smoking Cessation: Pharmacotherapy. Emma Dean Acting Population Health and Health Promotion Coordinator Lead Pharmacist- Smokefree
Best Practice for Smoking Cessation: Pharmacotherapy Emma Dean Acting Population Health and Health Promotion Coordinator Lead Pharmacist- Smokefree Why is it so hard to quit? People who smoke aren t weak
More informationSmoking Cessation. Disclosures. Thank You. None
Smoking Cessation Dr. Jamie Kellar; BSc, BScPhm, PharmD Clinician Educator Centre for Addiction and Mental Health Assistant Professor Leslie Dan Faculty of Pharmacy Disclosures None Thank You Several slides
More information5. Offer pharmacotherapy to all smokers who are attempting to quit, unless contraindicated.
0 11 Key Messages 1. Ask and document smoking status for all patients. 2. Provide brief advice on quit smoking at every visit to all smokers. 3. Use individual, group and telephone counselling approaches,
More informationNicotine Replacement and Smoking Cessation: Update on Best Practices
Nicotine Replacement and Smoking Cessation: Update on Best Practices Adrienne Duckworth, MSN, APRN, FNP-C, CTTS Section of Hematology/Oncology WVU Department of Medicine WVU Cancer Institute Objective
More informationOutpatient Tobacco Addiction Treatment Pathway Additional Notes
Outpatient Tobacco Addiction Treatment Pathway Additional Notes First Line: Varenicline (provide in conjunction with counselling/support, but if such support is refused or is not available, this should
More informationSmoking cessation therapy
Appendix 1 Smoking cessation therapy Q. Can a dentist prescribe medications for smoking cessation? A. Yes. Dentists are allowed and are encouraged to help patients with smoking cessation by counseling
More informationEffective Treatments for Tobacco Dependence
Effective Treatments for Tobacco Dependence Abigail Halperin MD, MPH Director, University of Washington Tobacco Studies Program Ken Wassum Associate Director of Clinical Development and Support Quit for
More informationSMOKING CESSATION. Recommendations 5As Approach to Smoking Cessation. Stages of Change Assisting the Smoker. Contributor Dr. Saifuz Sulami.
SMOKING CESSATION 08 Recommendations 5As Approach to Intervention Stages of Change Assisting the Smoker Pharmacotherapy Contributor Dr. Saifuz Sulami Advisor Dr. Audrey Tan 79 nhg_guideline_14102010_1112.indd
More informationNicotine Replacement Therapy (NRT).
Nicotine Replacement Therapy (NRT). Information for smokers 1 What is NRT? The aim of Nicotine Replacement Therapy (NRT) is to reduce the withdrawal symptoms associated with nicotine addiction by replacing
More informationDispensing of Nicotine Replacement Therapy (NRT)
Simcoe Muskoka District Health Unit Print Version Medical Directive Number: Topic: Dispensing of Nicotine Replacement Therapy (NRT) Revised: October 2011 Approved: May 21, 2007 Description Nicotine Replacement
More information1. Describe the benefits of smoking cessation. 2. List the withdrawal symptoms of quitting smoking. Cessation
Time to Butt Out Adil Virani, BSc (Pharm), Pharm D, FCSHP Objectives After this presentation, participants should be able to: 1. Describe the benefits of smoking cessation 2. List the withdrawal symptoms
More informationMEDICATION COVERAGE POLICY PHARMACY AND THERAPEUTICS ADVISORY COMMITTEE
MEDICATION COVERAGE POLICY PHARMACY AND THERAPEUTICS ADVISORY COMMITTEE POLICY: Smoking Cessation Products LAST REVIEW 5/8/2018 THERAPEUTIC CLASS: Psychiatric Disorders REVIEW HISTORY 5/17, 5/16, 5/15,
More informationTobacco Cessation: Priority for Health Providers. Acknowledgements. Tobacco Cessation: Secondhand Smoke. Smoke-Free Environment & CA
Acknowledgements Smoking Cessation Leadership Center http://smokingcessationleadership.ucsf.edu/ Rx for Change http://rxforchange.ucsf.edu/ Tobacco Use and Dependence: 2008 Update http://www.surgeongeneral.gov/tobacco
More informationIntroduction to pharmacotherapy
Introduction to pharmacotherapy Dr. Shamim Jubayer. Research Fellow Dept. Epidemiology and Research National Heart Foundation Hospital And research Institute Effective tobacco cessation medications The
More informationIMPORTANT POINTS ABOUT MEDICATIONS
IMPORTANT POINTS ABOUT MEDICATIONS The U.S. Food & Drug Administration (FDA) advises that there are significant health benefits to quitting smoking. The health benefits of quitting smoking include a reduction
More informationBrief Intervention for Smoking Cessation. National Training Programme
Brief Intervention for Smoking Cessation National Training Programme Introduction Monitor tobacco use and prevention policies Protect people from tobacco smoke Offer help to quit tobacco use Warn about
More informationWanting to Get Pregnant
Continuing Medical Education COPD Case Presentation LEARNING OBJECTIVES Those completing this activity will receive information that should allow them to Assist a patient in developing a quit plan; Advise
More informationPHARMACOTHERAPY OF SMOKING CESSATION
PHARMACOTHERAPY OF SMOKING CESSATION Domenic A. Ciraulo, MD Director of Alcohol Pharmacotherapy Research Center for Addiction Medicine Department of Psychiatry Massachusetts General Hospital Disclosure
More informationSmoking Cessation A Clinicians Perspective. Jeff Wilson, MD
Smoking Cessation A Clinicians Perspective Jeff Wilson, MD Overview Tobacco control what we have accomplished and the road ahead Role of the health care professional Using pharmacotherapy Electronic cigarettes
More informationNYSMPEP Smoking Cessation Guidance: Key Message 3
NYSMPEP Smoking Cessation Guidance: Key Message 3 Key Message 3: All smokers trying to quit should be offered medication (except when contraindicated or for specific populations). The Agency for Healthcare
More information3. Chantix [package insert]. New York, NY: Pfizer, Inc,; Ramon JM, Morchon S, Baena A, Masuet-Aumatell C. Combining varenicline and nicotine
How can there be a warning regarding concomitant use of varenicline with nicotine replacement therapy yet patients can be on varenicline and smoke concurrently? April 20, 2017 The United States (US) Preventive
More informationPharmacotherapy for Tobacco Dependence Treatment
Pharmacotherapy for Tobacco Dependence Treatment Nancy Rigotti, MD Professor of Medicine, Harvard Medical School Director, Tobacco Research and Treatment Center, Massachusetts General Hospital nrigotti@partners.org
More informationTobacco Use Dependence and Approaches to Treatment
University of Kentucky UKnowledge Nursing Presentations College of Nursing 11-2011 Tobacco Use Dependence and Approaches to Treatment Audrey Darville University of Kentucky, audrey.darville@uky.edu Chizimuzo
More informationClearing the Air: What You Need to Know and Do to Prepare to Quit Smoking
Clearing the Air: What You Need to Know and Do to Prepare to Quit Smoking Getting Ready to Quit Course Creating Success! THINK ABOUT Process of Changing an Addiction Your Pros and Cons of Smoking and Quitting
More informationPharmacotherapy for Treating Tobacco Dependence
Pharmacotherapy for Treating Tobacco Dependence Sheila K. Stevens, MSW Education Coordinator Nicotine Dependence Center 2013 MFMER slide-1 Rationale for Pharmacological Therapy Success rate doubles Manage
More informationHelping People Quit Tobacco
Helping People Quit Tobacco Peter Selby MBBS, CCFP, MHSc, ASAM Associate Professor, University of Toronto Clinical Director, Addictions Program, CAMH Principal Investigator, OTRU Disclosures! Grants/research
More informationTime to Butt Out. Adil Virani, BSc (Pharm), Pharm D, FCSHP
Time to Butt Out Adil Virani, BSc (Pharm), Pharm D, FCSHP Objectives After this presentation, participants should be able to: 1. Describe the benefits of smoking cessation 2. List the withdrawal symptoms
More informationTOBACCO CESSATION: INCORPORATING MOTIVATIONAL INTERVIEWING AND EXAMINING THE ROLE OF E-CIGS
Learning Objectives TOBACCO CESSATION: INCORPORATING MOTIVATIONAL INTERVIEWING AND EXAMINING THE ROLE OF E-CIGS Cheyenne Newsome, PharmD PGY2 Ambulatory Care Resident University of New Mexico College of
More informationHIV and Aging. Making Tobacco Cessation a Priority in HIV/AIDS Services. Objectives. Tobacco Use Among PLWHA
HIV and Aging Making Tobacco Cessation a Priority in HIV/AIDS Services June 27, 2008 Amanda Brown, MPH Ruth Tripp, MPH, RN Objectives To explore existing knowledge of the HIV and smoking connection. To
More informationSmoking and Nicotine Replacement Therapy (NRT) Lec:5
Smoking and Nicotine Replacement Therapy (NRT) Lec:5 Tobacco use remains the single largest preventable cause of mortality. Cigarette smoke is a complex mixture of an estimated 4800 compounds. Approximately
More informationReady to give up. Booklet 3
Ready to give up Booklet 3 This booklet is written for people who have decided that they want to stop smoking. You can use this booklet on its own or go through it with the person who gave it to you. You
More informationMedication Management to Aid in Smoking Cessation. Rachel Constant, Pharm.D. Baptist Health Corbin Pharmacy Resident 3/22/2019
Medication Management to Aid in Smoking Cessation Rachel Constant, Pharm.D. Baptist Health Corbin Pharmacy Resident 3/22/2019 1 Learning Objectives: Review the prevalence of tobacco use. Describe tools
More informationTOBACCO CESSATION: INCORPORATING MOTIVATIONAL INTERVIEWING AND EXAMINING THE ROLE OF E-CIGS
TOBACCO CESSATION: INCORPORATING MOTIVATIONAL INTERVIEWING AND EXAMINING THE ROLE OF E-CIGS Cheyenne Newsome, PharmD PGY2 Ambulatory Care Resident University of New Mexico College of Pharmacy Learning
More informationThe 5A's are practice guidelines on tobacco use prevention and cessation treatment (4):
Smoking Cessation Module Tobacco use is the single greatest preventable cause of chronic diseases and premature deaths worldwide. The Canadian Cancer Society reports that tobacco product use is responsible
More informationChantix Label Update 2018
Chantix Label Update 2018 Chantix (varenicline) Prescribing Information Chantix Prescribing Info URL and Disclaimer Please refer to the full Prescribing Information on important treatment considerations
More informationSt. Joseph s Health PROVIDER BRIEF. Tobacco Dependence Treatment Guidelines Perinatal and Postpartum Women
St. Joseph s Health PROVIDER BRIEF Tobacco Dependence Treatment Guidelines Perinatal and Postpartum Women Quitting smoking is perhaps the most important action a pregnant woman can do to ensure the health
More informationNicotine Replacement Therapy, Zyban and Champix. Name of presentation
Nicotine Replacement Therapy, Zyban and Champix Nicotine Replacement Therapy (NRT) - Rationale for use Nicotine is highly addictive and causes unpleasant withdrawal symptoms which often undermine a quit
More informationTobacco & Nicotine: Addiction and Treatment
Tobacco & Nicotine: Addiction and Treatment Tim McAfee, MD, MPH Chief Medical Officer - Free & Clear 206-876-2551 - tim.mcafee@freeclear.com Affiliate Assistant Professor, University of Washington, School
More informationClinical Guideline / Formulary Document Pharmacy Department Medicines Management Services
Clinical Guideline / Formulary Document Pharmacy Department Medicines Management Services SMOKING CESSATION Introduction NICE recommends that Nicotine Replacement Therapy (NRT), bupropion [Zyban ] and
More informationDERBYSHIRE JOINT AREA PRESCRIBING COMMITTEE (JAPC)
DERBYSHIRE JOINT AREA PRESCRIBING COMMITTEE (JAPC) Derbyshire Formulary for Nicotine Replacement Therapy (NRT) 1. Supporting Smokers to stop smoking The most effective method to quit smoking is by quitting
More informationSmoking Cessation: Good News at Last!
Smoking Cessation: Good News at Last! Andrew L. Pipe, CM, MD The Minto Prevention & Rehabilitation Centre University of Ottawa Heart Institute Ottawa, Ontario. Canada apipe@ottawaheart.ca Declaration of
More informationEVIDENCE-BASED INTERVENTIONS TO HELP PATIENTS QUIT TOBACCO
EVIDENCE-BASED INTERVENTIONS TO HELP PATIENTS QUIT TOBACCO Lena Matthias Gray, MSA, CTTS-M University of Michigan MHealthy Tobacco Consultation Service Overview of Tobacco Use The World Health Organization
More informationHow best to get your patients to stop smoking. Dr Alex Bobak GP and GPSI in Smoking Cessation Wandsworth, London
How best to get your patients to stop smoking Dr Alex Bobak GP and GPSI in Smoking Cessation Wandsworth, London 1 2 Smoking can cause at least 14 different types of cancer 3 Smokers want to stop All smokers
More informationTobacco Basics and Brief Cessation Interventions. Prepared by: Margie Kvern, RN, MN Diane Mee, RN, BN October 2014
Tobacco Basics and Brief Cessation Interventions Prepared by: Margie Kvern, RN, MN Diane Mee, RN, BN October 2014 Outline Tobacco Basics WRHA Clinical Practice Guideline for Management of Tobacco Use and
More informationSmoke-free Hospitals. Linda A. Thomas, MS University of Michigan Health System Tobacco Consultation Service
Smoke-free Hospitals Linda A. Thomas, MS University of Michigan Health System Tobacco Consultation Service Today s Subjects 5A s and Clinician Training and Use with the Hospitalized Patient NRT use in
More informationCessation Medicine Reference Guide Table of Contents
Cessation Medicine Reference Guide Table of Contents 1. Patch 2. Nicotine Gum 3. Nicotine Lozenge 4. Inhaler 5. Nasal Spray 6. Bupropion SR (Zyban) 7. Chantix (Varenicline) Patch Typical course of therapy
More informationVarenicline and Other Pharmacotherapies for Tobacco Dependence
Varenicline and Other Pharmacotherapies for Tobacco Dependence J. Taylor Hays, M.D. Associate Director Nicotine Dependence Center Mayo Clinic 2012 MFMER slide-1 Learning Objectives Understand the mechanism
More informationSee Important Reminder at the end of this policy for important regulatory and legal information.
Clinical Policy: Reference Number: CP.CPA.113 Effective Date: 11.16.16 Last Review Date: 11.17 Line of Business: Commercial Revision Log See Important Reminder at the end of this policy for important regulatory
More informationQuitting is all about finding what works for you.
Quitting is all about finding what works for you. Your guide to finding the right support 02 Smokefree Your way Well done you I can do it! Smokefree provides advice, support and encouragement to help people
More informationSee Important Reminder at the end of this policy for important regulatory and legal information.
Policy: Smoking Cessation Products Reference Number: TCHP.PHAR.18002 Effective Date: 01.01.19 Last Review Date: 10.12.18 Line of Business: Oregon Health Plan Revision Log See Important Reminder at the
More informationEMERGING ISSUES IN SMOKING CESSATION
EMERGING ISSUES IN SMOKING CESSATION Andrew Pipe, CM, MD Chief, Division of Prevention & Rehabilitation University of Ottawa Heart Institute Faculty/Presenter Disclosure Andrew Pipe, CM, MD University
More informationTobacco Cessation The Role of the Dentist/Oral Medicinist
Tobacco Cessation The Role of the Dentist/Oral Medicinist Jennifer Frustino, DDS PhD Oral Oncology & Maxillofacial Prosthetics Erie County Medical Center Buffalo, NY Statement of Disclosure I have no actual
More informationBackground. Abstinence rates associated with varenicline
What are the range of abstinence rates for varenicline for smoking cessation? Do they differ based on treatment duration? Are there any studies utilizing 3-4 months of varenicline treatment? Background
More informationPage 1 of 7 INITIAL EVALUATION MANAGEMENT. STATUS Yes. See page 2. Refer patient to a tobacco treatment program 3 (preferred) Patient interested?
Page 1 of 7 INITIAL EVALUATION Screen current tobacco use status Has patient smoked more than 100 cigarettes in lifetime? Has patient smoked or used tobacco in the last 12 months? STATUS Within the last
More informationPhil Mohler, M.D Crossroads Blvd P.O. Box Grand Junction, CO July 2016
Phil Mohler, M.D. phil.mohler@rmhp.org 2775 Crossroads Blvd P.O. Box 10600 Grand Junction, CO 81502-5600 Avoid these expensive me-too drugs: Intermezzo Vimovo Livalo Pristiq Viibyrd Edarbi Daliresp July
More informationSECTION 17: NICOTINE REPLACEMENT. Formulary and Prescribing Guidelines
SECTION 17: NICOTINE REPLACEMENT Formulary and Prescribing Guidelines 17.1 Introduction These guidelines should be used in conjunction with EPUT No Smoking Policy (HRP20) for service users who are 12 years
More informationOver the Road Truck Driver Who Smokes
Continuing Medical Education Case Presentation 1 CME Credit Physicians Physician Assistants Nurse Practitioners Over the Road Truck Driver Who Smokes RELEASE & REVIEW DATE This activity was last reviewed
More informationTobacco Cessation: Best Practices in Cancer Treatment. Audrey Darville, PhD APRN, CTTS Certified Tobacco Treatment Specialist UKHealthCare
Tobacco Cessation: Best Practices in Cancer Treatment Audrey Darville, PhD APRN, CTTS Certified Tobacco Treatment Specialist UKHealthCare Objectives 1. Describe the current state of tobacco use treatment
More informationCounseling the Tobacco Dependent Patient. Gretchen Whitby, CNP The Lung Center
Counseling the Tobacco Dependent Patient Gretchen Whitby, CNP The Lung Center http://www.surgeongeneral.gov/tobacco/treating_tobacco_use08.pdf Tobacco Dependence Tobacco dependence is a chronic disease
More informationTitle: Varenicline for Smoking Cessation. Date: June 4, Context and policy issues:
Title: Varenicline for Smoking Cessation Date: June 4, 2007 Context and policy issues: The prevalence of smoking in Canada continues to drop, according to the 2005 Canadian Tobacco Use Monitoring Survey.
More informationSmokeless Tobacco Cessation: Review of the evidence. Raymond Boyle, PhD Tobacco Summit 2007 MDQuit.org
Smokeless Tobacco Cessation: Review of the evidence Raymond Boyle, PhD Tobacco Summit 2007 MDQuit.org Previous Reviews of ST evidence Hatsukami and Boyle (1997) Evidence base is limited by small sample
More informationFast Facts. Morbidity and Mortality (Related to Tobacco Use)
Fast Facts Morbidity and Mortality (Related to Tobacco Use) Tobacco and Disease Tobacco use causes o Cancer o Heart disease o Lung diseases (including emphysema, bronchitis, and chronic airway obstruction)
More informationChantix (Varenicline) and Risk of Cardiovascular Events
PL Detail-Document #270803 This PL Detail-Document gives subscribers additional insight related to the Recommendations published in PHARMACIST S LETTER / PRESCRIBER S LETTER August 2011 Chantix (Varenicline)
More informationUpdate on Medications for Tobacco Cessation
Update on Medications for Tobacco Cessation Marc Fishman MD Johns Hopkins University Dept of Psychiatry Maryland Treatment Centers Baltimore MD MDQuit Best Practices Conference Jan 2013 Nicotine Addiction
More informationAdolescents and Tobacco Cessation
Adolescents and Tobacco Cessation Jonathan D. Klein, MD, MPH American Academy of Pediatrics Julius B. Richmond Center and the University of Rochester Rochester, NY Goal To review current evidence and perspectives
More informationSmoking Cessation: Where Are We Now? Nancy Rigotti, MD
Smoking Cessation: Where Are We Now? Nancy Rigotti, MD Director, MGH Tobacco Research and Treatment Center Professor of Medicine, Harvard Medical School nrigotti@partners.org OVERVIEW The challenge for
More informationSmoking Cessation and the Pharmacist
Smoking Cessation and the Pharmacist Jennifer Roberts Assistant Director, Research Pharmacy 1 Objectives Review smoking cessation medication use, based on public health guidelines, as well as contraindications
More informationEssentials of Smoking Cessation (2017)
Essentials of Smoking Cessation (2017) Dr Alex Bobak Smoking the size of the problem: Biggest preventable cause of death and disease bar none >50% of long term smokers die prematurely from smoking related
More informationSmoking Cessation Services Guidance
Smoking Cessation Services Guidance Alabama Medicaid Tobacco Treatment Coverage Covered Services/Medication 1. Free tobacco cessation counseling is provided through the Alabama Tobacco Quitline. Refer
More informationMEDICAL DIRECTIVE Title: Administration of Nicotine Replacement Therapy by Health Professionals at Pinewood Centre of Lakeridge Health
Approved by/date: Medical Advisory Comm. Mar 25, 2014 Authorizing physician(s)/nurse practitioner Dr Eli Sagi, Chief of Psychiatry, Medical Director, Mental Health and Pinewood Centre Dr. Ihab Sorial,
More informationBreaking the Chains of Nicotine Dependence - A Breakthrough Approach
Breaking the Chains of Nicotine Dependence - A Breakthrough Approach Dr Rob Young Senior Lecturer & Consultant Physician Auckland Hospital, New Zealand Smoking Cessation in 2001 Smoking contributes to
More informationHealth Professional Manual
Health Professional Manual Session: Smoking Cessation Smoking and COPD Strategies for quitting smoking Adapted from the Living Well with COPD program (2nd edition), Montreal Chest Institute, Canada SESSION
More informationSMART STEPS towards a tobacco-free life
SMART STEPS towards a tobacco-free life Ready to Quit Smoking? You decide when. We ll show you how. Smart steps... Ready to Put Tobacco Behind You? Congratulations on deciding to quit! Quitting tobacco
More informationUPDATE TREATMENT OF TOBACCO USE DISORDERS
Psychiatry and Addictions Case Conference UW Medicine Psychiatry and Behavioral Sciences UPDATE TREATMENT OF TOBACCO USE DISORDERS MARK DUNCAN MD UNIVERSITY OF WASHINGTON OBJECTIVES 1. Remind everyone
More informationSmoking Cessation Interventions In Hospital Settings: Implementing the Evidence
Smoking Cessation Interventions In Hospital Settings: Implementing the Evidence Nancy Rigotti, MD Tobacco Research & Treatment Center, General Medicine Division, Massachusetts General Hospital, Harvard
More informationKeywords: tobacco, cigarette smoke, nicotine, dopamine, smoking cessation, acethylcholine, varenicline (champix )
Review Article and Clinical Experience: ENICLINE (CHAMPIX ) : A BREAKTHROUGH FOR SMOKING CESSATION TREATMENT (An α4ß2 Nicotinic Acethylcholine Receptor Partial Agonist) Askandar Tjokroprawiro Diabetes
More informationMonth/Year of Review: March 2014 Date of Last Review: April 2012
Drug Use Research & Management Program Oregon State University, 500 Summer Street NE, E35, Salem, Oregon 97301-1079 Phone 503-947-5220 Fax 503-947-1119 Copyright 2012 Oregon State University. All Rights
More informationFormulary and Prescribing Guidelines
Formulary and Prescribing Guidelines SECTION 17: NICOTINE REPLACEMENT THERAPY 17.1 Introduction These guidelines should be used in conjunction with SEPT No Smoking Policy (HRP20) and for service users
More informationAddressing Tobacco Use in Iowa
Addressing Tobacco Use in Iowa A BRIEF TOBACCO INTERVENTION FOR HEALTHCARE PROVIDERS Lorene Mein Beth Turner Alyssa Reichelt DNP, ARNP, FNP-BC MA, CHES MA Mercy Clinics American Lung Association American
More informationHIV and Cardiovascular Risk The Ottawa HIV Quit Smoking Study
HIV and Cardiovascular Risk The Ottawa HIV Quit Smoking Study Louise Balfour PhD Paul MacPherson PhD, MD, FRCPC Division of Infectious Diseases Ottawa Hospital University of Ottawa HIV and Cardiovascular
More information21 INSTRUCTOR GUIDELINES
STAGE: Ready to Quit Ms. Crosby is a 32-year-old woman who recently began attending a worksite group program for smoking cessation. Her group has set a quit date for one week from today, and she would
More informationTobacco treatment for people with serious mental illness (SMI)
Tobacco treatment for people with serious mental illness (SMI) An opportunity to close the mortality gap Massachusetts Mental Health Center 1 National Resource Center for Academic Detailing A compelling
More informationTreating Tobacco Use:
Treating Tobacco Use: Optimizing for the Best Outcomes Nancy Rigotti, MD Director, MGH Tobacco Research and Treatment Center Professor of Medicine, Harvard Medical School nrigotti@partners.org Primary
More informationTREATMENT INTERVENTIONS
SMOKING CESSATION TREATMENT INTERVENTIONS Smoking and Health Tobacco is the single most preventable cause of death in the world today. kills more than five million people By 2030, the death toll will exceed
More informationSmoking Cessation. MariBeth Kuntz, PA-C Duke Center for Smoking Cessation
Smoking Cessation MariBeth Kuntz, PA-C Duke Center for Smoking Cessation Objectives Tobacco use at population level Tobacco use and control around the world What works for managing tobacco use Common myths
More informationTRENDS IN TOBACCO UNDERSTAND 5/26/2017 LEARNING OBJECTIVES. Understand the types of tobacco products trending in today s market & associated risks
TRENDS IN TOBACCO And What Employers Can Do to Support Cessation Katy Tombaugh, Certified Tobacco Treatment Specialist Founder & CEO, Wellness Collective LEARNING OBJECTIVES Understand the types of tobacco
More informationSMOKING CESSATION IS HARD
POWER TO BREAK THE HOLD OF NICOTINE ADDICTION 1 SMOKING CESSATION IS HARD Most smokers try to quit 5-7 times before they are successful. 2 Why is it so hard to quit? Typical withdrawal symptoms from stopping
More informationTuberculosis and Tobacco
ᐋᓐᓂᐊᖃᕐᓇᙱᑦᑐᓕᕆᔨᒃᑯᑦ Department of Health Munaqhiliqiyitkut Ministère de la Santé Tuberculosis and Tobacco Overlapping Epidemics in Nunavut Brought to you by Tuberculosis (TB) Program Educates and supports
More informationAfter the Last Cigarette
After the Last Cigarette Treatment Options for Quitting Tobacco By Susan Kahler, MBA, CTTS Risks from Smoking The Highly Engineered Product Nicotine Delivered by Inhalation Characteristics of Nicotine
More informationLegacy Emanuel Medical Center Nicotine Withdrawal Prevention Protocol (NicWiPP) Provider Education
Legacy Emanuel Medical Center Nicotine Withdrawal Prevention Protocol (NicWiPP) Provider Education Legacy Health Tobacco Program Medical Director: Charles J. Bentz MD, FACP Tobacco Treatment Specialist:
More informationA Guide to Help You Reduce and Stop Using Tobacco
Let s Talk Tobacco A Guide to Help You Reduce and Stop Using Tobacco Congratulations for taking this first step towards a healthier you! 1-866-710-QUIT (7848) albertaquits.ca It can be hard to stop using
More information9/16/2016. I would feel comfortable dispensing/prescribing varenicline to a patient with a mental health disorder. Learning Objectives
The Smoking Gun: for Smoking Cessation in Patients with Mental Health Disorders BRENDON HOGAN, PHARMD PGY2 PSYCHIATRIC PHARMACY RESIDENT CTVHCS, TEMPLE, TX 09/23/2016 I would feel comfortable dispensing/prescribing
More informationTobacco Cessation For Providers. Betty Murphy Health Promotion Program Naval Hospital Rota
Tobacco Cessation For Providers Betty Murphy Health Promotion Program Naval Hospital Rota Tobacco Statistics Strategies for Implementation Stages of Change Pharmacotherapy Tobacco Use Statistics 70% of
More information