Quitting Smoking · Smoking Across 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

References

Module 9

Quitting Smoking

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.

As stipulated in Section 22A subsection 4 and 5 of the Medicines and Related Substances Act 101 of 1965, product recommendations can only be made by Pharmacists and Pharmacist Assistants acting under the personal supervision of a pharmacist (S1 – S2). Any customer seeking medical advice from a Front Shop Assistant should be referred to the Pharmacist on duty.

OF CHRONIC RESPIRATORY

DISEASE

±42%OF LUNG CANCER DEATHS

±71%OF

CARDIOVASCULAR DISEASE

±10%

Nicotine, the key ingredient in commercial tobacco products, causes smoking dependency2b.

Cravings can begin within days of the first cigarette2c. Nicotine stimulates the brain’s dopamine reward system2d. Dopamine is a chemical or neurotransmitter which is associated with feelings of pleasure3. It is a need for this enjoyment that keeps smokers addicted.

Risks of smoking

Smoking tobacco is harmful to almost every organ in the human body2e. 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 health2f.

Globally, tobacco smoking is responsible for1b:

Smoking addiction

Benefits of quitting

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 hours

Nicotine 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 years Heart attack risk is reduced to the same as a person who has never smoked


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Module 9 Quitting Smoking

Common Withdrawal Symptoms

Patients trying to quit smoking may experience5a:


• Insomnia

• Hunger

• Weight gain

• Headaches

• Gastrointestinal disturbances

• Sleep disturbances

• Strong cravings for cigarettes

• Anxiety

• Depression – usually mild, but can be major

• Reduced concentration

• Irritability

• Restlessness

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).13

• Relapse most frequently occurs within the first few days of a quit attempt when withdrawal symptoms are the greatest10-13

• Over 75% of unaided quitters relapse within the first week11

• Evidence suggests that smoking cessation interventions should focus on early relapse prevention10

67% 76% 78% 81%

33% 24% 22% 19%

Relapse

Complete abstinence

Smokers need the most support in the initial stages of their quit attempt10

Relapse pattern in smokers who quit unaided (n=630)11

Time post-cessation% S

mo

kers

who

mak

e an

una

ided

q

uit

atte

mp

t o

n d

ay 0

0

20

40

60

80

100

2 days 7 days 14 days 1 month


VS

Abstinence in the first week is key to long-term quitting success13

First week abstainers are

9x to still be abstinent at week 52 than those who smoke during the first week (p<0.001)13

The first few days are the hardest

Comparative levels of efficacy in treatments for controlling withdrawal symptoms13

1.5

1.0

0.5

0

0.501 23 45 67 8

423 (p<0.001)

393 (p<0.001)

317 (p=0.02)

249 (p=0.022)

Adverse mood withdrawal symptoms in abstinent subjects13

Weeks after start of treatment

Ad

vers

e m

oo

d s

core

Placebo

15mg

25mg

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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 cases7.


Treatments that help with quitting smoking

Effective treatments for quitting smoking include:

Remedy Availability Effect

Nicotine replacement therapy (NRT) products, such as Nicorette®6a

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 counselling6b Take up therapy or join a counselling group.

Counselling helps modify behaviour and emotional reactions.

Did You Know? Quitting cold turkey (completely all at once) is better than slowly lowering the number of cigarettes smoked, as people who smoke fewer cigarettes may unconsciously inhale more deeply to attain the same nicotine levels6.

Tips for patients who want to stop smoking

People can change the habits that encourage smoking during everyday activities. Common triggers include6c:

• Telephone conversations

• Coffee breaks

• Meals

• Sexual activity

• Boredom

• Traffic problems

People who recognise or are aware of their smoking cues can modify their behaviour. Some tips for kicking the habit include:

• Hiding matches, lighters and ashtrays8

• Designating the home a non-smoking area8

• Asking friends and colleagues who smoke to avoid smoking around you8

• Avoiding places where people smoke, such as smoking sections and restaurants and bars8

• Taking a walk instead of having a coffee break6c

• Eating candy or chewing a toothpick or gum instead of smoking6c

• Avoiding alcohol, since alcohol consumption can temporarily reduce a person’s resolve to quit6c

Supporting patients who want to quit smoking

Even when smokers know the health risks, it is hard to overcome the powerful withdrawal symptoms5b. It can be beneficial to warn your customers about these withdrawal symptoms, but to also assure them that5a:

• Symptoms are worst in the first week – the time when most people relapse

• The majority of the withdrawal symptoms subside within 2 weeks


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Support Program

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 time6e.

• 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 nicotine6f.

• 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 sugar9.

The new NICORETTE® Transdermal Patch 25 mgNicorette® now offers 3 new Transdermal Patches - available in 3 strengths to successfully complement support programs based on the level of smoker trying to quit.

For patients who smoke 10 or more cigarettes a day start with

25 mg

For patients who smoke less than 10 cigarettes a day start with

15 mg

25 mg 8 weeks

15 mg 2 weeks

10 mg 2 weeks

15 mg 8 weeks

10 mg 4 weeks

12-week Programme

12-week Programme


NEW

NEW

• 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.

Case Study 1 Blake, 31, Head of Strategy

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?


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.

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Recommendation

Since Blake is struggling to stop smoking you can recommend the following Nicorette® product:


New Nicorette® Transdermal Patch 25 mg

(for 8 weeks)

What’s it for?

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.

What’s inside?

Nicorette® Transdermal Patch 25 mg: Transdermal delivery system releasing 25 mg of nicotine respectively over 16 hours.

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.

• 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.

Case Study 2 Debbie, 50, Landscape Designer

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?


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.

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Recommendation Since Debbie is struggling to stop smoking you can recommend the following Nicorette® products:Nicorette® 2 mg (low dependency) or Nicorette® 4 mg (high dependency)

What’s it for?Active control over nicotine cravings, and flexible, on-demand dosing when needed.


What’s inside?

Dosage

• 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 chew and fights cravings for up to 2 hours.

• 10 – 12 pieces of gum daily for up to 3 months*.

Advise Debbie to choose between the two products depending on her cravings.

Nicorette® 4 mg: Each piece contains nicotine-resin complex 20 % 20,0 mg equivalent to 4 mg nicotine.

Nicorette® 2 mg: Each piece contains nicotine-resin complex 20 % 10,0 mg equivalent to 2 mg nicotine

*Depends on smoking patterns.


Recap: Nicorette®NEW PATCHES• Active control

over cravings

• Flexible, on-demand dosing when needed

• Smoking cessation may be achieved within 2 – 3 months

GUMS• Active control over cravings

• Flexible, on-demand dosing when needed

• Gum available in palatable flavours: Freshfruit and Freshmint

• Gum available in 2 mg and 4 mg formats for low and high dependency smokers

• Smoking cessation may be achieved within 2 – 3 months

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Test Your KnowledgeYou’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.

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 smell becomes clearer

d Pulse rate returns to normal


S0 Nicorette® Gum Freshfruit 4 mg: Reg.No.: A40/34/0566.

S0 Nicorette® Gum Freshmint 4 mg: Reg.No.: A40/34/0523.

S0 Nicorette® Gum Freshfruit 2 mg: Reg.No.: A40/34/0565.

S0 Nicorette® Gum Freshmint 2 mg: Reg.No.: A40/34/0520.

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.

Nicorette Transdermal Patch 10 mg – 45/32.16/0952



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Documents

Quitting Smoking · Smoking Across 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