1. Session #5 Medication

2. Outline Session #5 Welcome and introductions
Group expectations and behaviour
Medications
Non-prescription
Prescription
Review (if time)
PACT - MHG

3. Group Guidelines Review…
Review flipchart or insert slide from week 1 for review
Ask for a volunteer to read out loud
PACT - MHG

4. Medications Help you to Choice depends on
Manage cravings and withdrawal symptoms
Choice depends on
addiction level (Modified Fagerstrom)
personal situation and preference
prior quit experience
For patients ready to quit – and usually if > 10 cigarettes per day
- many medications used to treat mental illness are removed from the body faster in smokers
- smokers often end up on higher medication doses because of this interaction
- might be possible for individuals to have some medication dose reduced if they quit smoking successfully…
NOTE – not intended to go into any specifics – better to discuss one-on-one with those who actually decide to reduce or quit…mention only in general terms due to variability in individual circumstances
PACT - MHG

5. Discussion How soon after you wake up do you need to have a cigarette?
Do you get up through the night to have a cigarette?
PACT - MHG

6. Discussion Have you tried to quit before? How long did you stay quit?
Did you use a medication?
PACT - MHG

7. Medications
Medication PLUS supportive counselling greatly increases chance for a long-term quit
Do not MAKE you quit
You must WANT to quit!
PACT - MHG

8. Types of medication Nicotine Replacement Therapy (NRT)
Patches (long acting)
Gum (short acting)
Lozenge (short acting)
Inhaler (short acting)
Oral spray (short acting)
Bupropion (Zyban)
Varenicline (Champix)
PACT - MHG

9. Nicotine Patch > 20 cigarettes a day < 20 cigarettes a day
start with 21mg once/day for 3-4 weeks
< 20 cigarettes a day
start with 14mg once/day for 3-4 weeks
Tapering: reduce patch strength every 3-4 weeks (e.g. from 21mg → 14mg → 7mg)
~ 8-12 weeks in total (can reduce more slowly if necessary)
PACT - MHG

10. Nicotine Patch To ensure patch stays in place for 24h
site s/b clean, non-hairy, completely dry
apply and press from centre to outside edge
apply pressure to patch for ~10 seconds
Can remove overnight
if interferes with sleep
apply new patch in morning
chew NRT gum for initial morning craving
PACT - MHG

11. Nicotine Patch Side effects:
Skin reaction – up to 50% local skin reactions
Important to rotate site
Hydrocortisone cream if needed
Headache, dizziness, blurred vision, nausea, vivid dreams
PACT - MHG

12. Nicotine Gum > 20 cigarettes a day < 20 cigarettes a day
Thrive 2 mg, Nicorette 4 mg
< 20 cigarettes a day
Thrive 1 mg, Nicorette 2 mg
~ pieces per day (max 20/day)
Tapering: reduce by 1-4 pieces per day each week
~ 12 weeks in total (can reduce more slowly if necessary)
PACT - MHG

13. Nicotine Gum Bite, Bite – until mild tingling
Park between gum and cheek ~ 1 minute
Repeat bite-bite-park until tingling stops (~ 30 minutes) then discard
Avoid food/drink for 15 minutes before/after/during chewing (30 minutes for acidic drinks)
Acidic beverages (coffee/tea/soda/juice) ↓ absorption, ↓ effectiveness
PACT - MHG

14. Nicotine Gum Side effects burning in throat, hiccups, gas sore jaw
Reduce by proper technique
sore jaw
PACT - MHG

15. Nicotine Lozenge If smoke within 30 minutes of waking
Start with 4 mg
If smoke in > 30 minutes of waking
Start with 2 mg
~ 8-12 lozenges per day (max 15)
Taper: after first six weeks, reduce #/day and strength based on withdrawal symptoms
PACT - MHG

16. Nicotine Lozenge
Suck slowly until taste is strong, rest in cheek until taste fades, repeat
Lasts ~ 30 minutes
Avoid food/drink for 15 minutes before/after/during (30 minutes for acidic drinks)
Acidic beverages (coffee/tea/soda/juice) ↓ absorption, ↓ effectiveness
PACT - MHG

17. Nicotine Lozenge Side effects Nausea, heartburn, hiccup
Reduce by proper technique
Mouth-throat irritation
Headache
PACT - MHG

18. Nicotine Inhaler
PACT - MHG

19. Nicotine Inhaler One cylinder = ~ 20 minutes puffing
5-20minutes at a time, as would a cigarette
Avoid food/drink for 15 minutes before/after/during (30 minutes for acidic drinks)
Delivers ~ 4mg nicotine per cartridge
Nicotine released as a vapour with each puff
PACT - MHG

20. Nicotine Inhaler Use only at room temperature
Clean mouthpiece regularly with soap/water
PACT - MHG

21. Nicotine Inhaler Side effects
Throat irritation, cough, bad taste in mouth/throat, runny nose
PACT - MHG

22. Nicotine QuickMist Fine mist oral spray, mint taste
Controls cravings in ~ 60 seconds
1-2 sprays every minutes
Maximum:
2 sprays per dose
4 sprays per hour
64 sprays per day
Tapering: as cravings reduce
PACT - MHG

23. Nicotine QuickMist Prime the dispenser before first use
May need to repeat if not used for 2 days or more
Hold spray nozzle close to open mouth
Press nozzle once to release spray
Avoid spray on lips
Don’t inhale when spraying (keeps spray in mouth, not throat)
Don’t swallow for a few seconds after
PACT - MHG

24. Nicotine QuickMist Side effects: Tingling/burning lips Hiccups
Annoying but not harmful
Spray only in mouth, avoid spray on lips
Hiccups
Strong taste in mouth
PACT - MHG

25. Nicotine Overdose Cold sweat Nausea Salivation Vomiting Abdominal pain
Diarrhea
Flushing
Headache
Dizziness
Weakness
Mental confusion
Tremour
Disturbed hearing/vision
Overdose can occur easily if correct technique not used – and/or – if continuing to smoke while using NRT
PACT - MHG

26. Reasons NOT to use NRT Unstable heart condition
Pregnancy and breastfeeding
Under 18 years of age
UNLESS
Under doctor supervision
PACT - MHG

27. Wiggle Break!!
PACT - MHG

28. Bupropion (Zyban)
150mg tablet daily x 3 days, then increase to twice daily
~ 12 week duration
Start one week before quit date
Anti-depressant drug – helps control cravings
Originally on market as an anti-depressant
PACT - MHG

29. Bupropion (Zyban) Side Effects: Do NOT use:
Insomnia, dry mouth, nausea, constipation, disturbed concentration
Do NOT use:
Pregnancy, breast feeding
Seizure disorder
More that 4 servings alcohol/day
PACT - MHG

30. Varenicline (Champix)
Binds to nicotine receptors in brain
Blocks nicotine from binding to receptor
Acts like nicotine – small release of dopamine
Feel unwell if continue to smoke
PACT - MHG

31. Varenicline (Champix)
0.5mg tablet once daily x 3 days the twice daily x 4 days
1.0 mg tablet twice daily
Minimum 12 weeks
Some may benefit from 24 weeks
Start 7-10 days before quit date
PACT - MHG

32. Varenicline (Champix)
Side effects
Nausea, vomiting
Headache, insomnia, abnormal dreams
Food, water, 2nd tablet ~3-4pm
DO NOT use:
Pregnancy, breastfeeding
Unstable mental illness
CAUTON – depression, thoughts of suicide (rare)
PACT - MHG

33. Combination therapy NRTs can be combined NRT and Zyban – possible
example: daytime patch, morning gum
NRT and Zyban – possible
Do NOT combine NRTs and Champix
Combination therapy ONLY with advice from pharmacist or doctor
PACT - MHG

34. Discussion
Are you thinking of reducing or quitting?
PACT - MHG

35. Why reduce or quit? Quick improvements in health
sleep & breathe easier
sense of taste and smell improve
reduce blood pressure
Long term health improvements
Heart, lungs, cancer, diabetes
Longer life – improved quality
More money!
More confidence – better life balance
PACT - MHG

36. Try using the 4 Ds Drink plenty of water Delay for 5-7 minutes
Do something else
Deep breathing
PACT - MHG

37. Remember - Motivation is internal No one else can do it for you
PACT - MHG

38. Challenge for the week:
Reduce tobacco use
Choose two ways you can handle withdrawal symptoms
Walk for 30 minutes every day
PACT - MHG