Question

A 46-year-old white male presents with a history of smoking 1.5 packs per day for the last 30 years. He has a very stressful job and his co-workers frequently go to "happy hour" at the local bar after a long day at work. When he is at home the patient has a sedentary lifestyle. He has tried to stop smoking "cold turkey" 2 years ago and remained abstinent for approximately 1 year, but has never tried any pharmacologic smoking cessation aids. During his previous attempt to quit smoking he became very anxious, irritable, and depressed. He had trouble sleeping and concentrating at work. He has a medical hx of Hypertension for the past 10 years and has not complied with the therapeutic regimen. His family has encouraged him to stop smoking for years. He is currently at the clinic for his blood pressure check-up and inquires about smoking cessation options.

1. Which smoking cessation aid would you recommend starting in this patient? Why?
2. What adverse effects could you see with the product that you chose ?
3. What are some nondrug methods that may enhance smoking cessation in this patient?
4. What does the current literature state about smoking cessation treatments?
5. What patient education and literature is available?
6. What are teen rates for smoking currently?

Answer 1

1) I will recommed Chantix ( varenicline tartrate) and Zyban ( buproprion hydrochloride).

Varenicline exerts it's effects as nicotinic and receptor antagonist.

This is because they are FDA approved smoking cessation products that do not contain nicotine.

Both are available in tablet form.

2) Adverse effects associated with above medication are:

For Chantix : nausea, constipation,gas, vomiting, trouble sleeping,unusual or strange dreams.

For Zyban: dry mouth and insomnia.

3) Non-drug i.e., Non-pharmacological therapies include patient education, behavioural therapy, self help materials and telephone counselling improve likelihood of smoking cessation.

4) According to current literature, the first line medication treatment for smoking cessation is Nicotine replacement therapy ( NRT) and sustained release.

Other medications used as second line treatment are clonidine, nortriptyline, varenicline.

5) Patient education about the smoking cessation:

a) make a list of reasons for quitting, this foundation will support your quit smoking plan. Reasons for quitting might include:. Improves health. Lower risk of disease in future. Not exposing family or friends to second hand smoke. Money saving.

b) Donot smoke ,not even just one .

c) If you are having strong cravings and withdrawal despite using medication,talk to your doctor about adjusting the medication paln to better control these symptoms.

d) Drink plenty of water and juice.

e) keep physically active.

f) Avoid situation and people that triggers you to smoke.

g) Attend a support group, councelling session or stop smoking class.

h) practice stress management or relaxation techniques.

i) keep your hands busy with cigarette substitute or an activity such as writing or knitting.

j) keep your mind distracted when necessary with a book or puzzle.

6) the teen rates for smoking are 8.1% for high school students (7.3% for girls and 8.8%for boys).

This is according to CDC,2019 National Youth and Tobacco Survey.