Help Patients Quit Smoking: A Road Map for Clinicians
Tobacco use is the “primary cause of disease, disability, and death in the United States.”1 Nearly 40 million U.S. adults smoke cigarettes, and about 4.7 million middle and high school students use tobacco products, including e-cigarettes.1 Cigarette smoking is a “major modifiable health risk factor”, but cessation of smoking is difficult and the average smoker attempts to quit 5 times before achieving permanent success.2
Successful cessation of smoking involves a 2-pronged approach to smoking – physiological and behavioral, according to Nervana Elkhadragy, PharmD, MS, TTS, Purdue University, College of Pharmacy, Indianapolis.
“We handle both at the same time – physiological addiction and human behavior associated with smoking,” he said MPR.
Landscape Cession Framework
Smoking can provoke discussion with patients, leading to frustration among many physicians.3 To launch the conference, the USPSTF, the American Academy of Family Physicians, and other organizations recommend “Five A’s” (Ask, Remind, Assiss, and Assize) to bond with patients suffering from smoking cessation.
Addressing Physiological Microbiology with Pharmacotherapy
There are 7 US Food and Drug Administration (FDA) approved medications to treat nicotine addition; 5 Nicotine therapies (NRT) take the form of a gum, a tablet, a transdermal cloth, a nasal spray, and an oral inhaling. Two additional medications are varenicline (nicotinic receptor partial agonist) and bupropion (antidepressant).4
“The choice of drugs depends on several factors, which should be examined with a patient prescription or with a pharmacist,” said Dr Elkhadragy.
For example, some NRT formulas (for example, gum, lozenges, nasal spray, and oral inhalers) are often needed on the dosage, which can disrupt adhesion. In contrast, dosing requires bupropion and varenicline only twice a day, and NRT requires transdermal patch only once daily dosing. On the other hand, some patients prefer oral use of eating gum or sucking tablets.
NRT agents can be used in settlement, Dr Elkhadragy noted. “For example, a person may use a nicotine patch, which does anything every day, but in some situations it needs the help of a particularly excited person. Say a person who always smoked during the morning drive to work, I could also recommend chewing gum on that drive.
He advised smoking to increase certain enzymes, such as cytochrome P1A2 (CYP1A2), thus giving up normal enzyme levels. Drugs caused by CYP1A2 enzymes (eg clozapini, olanzapini, duloxetine, mirtazapini) require lower dosing, due to decreases in enzyme production.5
Similarly, caffeine breaks down the CYP1A2 enzyme, “so smokers tend to drink more than other people – for example, they drink 4 cups of coffee, which is equivalent to 2 cups in another cup” by Dr. Elkhadragy. he said. However, when smoking is reduced, the enzyme is reduced and if you continue to drink 4 cups of coffee, you are at risk of caffeine poisoning.
This is especially problematic because caffeine can be confused with nicotine withdrawal, as certain symptoms such as irritability, insomnia, and anxiety are common to both. “Patients can attribute their misery to nicotine withdrawal; take their medicine, do not work, and can smoke again,” he said.
She urged physicians and pharmacists to “encourage patients to ask about the use of caffeine and smokers who are taking inhaled mixed caffeine.”