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Learning from passmedicine questions – Smoking cessation treatment

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Refer to NHS stop smoking services (smoking cessation clinic)

A 28 year old woman has a routine appointment in your morning gp surgery as she has just found out she is six weeks pregnant she would like some help with smoking cessation during her pregnancy and to discuss treatment options currently she smokes 10 cigarettes a day due to her busy schedule she doesn’t think she would be able to make it to regular meetings what

Is the most appropriate smoking cessation treatment to offer her since she’s pregnant she may be unable to take some things i’m not sure if she can take any of these drugs because not sure if it’s safe in pregnancy i think stop smoking clinic referral is the easy option to choose because they were no better yeah let’s see the answer is nicotine replacement

Therapy so pregnant women who smoke nicotine replacement therapy should be offered varinicline and bupropion are contraindicated okay bupropion and veterinary clean are contraindicated in women who are pregnant or breast feeding and should not be offered to this patient a stop smoking cleaning referral would be appropriate but this patient has informed you that

Will be difficult to for her to attend regular meetings i see okay so the clinic appointment will require regular meetings e-cigarettes should not be routinely advised as the effects of the e-cigarette vapor on the fetus are unknown however nice recommends not discouraging a woman if they are already successfully using e-cigarettes to stop smoking nicotine

Rebasement therapy is the only treatment license for smoking cessation in pregnancy kill co let’s have a read through past medicines notes smoking sensation cessation nice release guidance in 2008 on the management of smoking cessation general points include patients should be offered nicotine replacement therapy verniclean or biportrion i state that clinicians

Should not favor one medication over another nrt bernie clean or buprefion should normally be prescribed as part of a commitment to stop smoking on or before a particular date target stop date prescription of nrt bernie clean or bupropion should be sufficient to last only until two weeks after the target stop date normally this will be after two weeks of nicotine

Replacement therapy and three to four weeks for varenicline and bupropion to allow for the different methods of administration and mode of action further prescriptions should be given only to people who have demonstrated that their quit attempt is continuing if unsuccessful using nrt berenickian or people do not offer a repeat prescription within six months unless

Special circumstances have intervened do not offer nrt variant or be appropriate in any combination so either one of these three nicotine replacement therapy adverse effects include nausea and vomiting headaches and flu-like symptoms let’s recommend offering a combination of nicotine patches and other form and another form of nrt such as gum inhaler lozenge or

Nasal spray to people who show a high level of dependence on nicotine or who have found single forms of nrt inadequate in the past veroniclean a nicotinic receptor partial agonist should be started one week before the patient’s target state to stop the recommended course of treatment is 12 weeks but the patient should be monitored regularly and treatment only

Continue if not smoking there seems to be some inconsistencies here it says prescription of nrt very nickely or bupropion should be sufficient to last only until two weeks after the target stop date normally this will be after two weeks of nrt therapy and three to four weeks of very nice clean ambupropion over here it says recommended course of treatment is 12

Weeks should be started one week before the patient’s target date to stop has been shown in studies to be more effective than bupropion nausea is the most common adverse effect other common problems include headache insomnia abnormal dreams nausea headache flu-like symptoms insomnia and abnormal gyms randy clinton should be used with caution in patients with a

History of depression or self-harm there are ongoing studies looking at the risk of suicidal behavior in parent patients taking variance contraindicated in pregnancy and breastfeeding bupropion and norepinephrine and dopamine reuptake inhibitor and nicotinic antagonist antagonist the rest are agonists why is this work should be started one to two weeks before the

Patient’s target date to stop small risk of seizures one in one thousand contrary indicated in epilepsy pregnancy and breastfeeding having an eating disorder is a relative contraindication the pregnant woman let’s recommend in 2010 that all pregnant women should be tested for smoking using carbon monoxide detectors partly because someone find it difficult to say

That they smoke because the pressure not to smoke during pregnancy is so intense all women who smoke or have stopped smoking within the last two weeks or those with a carbon monoxide reading of seven parts per million or above should be referred to nhs stop smoking services interventions the first line intervention in pregnancy should be cognitive behavioral

Therapy motivational interviewing and structured self-help and support from nhs stop work stop smoking services then evidence for the use of nrt in pregnancy is mixed but is often used if the above measures fail there is no evidence that it affects the child’s birth weight pregnant women should remove the patches before going to bed as mentioned above varying

Clean and bupropion are contraindicated so the most appropriate would actually be cognitive behavioral therapy motivational interviewing or structured self-help from nhs stop smoking services however all these require regular appointments so in this case specifically nicotine will be the correct answer the other two are contraindicated let’s find out why they

Are contraindicated very nicely in champigs it’s a partial agonist of the nicotine receptor clinical particulars therapeutic indications smoking citation binds with high affinity and selectively at the alpha 4 beta 2 neuronal nicotinic acetylcholine and receptors partial agonists you can see a moderate amount of data of pregnant women indicated no more

Formative or fetal neonatal toxicity of varying clean animal studies have shown reproductive toxicity as a precautionary measure is preferable to avoid the use of rhinoclean during pregnancy say section 5.3 section 5.3 is a very long section 5.2 5.3 pre-clinical safety data no clinical data review non-clinical data review no no special hazard for humans based

On conventional studies of safety pharmacology repeated those toxicity genotoxicity fertility and embryo fetal development in male rats those for two years with franklin there was those related increase in the incidence of hypernoma tumor of the brown fat in the offspring of pregnant rats with a variety clean there were decreases in fertility and increases in

The auditory startle response these effects were observed only at exposures considered sufficiently in excess of the maximum human exposure indicating little relevance to clinical use so it is very high dose and is in rats causes some tumors of the brown fat and reduce fertility increase auditory response otherwise high dose but it’s still not used in pregnancy

For safety reasons okay it’s like just in case bupropion bupropion xiban i’ve searched this before have i built propion hydrochloride smoking cessation selective inhibitor of the neural reuptake of catacol means neurogenesis and dopamine with minimal effect on the reuptake of indolo means serotonin and does not inhibit either mono amine oxidase the mechanism

By which pre-propane enhances the ability of patients to abstain from smoking is unknown but in past medicine it says it’s antagonists nicotinic antagonists in emc it says it’s unknown emc is more reliable however it’s presumed that action is mediated by no adrenaline or dopaminergic mechanisms okay that clears the confusion of why both agonies and antagonists

Can help with smoking sensation because by right nicotinic agonist should be what is helping with smoking sensation not antagonists if if you antagonize it don’t you worsen the withdrawal from nicotine yeah okay

Transcribed from video
Learning from passmedicine questions – Smoking cessation treatment By TomHan