Smoking Cessation Guide (part 1)

Please find the attached circular about smoking cessation guide part 1 .Please read it carefully and keep it in your pharmacy files as a
reference.

10/1/2020
Drug information center
Rania Dahnous
 Smoking Cessation Guide

 Smoking leads to disease and disability and harms nearly every organ of the body.
 Smoking causes cancer, heart disease, stroke, lung diseases, diabetes, and chronic obstructive pulmonary disease (COPD), which includes
emphysema and chronic bronchitis. Smoking also increases risk for tuberculosis, certain eye diseases, and problems of the immune system,
including rheumatoid arthritis.
 Children who are exposed to secondhand smoke are at increased risk for sudden infant death syndrome, acute respiratory infections, middle ear
disease, more severe asthma, respiratory symptoms, and slowed lung growth.
What is Tobacco dependence?
 Nicotine dependence occurs when you need nicotine and can't stop using it. Nicotine is the chemical in tobacco that makes it
hard to quit. Nicotine produces pleasing effects in your brain, but these effects are temporary, so you reach for another
cigarette.
 The more you smoke the more nicotine you need to feel good.
 Tobacco dependence is a chronic, relapsing disorder that, like other chronic diseases, often requires repeated intervention and
long-term support.
 The majority of people who use tobacco want to quit, but most try to quit multiple times before succeeding.
 Each year more than 70% of smokers want to quit and about 40% try, but only about 3% to 5% of them are successful without
formal help.

Nicotine withdrawal symptoms

-Cravings are caused by nicotine receptors in the brain. These receptors are increased in response to the previous nicotine use. The
receptors will make smokers want to continue smoking. Ignoring those receptors leads to withdrawal symptoms.-The symptoms of
nicotine withdrawal can begin within 30 minutes of your last use of tobacco and will depend on your level of addiction. Factors such
as how long you used tobacco and how much tobacco you use on a daily basis will impact the severity of your symptoms.
-Nicotine withdrawal symptoms include:
 Intense cravings for nicotine
 Tingling in the hands and feet
 Sweating
 Nausea and abdominal cramping
 Constipation and gas
 Headaches
 Coughing
 Sore throat
 Insomnia
 Difficulty concentrating
 Anxiety
 Irritability
 Depression
 Weight gain
Symptoms of nicotine withdrawal typically peak within two to three days, and often go away in two to four weeks. Some people
may experience nicotine withdrawal for several months.
How to manage nicotine withdrawal symptoms?
The Most common withdrawal Non pharmacological Treatment Pharmacological Treatment
symptoms
Headache  Rest in a quiet, dark room. 1. You may dispense OTC medications
 Use hot or cold compresses to your head such as paracetamol and ibuprofen if
or neck. there is no any contraindication for

Insomnia  Avoid or limit naps
 Avoid or limit caffeine.
 Avoid large meals and beverages before
bed.
 Make your bedroom comfortable for
sleep.
 Find ways to relax.
 Avoid trying too hard to sleep.
 Get out of bed when you're not
sleeping.
Irritability, anxiety, and depressed mood  Eat a balanced, healthy diet.
 Avoid or limit caffeine.
 Get enough sleep.
 Do regular exercise.
 Schedule time for hobbies.
 Talk to a friend
Constipation  Drink two to four extra glasses of water a
day.
 Try warm liquids, especially in the
morning.
 Add fruits and vegetables to your diet.
 Exercise most days of the week.
Fatigue  Eat often to beat tiredness.
 Do regular exercise.
 Sleep well.
their use.
2. You may dispense supplements such as
Songha Night®, Somnifera®, Calmium®.
if there is no any contraindication for
their use.
You may dispense supplements such as
Somnifera®, Stresstabs®, Stressease®,
moringa®. if there is no any
contraindication for their use
If the case is very severe refer the
patient to a doctor.
You may dispense a laxative. According
to the case if there is no any
contraindication for its use
You may dispense supplements such as
Neovita®, Gincosan®. if there is no any
contraindication for their use

Difficulty in concentration
Increased hunger and weight gain
 Reduce stress to boost energy.
 Cut out caffeine and fizzy drinks.
 Drink more water for better energy.
 Get enough sleep. You may dispense supplements such as
 Make time for exercise Ginsana®, Omega 3. if there is no any
 Take a break in work. contraindication for their use
 Eat healthy food.
 Drink caffeine
 Eat a balanced, healthy diet. You may dispense weight loss
 Do regular exercise. supplements. if there is no any
contraindication for their use

The non pharmacological treatment for smoking cessation (increase patient willingness, the 5A’s):
Successful intervention begins with identifying users and appropriate interventions based upon the patient's willingness to quit. The
five major steps to intervention are the "5 A's":

1. Ask - Identify and document tobacco use status for every patient at every visit.
2. Advise - In a clear, strong, and personalized manner, urge every tobacco user to quit.
3. Assess - Is the tobacco user willing to make a quit attempt at this time?
4. Assist - For the patient willing to make a quit attempt, use counseling and pharmacotherapy to help him or her quit.
5. Arrange - Schedule follow-up contact, in person or by telephone, preferably within the first week after the quit date.

When to refer the patient to a doctor?

If the patient suffers from chronic diseases, especially cardiovascular diseases, Psychiatric illness, renal impairment, Seizures. You
should refer him to the physician.