Ogni antibiotico è efficace in relazione a un determinato gruppo di microrganismi acquista antibiotici onlinein caso di infezioni oculari vengono scelte gocce ed unguenti.
An effective approach to smoking cessation
Developed By: Carolyn Whiskin, RPh, BScPhm, NCMP Educational Grant Provided By: UCB Canada Inc. March 2013
The information contained in this presentation is for educational
purposes only and is not intended to replace the advice of your health care provider.
Always consult your physician before starting any new program
At the end of this session, you will:
Gain a greater knowledge of the impact of nicotine and cigarette
smoke on your overall health, specifically as it relates to Rheumatoid Arthritis (RA)
Understand how nicotine causes addiction
Assess your personal motivation to quit and level of dependency
Develop a personal plan towards quitting
Register for the Smoker's Helpline
Build a community of support for each other
The most important thing
you can do to protect your health now and in the future.
Cigarettes are the
product that kills 1
in 2 people when
used as intended.
Rivara FP et al. Am J Prev Med 2004; 27(2):118-25.
Smoking In Canada
In 2010, 16.7% of Canadians (approximately 4.7
million) were current smokers.
Daily smokers in Canada smoked an average of
15.1 cigarettes per day
Over 60% of Canadians who have ever been
smokers have now quit.
How Canadians Quit
69% of smokers used the "reduce to quit" method.
6 in 10 smokers who attempted to quit used some
form of cessation assistance
Stop‐smoking medications, including nicotine
replacement therapy, were used by nearly half (48%)
More than a quarter of smokers "made a deal" with
a friend or family member to quit together.
Leading preventable cause of disease,
disability and death in Canada
Half of regular smokers will die
prematurely of a tobacco-related disease
Smokers who report they wish to quit:
Effects of Smoking
Smokers are 6 ½ times more likely to die from lung cancer
Double the risk for a stroke
Three times the risk to die from heart attack
Breast Cancer and
Large Swedish Study
Presented Results in 2011
Women smoking for 15 - 35 years had a
34% higher risk for breast cancer than
women who never smoked.
Women who smoked for at least 35 years
had a 59% higher risk.
Women who smoked for less than 15 years
had no increased risk for breast cancer.
Effects of Smoking On
Onset of RA is up to 2.4 times more
likely in people who smoke
There is a decreased response to
methotrexate and biologic medication in people who smoke
In people who smoke and have a
positive Rheumatoid Factor, it can be predicted that they will develop severe extra-articular RA
Smoking adds significantly to the
already increased risk of cardiovascular disease in people
Smoking May Increase the Need
For Other Medications
Insulin absorption can be decreased by 30%
Insulin resistance is increased
Stomach acid production is increased
Fluid retention is increased
Blood pressure is increased
Cardiovascular disease increased
Increased platelet activity- increased clotting
Macular Degeneration is increased by 4 fold
Erectile dysfunction is increased
When smokers develop chronic pain their level
of pain is worse than a non-smoker
Nicotine Effects The Brain
Nicotine enters the
brain within seconds
It attaches to nicotinic
This results in the
release of dopamine
Within days of
smoking, the nicotinic receptors increase- the brain changes!!
It Is More Than Nicotine
70 cancer causing
The smoke contains:
Craving for nicotine
Duration In Weeks
Potential Health Benefits of
CAD risk is similar to never smokers
Lung cancer risk is 30%-50% that of continuing smokers
Stroke risk returns to the level of people who have never smoked at
5-15 years post-cessation
CAD: excess risk is reduced by 50% among ex-smokers
Lung function may start to improve with
decreased cough, sinus congestion, fatigue,
and shortness of breath
Blood CO level may
return to normal
BP = blood pressure; CO = carbon monoxide; CAD = coronary artery disease American Cancer Society. Guide to Quitting Smoking. Available at: http://www.cancer.org. Accessed: July 29, 2010.; US Department of Health and Human Services. News Release, June 27, 2006. Available at: http://www.hhs.gov/news/press/2006pres/20060627.html. Accessed: July 29, 2010.
Adapted from Prochaska Stages of Behaviour Change
What do you think about quitting smoking?
What motivates us to
Recognition of the benefits
of a behavioural change
Sense of ability
to modify a behaviour
What are the benefits to quitting
in your personal life?
Health (be specific)
Impact on family/friends
Financial- What would you do
about these benefits often!
What challenges do you
List your triggers
Environment –where you
Keeping your hands busy
Friends/family who smoke
What will I do with my
Start a new project before quitting to occupy
New music book
Parts for "car" project
Home decorating, reorganization
Knitting, crocheting, bead-work etc
New Crossword/Sudoku book
Carry something to squeeze!!
How do I handle a
Cutting Back Leading Up To
Record every cigarette smoked
leading up to the quit date- use your cell phone or the back of cigarette package
Up to half of cigarettes smoked are
out of routine, by recording the cigarette before smoking it- you may realize you didn't really need it.
Inform friends/family of your quit date and ask for their
Not smoking around you or offering cigarettes
Not teasing you
Helping you make your home smoke free
Reminding you of "why" you quit – your personal
Quitting with you!!!
Probability Someone Will Quit Smoking According to
Type of Relationship with Contact Who Quits Smoking
Friend with higher level
Friend with lower level
Coworker in a small firm
Increase in probability of quitting (%)
Christakis NA, Fowler JH. N Engl J Med 2008; 358(21):2249-58.
Picking A Quit Date
There is never an ideal time to quit!!!
Choose a day with a regular
Avoid special events or milestones
Avoid a date when changes are
being made to your medications
Cut Back On Caffeine
Smoking increases the rate of
caffeine being cleared from the body
To avoid caffeine toxicity, reduce
caffeine intake by half upon quitting smoking
Replacing a portion of intake with decaffeinated coffee is one strategy
Preparing For The Quit
In consultation with your health care practitioner, decide if a
medication is needed. Varenicline (Champix ) and Bupropion (Zyban ) to be started at least 1 week
before the quit date. Nicotine replacement products can be started on the actual quit date.
Make your home and car smoke free
Start to cut back- use a smoking log
Have healthy snacks on hand- appetite will increase
Focus on your personal benefits of quitting
Do I need treatment beyond
Fragerstrom Nicotine Dependence
Complete the questionnaire to determine your
level of dependency.
Craving for nicotine
Duration In Weeks Time in Weeks
Nicotine Replacement Therapy
All treatments must
enough for a new non-smoking
This can often take
Bupropion (Zyban )
Varenicline (Champix )
Use 1-2 sprays at the time of a
Maximum dose is 2 sprays at a
time, 4 sprays per hour and 64 sprays per day.
May cause tingling/ burning of
lips- aim directly in the mouth
May cause hiccups
Works in 60 seconds!!!
Tips For Other Nicotine
Gum- Chew slowly to release
flavour/nicotine, then "park" gum between teeth and cheek until flavour gone – repeat
Inhaler- releases nicotine when you
inhale – breathe in slowly, cartridge lasts for 20 minutes of inhaling
Lozenge- Dissolve slowly in the mouth
moving from side to side (20-30 minutes). The lozenge should not be chewed or swallowed whole. Don't eat or drink while the lozenge is in your mouth
Apply patch daily to a clean,
non- hairy area of skin
You can shower with the patch
Gum, lozenges, spray or
inhaler can be used in combination with the patch.
Starting doses is based on 1
mg of patch per cigarette smoked.
A 10 week step down therapy is
Bupropion (Zyban )
Start treatment 1-2 weeks before quit date
150 mg tablets
For the first 3 days, 1 tablet at breakfast
Then 1 tablet twice daily
8-12 weeks of treatment minimum
Can be taken along with nicotine
Also used as an antidepressant
Varenicline (Champix )
Start treatment at least 1 week after quit date
Two week starter pack includes:
0.5 mg daily for 3 days
Then 0.5 mg twice daily for 4 days
Then 1 mg twice daily for 7 days
Maintenance therapy: 0.5mg or 1 mg tablets twice
Take with food and a full glass of water to avoid
Stimulates the nicotinic receptor while blocking the
effects of actual nicotine, therefore nicotine replacement products have no benefit while on Varenicline.
Cost of Prescription
28 day supply of Zyban =$82.41
28 day supply of Champix =$133.38
28 day supply of Cigarettes =$280.00
based on 1 pack/day
Many private insurance plans cover the
cost of prescribed smoking cessation treatments
Government plans in some provinces
cover smoking cessation products for senior citizens and residents receiving social assistance or those with a disability
Cost Of Nicotine
Public Health Units may offer campaigns
throughout the year for free nicotine replacement products. (ie. STOP program)
Gum- $35.99/ 108 pieces (1 piece of gum/craving)
Spray- $45.99 /150 sprays (1-2 sprays per craving)
Lozenge- $14.99/22 lozenges (1 lozenge per craving)
Inhaler- $54.99/42 cartridges (may use 6/day)
Patch- $29.99-$37.99/7 patches (use 1/day)
Cigarettes contain more than one
chemical which acts like an
When quitting smoking, the loss of these
chemicals may uncover a pre-existing
Mood changes must be watched for
regardless of the treatment chosen.
Tobacco products are responsible for an
estimated 47,000 deaths every year in
(22% of all deaths in Canada)
The time to act is now!!!
What is the most important piece of information
you have learned from this session?
What changes will you make in the week ahead?
What additional information do you need to move
forward in quitting?
Your Partner In RA Care
Pituitary 7: 83–87, 2004 2005 Springer Science + Business Media, Inc. Manufactured in The Netherlands. Pituitary Apoplexy During Therapy with Cabergoline in anAdolescent Male with Prolactin-Secreting Macroadenoma Mirta Knoepfelmacher, Miriam C. Gomes, Maria E.Melo, and Berenice B. MendoncaDepartment of Endocrinology, Hospital das Cl´ınicas, Universityof S ˜ao Paulo Medical School, S ˜ao Paulo, Brasil
Question answering for general practitioners An information presentation module for the IMIX demonstrator Question answering for general practitioners An information presentation module for the IMIX demonstrator M.C.G. van Langen Universiteit Twente, October 2005 Business Information Technology