Tobacco cessation fall 2011 Instructor (1)_ For use in lecture (2)

Pharmacologic fda approved medications counseling and

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Pharmacologic  FDA-approved medications Counseling and medications are both effective, but  the combination of counseling and medication is  more effective than either alone. Fiore et al. (2008). Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: USDHHS, PHS, May 2008.
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NONPHARMACOLOGIC  METHODS Cold turkey: Just do it! Unassisted tapering (fading)  Reduced frequency of use Lower nicotine cigarettes Special filters or holders Assisted tapering   QuitKey Computer developed taper based on  patient’s smoking level Includes telephone counseling support
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NONPHARMACOLOGIC  METHODS  (cont’d) Formal cessation programs Self-help programs Individual counseling Group programs Telephone counseling 1-800-QUITNOW  1-800-786-8669 Web-based counseling Acupuncture therapy Hypnotherapy Massage therapy
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PHARMACOTHERAPY Fiore et al. (2008). Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: USDHHS, PHS, May 2008. Medications significantly improve success rates.   * Includes pregnant women, smokeless tobacco users, light smokers, and adolescents. “Clinicians should encourage all patients attempting to quit to use effective medications for tobacco dependence treatment, except where contraindicated or for specific populations* for which there is insufficient evidence of effectiveness.”
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PHARMACOLOGIC METHODS:  FIRST-LINE THERAPIES Three general classes of FDA-approved  drugs for smoking cessation: Nicotine replacement therapy (NRT) Nicotine gum, patch, lozenge, nasal spray, inhaler Psychotropics Sustained-release bupropion Partial nicotinic receptor agonist Varenicline
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PHARMACOTHERAPY:  USE in PREGNANCY The Clinical Practice Guideline makes no recommendation  regarding use of medications in pregnant smokers Insufficient evidence of effectiveness Category C: varenicline, bupropion SR Category D: prescription formulations of NRT “Because of the serious risks of smoking to the pregnant smoker and the fetus, whenever possible pregnant smokers should be offered person-to-person psychosocial interventions that exceed minimal advice to quit.” (p. 165) Fiore et al. (2008). Treating Tobacco Use and Dependence: 2008 Update. Clinical Practice Guideline. Rockville, MD: USDHHS, PHS, May 2008.
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PHARMACOTHERAPY:  OTHER SPECIAL  POPULATIONS Pharmacotherapy is  not  recommended for: Smokeless tobacco users No FDA indication for smokeless tobacco cessation  Individuals smoking fewer than 10 cigarettes per day Adolescents Nonprescription sales (patch, gum, lozenge) are restricted to  adults  18 years of age NRT use in minors requires a prescription Fiore et al. (2008). Treating Tobacco Use and Dependence: 2008 Update.
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