Home' Australian Pharmacist : Australian Pharmacist December 2014 Contents Australian Pharmacist December 2014 I © Pharmaceutical Society of Australia Ltd.
CONTINUING PROFESSIONAL DEVELOPMENT
COUNSELLING IN PRACTICE
Counselling on smoking
BY SARAH GRAY, MPS
Kirsty, 28, needs help to quit smoking. Kirsty and her husband are keen
to start a family. She wants to stop smoking before falling pregnant and
is concerned about this as she has tried and failed to quit several times
in the past. Kirsty currently smokes about 20 cigarettes a day, the first
soon after she wakes up. She has no known allergies but takes Pariet
(rabeprazole) 20 mg daily for reflux. Kirsty wants your advice on how to
give herself the best chance of success on this attempt.
Why should I consider quitting?
Tobacco smoke causes harm to
many body organs, and is associated
with a vast array of health problems
including coronary artery disease,
chronic obstructive pulmonary disease
(COPD), stroke, rheumatoid arthritis
In addition, tobacco
smoke has been associated with the
development of some types of cancer
including pancreatic, bladder, lung
and stomach. Smoking is responsible
for 20% of all cancer-related deaths in
During pregnancy, tobacco
smoke can cause additional health
problems including effects on fetal
growth (leading to low birth-weight
babies), increased risk of miscarriage,
bleeding complications, preterm
delivery, reduced fetal lung function
and, in some cases, infant death (most
commonly due to sudden infant death
The health benefits associated
with quitting are significant.
Smoking cessation at any age can
benefit health and lengthen life
expectancy by up to 10 years.
Smoking cessation results in a reduced
risk of developing chronic diseases,
slows disease progression and reverses
damage to the body.
quit before the age of 35 can avoid
almost any excess risk of developing
Pharmacists should take the
opportunity to identify patients who
smoke, document their smoking
status, explore motivation to quit
and offer appropriate treatment.
The 5As approach is an evidence-based
framework for structuring smoking
cessation (see Box 1).
Melbourne-based Sarah Gray (formerly Curulli)
is Clinical Education Pharmacist at the Hydration
After reading this article, pharmacists should be
• Discuss health risks of smoking and benefits of
• Identify medicines available to assist smoking
• Provide counselling and advice on nicotine
replacement therapy (NRT ).
Competency standards (2010) addressed: 1.3,
2.1, 6.1, 7.3 .
Accreditation number: CAP141212A
What medicines can assist with
Three pharmacotherapy options
are available for smoking
cessation – nicotine replacement
therapy (NRT), varenicline and
pharmacotherapy should be offered to
all motivated smokers who show signs
of nicotine dependence.
The choice of
pharmacotherapy is based on patient
preference and clinical suitability.
It is important to take into account
factors such as convenience, previous
experience, potential adverse effects,
drug interactions and cost.
NRT is the only pharmacotherapy for
smoking cessation available without
a prescription. The aim of NRT is to
provide the body with some level of
nicotine in an attempt to reduce the
risk of withdrawal symptoms without
exposing the body to the harmful
elements of tobacco smoke.
various forms and strengths of NRT
available (see Table 1).
All forms of NRT
increase quit rates by 50–70% compared
Non-nicotine pharmacotherapy options
– varenicline and bupropion – are
prescription-only medicines. Varenicline
(Champix) is a nicotinic acetylcholine-
receptor partial agonist.
It exerts its
action through blockade of the effects
of nicotine at nicotinic acetylcholine
receptors, leading to a reduction in
the pleasurable effects of smoking.
In addition, the partial agonist
activity alleviates nicotine withdrawal
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