Home' Australian Pharmacist : May 2011 Contents Vol. 30 -- May #05
Continuing Professional Development
The articles in this series are independently researched and compiled by PSA commissioned authors and peer reviewed.
a short acting nicotine product such
as gum or inhaler or nicotine patches
plus bupropion.10 A study published in
the New England Journal of Medicine
compared bupropion, nicotine patches,
combined therapy and placebo in
hospital patients, excluding those
suffering from depression.10 The
outcome for abstinence 12 months
following the trial was comparable
between nicotine patches and placebo
at 16.4% and 15.6% respectively, while
the difference was not statistically
significant, bupropion alone was 30.3%
and combined bupropion and nicotine
patches was 35.5%.10
A Cochrane Collaboration study
assessed psychological interventions
to aid smoking cessation including self-
help material, brief therapist delivered
interventions and intensive individual or
group counseling.11 The study showed
consistent evidence that individual
counselling increases the likelihood of
cessation compared to less intensive
support.11 Furthermore, counselling
interventions given outside routine
clinical care, by smoking cessation
counsellors (including health educators
and psychologists) assisted smokers
Brief medical advice given by health
professionals for 3--5 minutes can
generate a quit rate of up to 7.5%
at 12 months.1 A higher quit rate of
20--24% can be achieved if a range
of effective interventions, including
dealing with relapse and enlisting
in support program such as QUIT
is encompassed in the patient's
Mrs. Smith would benefit from a
HMR to discuss the issues of nicotine
dependence or booking a time with
the pharmacist to discuss issues
surrounding her smoking. During the
discussion, the pharmacist should
explain the properties of nicotine
to Mrs Smith (as detailed above). It
should be emphasised that smoking
cessation is the only intervention
that has been shown to improve
the natural history of COPD.1 The
pharmacist should discuss smoking
cessation with Mrs. Smith's GP
and recommend that psychologist
counselling with pharmacotherapy will
provide the best chance for Mrs Smith
to successfully quit smoking and that
the best pharmacotherapy option
would be combined nicotine patches
with other NRT or bupropion.10
Nicotine dependence is a chronic
condition with a high rate of relapse,
with most smokers making on
average five or six serious attempts
to quit. Mrs Smith may or may
not be able to stop smoking this
time around. However providing
patient counselling, appropriate
pharmacotherapy and ongoing
support through psychotherapy and/
or the QUIT line will improve her
chances of successfully overcoming
nicotine dependence than using
Author's note -- A resource
While this may not fit within the
parameters of a clinical article such
as this, as an ex-smoker of six years
the book, Allen Carr's easy way to
stop smoking, was a life saver for me.
I have recommended this book, as a
pharmacist, to many customers and
it may be a useful resource for some
people trying to quit. The web site is:
1. eTG Complete [CD-ROM]. Melbourne: Therapeutic
Guidelines; 2010 Nov.
2. Fact sheet: Statistics on smoking: The non-smoking
movement of Australia 2007 At: http://nsma.org.au/
3. Jarvis M. Why people smoke. ABC of smoking
4. Mallin R. Smoking Cessation, integration of behavioral
and drug therapy. Am Fam Phys. Mar 2002 at: www.
5. Fagersorm test for dependence at: www.health.wa.gov.
6. Rossi s, ed. Australian Medicine Handbook. Adelaide
(SA): Australian Medicine Handbook. 2010.
7. Australian Adverse Drug Reactions Bulletin. 2008;7. At:
8. Champix PI. eMIMS. CMP Medica; 2011.
9. National Prescribing Service. Side effects warning
about varenicline. Dec 2008 at: www.nps.org.
10. Jorenby DE, Leischow SJL, Mitchell AL, et al. A
controlled trial of sustained-release bupropion, a
nicotine patch, or both for smoking cessation. New
England Journal of Medicine 1999;340(9)685--
91. At: www.nejm.org/doi/pdf/10.1056/
11. Lancaster T, Stead LF. Individual Behavioral Counseling
for smoking cessation (Review). The Cochrane
Collaboration. Issue 4. 2008.
1. The LEAST common adverse
effect of varenicline is?
c) Suicide thoughts.
d) Abdominal cramps.
2. Which of the following
statements is FALSE?
a) Varenicline is a partial agonist on
nicotinic acetylcholine receptors.
b) Bupropion has antidepressant
c) The use of bupropion is limited
due to its potential to cause
d) Nicotine in chronic smokers helps
to improve cognitive function and
3. Brief medical counselling of
five minutes has been shown
to result in a quit rate of up to
15% at six months.
A score of 3 out of 4 attracts 0.75 CPD credits.
4. Which of the following
statements is MOST
a) Smokers in the pre-contemplation
stage of smoking cessation would
benefit from NRT.
b) Bupropion causes insomnia in
more than 40% of patients.
c) In NRT therapy patches have been
shown to be the most effective,
with 20% success rate compared
d) Varenicline is the drug of choice for
nicotine dependence in patients
suffering from depression.
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