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 Tobacco use

andDependence

Based on Malaysian

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Assessment of tobacco use

•

Screen for tobacco use• Uses tobacco and no illin! to ma"e a #uit attempt

• Uses tobacco but not no illin! to ma"e a #uit attem

• $nce used tobacco but %as since #uit

• &e'er re!ularly used tobacco

• Assess for• (e'el of addiction usin! )a!erstrom *uestionnaire +

of ci!arettes smo"ed

• ,eadiness for #uittin!

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Brief clinical inter'ention -if illi#uit.•

As" about tobacco use at e'ery 'isit• Ad'ise to #uit in a clear/ stron! personalied ma

• Assess illin!ness to ma"e a #uit attempt t%is ti• 1f patient is illin!/ pro'ide assistance

• 1f patient ill participate in intensi'e treatment/ refer

intensi'e inter'ention• 1f patient clearly states unillin!ness/ pro'ide moti'a

inter'ention

• 1f patient is a member of special population-adolescentpre!nant./ consider pro'idin! additional

information

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•

Assist in #uit attempt• Set a #uit date -ideally it%in 2 ee"s. ,educe t%e n

ci!arettes !radually before set date

• Tell family/ friends/ co4or"ers about #uittin! and re#understandin! and support

•

5ncoura!e ot%er smo"ers in %ouse%old to #uit it% t%not smo"e in t%eir presence to minimie ris" of treatmfailure

• Ad'ice patient to remo'e tobacco products from t%eiren'ironment

• Anticipate nicotine it%draal symptoms and ays to

o'ercome t%em

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•

Arran!e follo4up• )ollo4up contact s%ould occur soon after t%e #uit da

-ideally 6rst ee".

• Subse#uent follo4ups are recommended ee"ly it%mont%/ to ee"ly for 2nd and 3rd mont% and mont%lymont%s

• 1f tobacco use %as occurred/ re'ie circumstances anrecommitment to total abstinence ,emind patient t%lapse can be used as a learnin! e8perience Assessp%armacot%erapy use and problems

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Moti'ational inter'ention -ifunillin! to #uit.•

,ele'ance• 5ncoura!e patient to identify e! rele'ance to on dis

status/ family/ etc

• ,is"s• As" patient to identify potential ne!ati'e conse#uenc

tobacco use• S%ort4term ris"s9 S$B/ A5BA/ impotence/ infertility

• (on!4term ris"s9 C:A/ 1;D/ C$PD/ cancers -laryn8/ orap%aryn8/ oesop%a!us/ pancreas/ bladder/ cer'i8.

• 5n'ironmental ris"s9 cancer in spouse/ smo"in! in c%increased ris" for lo birt% ei!%t

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•

,eards• As" patient to identify potential bene6ts of stoppin! t

use

• 5! impro'ed %ealt%/ food tastes better/ sa'e money/ c%ildren

•

,oadbloc"s• As" patient to identify barriers to #uittin! and addres

• 5! it%draal symptoms/ fear of failure/ lac" of supp

• ,epetition• ,epeat t%e moti'ational inter'ention e'ery time an

unmoti'ated patient 'isits clinic settin!

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,elapse pre'ention -if recently

•

Con!ratulate patient• ,einforce patient

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P%armacolo!ical inter'ention

•

Special consideration s%ould be !i'en before usip%armacot%erapy in• Patients it% medical contraindications -recent M1/ lif

t%reatenin! arr%yt%mia/ unstable or orsenin! an!incerebro'ascular accident or %ypersensiti'ity to nicoti

• Pre!nantbreastfeedin! omen

• Adolescent smo"ers

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&icotine !um

•

&icorette 2m! for patients smo"in! =20 ci!arettday/ >m! for patients smo"in! ?20 ci!arettes a

• Gum s%ould be used up to @2 ee"s it% no mo2> piecesday

• Side eects9 mout% soreness/ dyspepsia/ a ac%

• A'oid in patients it% serious arr%yt%mias/ it%iee"s post4M1/ patients it% serious or orseninan!ina pectoris

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&icotine patc%

•

&icotinell TTS 30 -2@m!./ 20 -@>m!./ @0 -m!.• At t%e start of eac% day/ place a ne patc% on a

relati'ely %airless location beteen nec" and a

• Side eects9 local s"in reactions/ insomnia

• A'oid in patients it% serious arr%yt%mias/ it%i

ee"s post4M1/ patients it% serious or orseninan!ina pectoris

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&icotine in%aler

•

>m!cartrid!e -0 in%alations. at 74@7 cartrid!efor total 7 mont%s it% taperin! in 6nal 3 mont%treatment

• A'oid eatin! and drin"in! anyt%in! e8cept aterminutes before and durin! in%alation

•

Side eects9 cou!%in!/ r%initis• A'oid in patients it% serious arr%yt%mias/ it%i

ee"s post4M1/ patients it% serious or orseninan!ina pectoris

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Bupoprion S,

•

@E0m! $M 8 3 t%en increase to @E0m! BD for ee"s

• Side eects9 insomnia/ dry mout%

• A'oid in patients it% a %istory of seiure disordeeatin! disorder/ on anot%er form of bupropion or

%a'e used an MA$1 it%in last @> days