Week 5 Nurse 676B
Week 5 Nurse 676B
Smoking is a growing public health concern due to its associated adverse effects. Currently, it is estimated that over 480000 deaths in the US annually are attributable to smoking inclusive of secondhand smoke exposure(Barrington-Trimis et al., 2020). Similarly, a shift in the age of smoking is being observed in the US. Historically, most cigarette smokers in the US commenced in the adolescent period but today, the peak is tilting towards young adulthood. For instance, daily cigarette smoking among 12th-grade students in the US declined from its most recent peak of 24.6% in 1997 to 3.6% in 2018(Barrington-Trimis et al., 2020). The effects of cigarette smoking on an individual’s health are devastating. It is a risk factor for numerous malignancies, cardiovascular diseases and events, hypertension, diabetes, rheumatoid arthritis, and chronic obstructive airway diseases among other conditions(Ding et al., 2019). The purpose of this paper is to discuss pharmacological and non-pharmacological methods that facilitate smoking cessation based on a case study of Jackson, a 37-year-old male who is determined to cease the habit of smoking.
Studies describing the protective effects of smoking are limited to conditions such as breast cancer, ulcerative colitis, and uterine fibroids (Barrington-Trimis et al., 2020). On the other hand, evidence of menacing adverse effects of cigarette smoking on health is overwhelming. Consequently, cigarette smoking necessitates prevention or stoppage by all means available. However, this often presents a challenge owing to the nicotine present in cigarettes that confers addiction leading to transitioning to daily smoking which is catastrophic. Furthermore, it is elemental to note that the effects of cigarette smoking develop gradually and are directly proportional to packs per day and the duration of smoking. Some of the preventive efforts in place in the US include media campaigns, educational materials, and age restrictions (Ding et al., 2019).
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Similarly, pharmacological approaches have been in place to aid in smoking cessation. Bupropion and varenicline are examples of US Food and Drug Act-approved pharmacological agents for smoking cessation. Nevertheless, from the case study presented, I will prescribe varenicline to Jackson. Varenicline is a nicotine agonist. It acts by selectively binding to alpha 4, and beta 2 nicotinic acetylcholine receptors, and consequently prevents the binding of nicotine to its receptors resulting in a decreased desire to smoke (Singh & Saadabadi, 2021). Thus, varenicline inhibits dopaminergic activation produced by smoking and withdrawal symptoms.
According to Tonstad et al. (2020), sudden cessation of smoking is associated with withdrawal symptoms such as restlessness, cravings, anxiety, irritability, sleep, and concentration disturbances. To minimize these effects, varenicline is commenced one week prior to planned smoking cessation or commenced and then quit smoking between days 8 and 35 of treatment. The dose is escalated beginning 0.5 mg once daily for the first 3 days, then 0.5 mg twice daily for the next four days followed by 1 mg twice daily for 11weeks(Tonstad et al., 2020).
Adverse Effects, Medication Information and Follow-up
The most common adverse effects experienced by patients taking varenicline include insomnia, nausea, headaches, abnormal vivid dreams, suicidal ideation, agitation, constipation, drowsiness, sleep disturbances, sleepwalking, Steven Johnson’s syndrome, photosensitivity, and erythema multiforme(Singh & Saadabadi, 2021). Other side effects that have been reported include gingivitis, dizziness, arthralgia, angioedema, visual disturbances, and anemia. It is important to inform Jackson that nausea as an adverse effect will be mitigated by starting at a low dose and titrating upwards. Similarly, he should be made aware of these adverse effects and advised to stop taking the medication in the event that psychiatric symptoms or severe hypersensitivity develop (Singh & Saadabadi, 2021). Jackson should also know that treatment compliance is key to achieving the desired outcome and that the medication should be taken with a full glass of water after eating to decrease gastric upset.
Jackson should be followed up with close monitoring of renal function as well as assessment of mental and mood status. The patient is followed and evaluated for the desired outcome at the end of 12 weeks. Patients who have prosperously stopped smoking should continue with therapy for an additional 12 weeks for long-term abstinence while the unsuccessful or those with relapses are encouraged to make another attempt after identification and control of factors causing treatment failure (Singh & Saadabadi, 2021).
Besides pharmacological therapy, nonpharmacological methods such as individual counseling, group counseling, self-help, and telephone counseling (Nandita et al., 2020). However, Jackson will benefit more from individual counseling and self-help. Counseling should comprise of 1 or more face-to-face sessions of 10 minutes or longer coupled with a telephone contact for support (Nandita et al., 2020). The sessions should be tailed to the individual needs of the patient. Several models of counseling are available and include 5A’s and 5R’s models (Nandita et al., 2020). Similarly, Jackson would benefit from brief physician advice as well as follow-ups. Additionally, web-based cessation programs, educational materials, and media campaigns will help Jackson quit smoking.
Smoking is a habit that is highly addictive due to nicotine. All attempts should be made to prevent its initiation and facilitate its cessation to avoid its consequences. A combination of both pharmacological and non-pharmacological methods increases the likelihood of smoking cessation.
Barrington-Trimis, J. L., Braymiller, J. L., Unger, J. B., McConnell, R., Stokes, A., Leventhal, A. M., Sargent, J. D., Samet, J. M., & Goodwin, R. D. (2020). Trends in the age of cigarette smoking initiation among young adults in the US from 2002 to 2018. JAMA Network Open, 3(10), e2019022. https://doi.org/10.1001/jamanetworkopen.2020.19022
Ding, N., Sang, Y., Chen, J., Ballew, S. H., Kalbaugh, C. A., Salameh, M. J., Blaha, M. J., Allison, M., Heiss, G., Selvin, E., Coresh, J., & Matsushita, K. (2019). Cigarette smoking, smoking cessation, and long-term risk of 3 major atherosclerotic diseases. Journal of the American College of Cardiology, 74(4), 498–507. https://doi.org/10.1016/j.jacc.2019.05.049
Nandita, G., Shivalingesh, K. K., Swati, S., Resham, I., & Satyaki, V. (2020). Evaluation of pharmacological and non–pharmacological methods of smoking cessation; A Review. Journal of Addiction Medicine and Therapeutic Science, 6(1), 045–051. https://doi.org/10.17352/2455-3484.000037
Singh, D., & Saadabadi, A. (2021). Varenicline. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK534846/
Tonstad, S., Arons, C., Rollema, H., Berlin, I., Hajek, P., Fagerström, K., Els, C., McRae, T., & Russ, C. (2020). Varenicline: mode of action, efficacy, safety, and accumulated experience salient for clinical populations. Current Medical Research and Opinion, 36(5), 713–730. https://doi.org/10.1080/03007995.2020.1729708
Jackson is a 37-year-old male with a 10-year 1-PPD smoking history. He has no other health history and his last physical exam 6 months ago was normal. He is motived to quit and has been unsuccessful with OTC smoking cessation products. In the past 3 months, he has intermittently tried nicotine gum and lozenges. He is requesting a prescriptive option. What is your treatment recommendation for this patient? What important medication information regarding adherence, side effects, and follow-up should be included? What non-pharmacologic treatment education should Jackson receive?