Smoking Cessation

Objectives

Smoking Cessation

Ask patients about smoking at every visit. Document smoking status on the progress note and on the clinic summary sheet.

Assess the patient's willingness to quit.

Advise all smokers to quit, and document this advice in the chart.

Assist the patient in quitting, and document all offers of assistance:

Arrange follow-up visits.

Anticipatory guidance for adolescents.
 
 

Nicotine Replacement (as adjunct to behavioral therapy)

Assess for nicotine dependency:

Avoid or use cautiously in:
Available products:
Brand Dose/Schedule Dispense Maximum
Habitrol 21mg/24
4-6 wks 
14mg/24h*
2-4 wks 
7mg/24h
2-4 wks 
30/box 3 months
Nicoderm 21mg/24h
4-6 wks 
14mg/24h*
2-4 wks 
7mg/24h
2-4 wks 
14/box 3 months
Nicotrol 15 mg/16h
4-12 wks 
10mg/16h
2-4 wks 
5mg/16h
2-4 wks 
14/box 5 months
Prostep 22mg/24h
4-8 wks 
11mg/24h*
2-4 wks 
  7/box 3 months
*lower dose for cigarette use < 1-1/2ppd (apply to clean, dry, nonhary, noninflamed skin on trunk or upper arm) (advise careful storage and disposal of new and used patches) 
Polacrilex Dose Usual Pieces Per Day Maximum Per Day
Nicorette 2mg
chew over 
30 minutes 
9 to 12/day 30
Nicorette
DS 
4mg
chew over 
30 minutes 
9 to 12/day 20
(withdraw from Polacrilex over 3 months)
(advise careful storage and disposal of medication) 

 

Referral Sources:

Respiratory Therapy 5490

Cathy Couvilliion, RN 5647

References:

Husten CG, Manley MW. How to help your patients stop smoking. Am Fam Physician 1990;43(4):1017-26.


J. Hood, MD
updated 8/30/05


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