Second-line pharmacologic therapies, which have proven efficacy in helping patients to quit but do not have an FDA indication for smoking cessation and have undesirable side effects compared to first-line agents, include clonidine (Catapres) and nortriptyline (Pamelor;Aventyl), both available by oral administration
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To address motivational interviewing, most clinicians can use the five Rs (relevance, risk, rewards, repetition, roadblocks) to summarize the areas for smoking cessation ( 82 ) (Figure 6)
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A pair of needle nose pliers works great for this