1- Tobacco Cessation Flashcards
(39 cards)
Describe nicotine absorption at buccal (oral) mucosa
pH in mouth is 7.0, in acidic media (ionized -> poorly absorbed) and alkaline (nonionized -> well absorbed) so cigs are poorly absorbed in oral mucosa and pipes, cigar, spit tobacco, and oral nicotine are well absorbed
Describe nicotine absorption at the skin and GI tract
nicotine is readily absorbed through intact skin, well absorbed through the GI but low bioavailability due to first pass metabolism
Describe nicotine absorption at the lung
lung pH 7.4 and nicotine is readily absorbed, approximately 1 mg of nicotine is absorbed from each cig
What effects does nicotine have on the central nervous system?
-pleasure
-arousal, enhanced vigilance
-improved task performance
-anxiety relief
What effects does nicotine have on the cardiovascular system?
-increased HR
-increase cardiac output
-increased BP
-coronary vasoconstriction
-cutaneous vasoconstriction
What factors contribute to tobacco use?
-individual
-environment
-pharmacology
Describe the 2-part problem of tobacco dependence
-physiological (addiction) -> medication for cessation
-behavioral (habit) -> behavioral changes
treatment should address both aspects
How many cigs are in a pack?
20
What are non-pharmacological methods to treat tobacco cessation?
-cold turkey
-unassisted tapering
-assisted tapering (QuitSTART App)
-formal cessation programs
-acupuncture
-hypnotherapy
-message therapy
What are the 3 FDA-approved first-line therapy options for smoking cessation?
-nicotine replacement therapy (NRT)= nicotine gum, patch, ect.
-psychotropics= sustained-release bupropion
-partial nicotine receptor agonist= varenicline
What is the rational for use of nicotine replacement therapy (NRT)?
-reduces physical withdrawal from nicotine
-eliminates the immediate, reinforcing effects of nicotine by smoking
-allows patient to focus on behavioral and psychological aspects of tobacco cessation
What are the nicotine replacement products (NRT)?
-gum (nicorette)
-lozenge (nicorette)
-transdermal patch (nicoderm)
-nasal spray (nicotrol)
-inhaler (nicotrol)
What are some precautions that should be considered when recommending NRT?
patients with underlying cardiovascular disease (recent MI (2 weeks), serious arrhythmias, serious or worsening angina) NRT could be appropriate for these patients if they are under medical supervision
What are the available doses of gum?
2 mg, 4 mg
How is a dose of nicotine gum recommended to a patient?
-2mg = if first cig is smoked within 30 minutes
-4mg = if first cig is smoked after 30 minutes of waking up
What is the dosing schedule for nicotine gum?
-weeks 1-6= 1 piece every 1-2 hours
-weeks 7-9= 1 piece every 2-4 hours
-weeks 10-12= 1 piece every 4-8 hours
do NOT use more than 24 pieces/day
at least 9 pieces/day needed
no food or beverage 15 mins before use or during
Instructions for use: Nicotine Gum
-chew slowly
-stop chewing at the first sign of peppery taste then park it in the cheek
-resume chewing when peppery taste is gone
-resume process until taste is gone (about 30 mins)
What are patient counseling points for nicotine gum?
-use at least 9 pieces a day
-chewing gum will not provide the same satisfaction as smoking
-chewing to quickly might result in lightheadedness, N/V, irritation of throat and mouth, hiccups, indigestion
-side effects: mouth soreness, hiccups, dyspepsia, jaw muscle pain
What are the patient counseling points for nicotine lozenges?
-do NOT use more than 20 pieces per day
-at least 9 pieces per day for first 6 weeks
-do not chew
-do not eat or drink 15 minutes before or during
-side effects: nausea, hiccups, cough, heartburn, headache, flatulence, insomnia
What is the dosing of nicotine patch for a patient that has >10 cigs a day?
-STEP 1: 21mg x 6 weeks
-STEP 2: 14 mg x 2 weeks
-STEP 3: 7mg x 2 weeks
What is the dosing of nicotine patch for a patient <10 cigs a day?
-STEP 2: 14mg x 6 weeks
-STEP 3: 7mg x 2 weeks
What are the patient counseling patient points for nicotine patch?
-water will not harm patch
-do not cut patches
-keep out of reach of children and pets
-remove patch for MRI
-fold sticky parts of patch into self for disposal
-side effects: mild itching, burning, tingling, vivid dreams (may wish to remove during sleep), headache
-avoid in patients with dermatologic conditions
-skin may appear red for 24h, contact doctor if lasts 4 days
What is the dosing of nicotine nasal spray?
-one dose (1 mg nicotine)= 0.5mg spray in each nostril
-start with 1-2 doses per hour
-maximum dose 5 doses/hr or 40 doses/day
-best results is 8 doses a day for 6-8 weeks then taper for an additional 4-6 weeks
What are the instructions for use of nicotine nasal spray?
-prime the bottle before first use
-tilt head back and breath in through mouth while administering (do NOT sniff or inhale through nose!)
-wait 2-3 minutes before blowing nose
