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Flashcards in 10 - Smoking Cessation Deck (36)
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1

Low Doses of Nicotine causese what?

INCREASED 

Alertness

Cognitive Function

 

Cholinergic agonist = ^^ BP / HR / O2 Consumption

stimulate respiratory system

relax skeletal muscle

 

2

HIGH doses of Nicotine does what?

Stimulates "REWARD" Center in limbic system

Nicotine -> Brain -> Nicotine receptors stimulated

Ventral Tegmental Area --> Nucleus Accumbens

--> Prefrontal Cortex --> DOPAMINE RELEASE

3

Physical WITHDRAWAL effects

Sweating / Cold-like Symptoms

Tingling in extremeties

Nausea + Headache

4

Emotional Withdrawal effects of Nicotine

Anxiety / Irritability

Insomnia / Depression

Confusion / Difficulty concentrating

5

Non-Pharmacologic Treatment for

Smoking Cessation

Education

Trigger Planning

Motivational Interviewing

 

THE 5 A's

Ask / Advise / Assess / Assist / Arrange

6

Pharmacologic treament for

​Smoking Cessation

OTC Nicotine Replacement Therapy = NRT
Path / Gum / Lozenge

RX Medications

Buproprion SR = Zyban

Varenicline Tartrate = Chantix

Nicotine Inhaler

Nicotine Nasal Spray

7

Exceptions to Smoking Cessation Therapy

Pregnant / Adolescent

Light Smoker / smokeless tobacco users

 

Combo of meds + counseling is more effective than just 1

8

Rationale of NRT Therapy

Reduces PHYSICAL withdrawal from nicotine

Patient not exposed to carcinogens / toxic component of cigs

 

Use of NRT INCREASES QUIT RATES by ~2 Fold

9

Nicotine Patch Facts

Nicoderm CQ

Delivery to systemic circulationavoids hepatic FIRST PASS metabolism

ONLY LONG ACTING NRT product
QD dosing

10

Nicotine Patch DOSING

> 10 cigs per day = Step 1
 (21mg for 4-6 weeks)

Step 2:
14mg for 6 weeks (2 weeks)

Step 3:
7mg for 2 weeks

11

Nicotine Patch Administration

Apply to clean / dry / hairless area of skin
on upper chest / upper arm / hip

Leave on for 16-24 hours
ROTATE admin site
if falls off or loosens, REPLACE w/ new patch

Can be left on while SHOWERING / BATHING

Do not cut patch

12

Nicotine Patch

Side Effects / Education

Most common = Skin irritation / Redness ~50%
AVOID use in those with dermatologic conditions
psoriasis / eczema / atopic dermatitis

 

Vivid Dreams / Sleep disturbance

Headache / Nausea
nausea might be from TOO HIGH DOSE

 

13

Nicotine GUM + LOZENGE

Facts

SHORT ACTING NRT products

4mg or 2mg for both

Lozenge delivers ~25% MORE nicotine vs equivilant gum dose

Various Flavors

Absorption is pH dependent
has buffering agents

14

Nicotine GUM / LOZENGE

DOSING

4mg if 1st cig smoked within <30 min after waking

2mg if not

Chew at LEAST >9 pieces/day for first 6 weeks

DO NOT EXCEED 24 GUM PIECES PER DAY

DO NOT EXCEED 20 LOZENGES PER DAY
or 5 Lozenges in a 6 hour period

 

15

Nicotine GUM / LOZENGE

DOSING SCHEDULE

Weeks 1-6
1 piece Q1-2h

Weeks 7-9
1 piece Q2-4h

Weeks 10-12
1 piece Q4-8h

DO NOT EXCEED 24 PIECES PER DAY

DO NOT EXCEED 20 LOZENGES PER DAY
​or 5 Lozenges in a 6 hour period

16

MAX DOSING

for Nicotine GUM

DO NOT EXCEED

24 GUM PIECES

PER DAY

 

17

MAX DOSING for

Nicotine LOZENGES

DO NOT EXCEED

20 LOZENGES PER DAY
​or

5 Lozenges in a 6 hour period

18

Chew and Park Method

for Nicotine Gum Admin

Chew slowly until you notice a PEPPER TASTE OR TINGLE

"PARK" gum into the side of mouth

When taste or tingle FADES
chew again -> REPEAT

Repeat for 20-30 minutes

 

Avoid eating / drinking 15 minutes before/during chewing gum

19

Nicotine LOZENGE

Administration

1 lozenge in bowht and allow to slowly dissolve (20-30min)

do not CHEW or SWALLOW

Once in a while use tongue to move lozenge from side to side

 

Do not use within 15 minutes of eating/drinking ACIDIC foods or beverages

20

Side Effects of 

NICOTINE GUM / LOZENGES

Hiccups / Flatulence

Nausea / Heartburn / Dyspepsia

Mouth Soreness / jaw ache from gum

Gum may stick to dental work
avoid in those with dentures 

 

21

Advantages of Nicotine GUM / LOZENGE

Might satisfy ORAL cravings

might delay weight gain
4-mg

Patients can titrate therapy to manage withdrawal symptoms

22

Nicotine INHALER

Counseling / Considerations

Menthol Flavor / Helps with hand+mouth satisfaction

caution with those w/ reactive airway disease
absorption is pH dependent

 

Cough / Rhinitis / Dyspepsia / Headache

Mild irritation of MOUTH or THROAT

relatively mild and frequency declines with use

23

Nicotine INHALER

Administration

  1. Place 1 cartridge into inhaler
    1. Push Top / bottom of mouthpiece back together
  2. Puff on inhaler in short breaths
    1. during inhilation nicotine is vaporized
    2. absorbed across OROPHARYNGEAL MUCOSA
  3. ​Nicotine is used up after about 20 minutes of puffing
    1. do not use within 15 minutes of eating/drinking

24

Nicotine INHALER

DOSING

Start with >6 Cartridges/day 
during the first 3-6 weeks of therapy

Increase prn to a MAX of 16 cartridges/ day

Recommended duration is 3 months

Patients STRUGGLE to use enough cartridges

25

Nicotine NASAL SPRAY

Counseling / Considerations​

Nicotrol NS (10mg/ml)

Rapid Absorption = Quick onset
tilt head back to administer

High potential for abuse
avoid in those with Allergic Rhinitis

DO NOT Sniff / Swallow / Inhale
through nose as dose is being administered

Hot Peppery feeling in back of throat / nose

Sneezing / Coughing / Runny Nose / Watery Eyes
side effects limit its use

26

Nicotine NASAL SPRAY 

DOSING

Nicotrol NS (10mg/mL)

Use at LEAST > 8 doses/day
for the first 6-8 weeks for optimal results

1 dose = 0.5mg (1spray) in EACH nostril

May be beneficial to taper over 4-6 weeks

 

27

Nicotine NASAL SPRAY

Dosing Schedule / Max Doses

1-2 doses/hour
1 dose = 0.5mg (1 spray) in EACH nostril

MAX 5 doses/hour

MAX 40 doses/day

 

3 MONTHS OF THERAPY RECOMMENDE

28

Varenicline

MoA / Effects

Chantix
Binds with HIGH affinity & selectively
a2b2 neuronal nicotinic acetylcholine receptors

Stimulates low-level agonist activity
Competitively inhibits binding of nicotine

 

Reduce symptoms of nicotine WITHDRAWAL
blocks dopaminergic stimulation responsible for 
reinforcement / reward associated w/ smoking

29

Varenicline

DOSING

Patients should BEGIN THERAPY 1 week PRIOR to quit date
Increase dose GRADUALLY to minimize treatment-related 
nausea / insomnia

Days 1 -3 : 0.5mg QD

Days 4-7: 0.5mg BID

Days 8 to end: 1mg BID

 

has RENAL dosing

30

Varenicline

RENAL DOSING

CrCl <30 ml/min
0.5mg QD --> MAX 0.5mg BID

 

Hemodialysis Dosing:
0.5mg QD