Nicotine Flashcards
(34 cards)
1
Q
Name: The 5 A’s for Patients Willing to Quit
A
- Ask if the patient smokes
- Advise patients to quit
- Assess willingness to quit
- Assist in quit attempt
- Arrange follow-up
2
Q
Name: The 2-3 Pattern of Smoking Cessation (5)
A
- Onset of withdrawal is 2-3h after last cigarette
- Peak withdrawal is at 2-3d
- Expect improvement of withdrawal symptoms at 2-3 wk
- Resolution of withdrawal at 2-3 mo
- Highest relapse rate within 2-3 mo
3
Q
How to Assist Patient in Developing Quit Plan? (4)
A
STAR
- Set quit date
- Tell family and friends (for support)
- Anticipate challenges (e.g. withdrawal)
- Remove tobacco-related products (e.g. ashtrays/lighters)
4
Q
Describe tx for pregnant patients (4)
A
- counselling is recommended as first line treatment
- nicotine replacement therapy (NRT) should be made available to pregnant women who are unable to quit using non-pharmacologic methods
- intermittent NRT use (lozenges, gum) is preferred over continuous dosing of the patch
- no strong evidence that either major positive or negative outcomes were associated with gestational use of bupropion or varenicline; consider using only if benefits outweigh risks and consult Motherisk Helpline
5
Q
Name possible pharmacologic therapy for nicotine (3)
A
- Nicotine Replacement Therapy
- reduces cravings and withdrawal symptoms without other harmful substances that are contained in cigarettes
- Antidepressants (mechanism of action appears to be independent of antidepressant effect)
- bupropion SR (Zyban®), similar effectiveness of NRT vs. bupropion
- Varenicline (Champix®)
6
Q
Nicotine Replacement Therapy use with caution when? (3)
A
- immediately post-MI
- worsening angina
- arrhythmia
7
Q
A
8
Q
Describe: Varenicline (Champix®) (3)
A
- partial nicotinic receptor agonist (to reduce cravings) and partial competitive nicotinic receptor antagonist (to reduce the response to smoked nicotine)
- more effective than bupropion (23% abstinent from 9-52 wk with varenicline vs. 16% with bupropion vs. 9% with placebo)
- significant side effects may lower patient compliance
9
Q
Name Types of Nicotine Replacement Therapy (4)
A
- Nicotine Gum (OTC)
- Nicotine Patch (OTC)
- Nicotine Inhaler (OTC)
- Nicotine Nasal Spray (Rx)
10
Q
Describe dosage: Nicotine Gum (OTC) (3)
A
- 2 mg if <25 cig/d
- 4 mg if >25 cig/d
- 1 piece q1-2h for 1-3 mo (max 24 pieces/d)
11
Q
How to use Nicotine Gum (OTC)? (2)
A
- Chew until “peppery” taste then “park” between gum and cheek to facilitate absorption
- Continue to chew-park intermittently for 30 min
12
Q
Name side effets: Nicotine Gum (OTC) (5)
A
- Mouth soreness
- Hiccups
- Dyspepsia
- Jaw ache
- Most are transient
13
Q
Describe dosage: Nicotine Patch (OTC) (4)
A
- Use for 8 wk
- 21 mg/d x 4 wk
- 14 mg/d x 2 wk
- 7 mg/d x 2 wk
14
Q
Describe usage Nicotine Patch (OTC) (2)
A
- Start with lower dose if <10 cig/d
- Change patch q24h and alternate sides
15
Q
Name side effects: Nicotine Patch (OTC) (4)
A
- Skin irritation
- Insomnia
- Palpitations
- Anxiety
16
Q
Describe dosage: Nicotine Inhaler (OTC) (1)
A
6-16 cartridges/d up to 12 wk
17
Q
Describe: Nicotine Inhaler (OTC) (1)
A
Nicotine inhaled through mouth, absorbed in mouth and throat not in lungs
18
Q
Name side effects: Describe: Nicotine Inhaler (OTC) (2)
A
- Local irritation
- Coughing
19
Q
Name side effects: Nicotine Nasal Spray (Rx) (2)
A
Local irritation Coughing
20
Q
Describe mechanism: Bupropion (1)
A
Inhibits re-uptake of dopamine and/or norepinephrine
21
Q
Name side effects: Bupropion (2)
A
insomnia, dry mouth
22
Q
Describe dosage: Bupropion (3)
A
- 150 mg qAM x 3 d
- Then 150 mg bid x 7-12 wk 3.
- For maintenance consider 150 mg bid for up to 6 mo
23
Q
Describe how to prescribe: Bupoprion (2)
A
- Decide on a quit date
- Continue to smoke for first 1-2 wk of treatment and then completely stop (therapeutic levels reached in 1 wk)
24
Q
Name CI: Bupoprion (4)
A
- Seizure disorder
- Eating disorder
- MAOI use in past 14 d
- Simultaneous use of bupropion (Wellbutrin®) for depression
25
Desribe mechanism: Varenicline (2)
* Partial nicotinic receptor agonist
* and partial nicotinic receptor competitive antagonist
26
Name side effects: Varenicline (8)
* no/vo
* constipation
* headache
* dream disorder
* insomnia
* increased risk of psychosis
* depression
* suicidal ideation
27
Describe dosagE: Varenicline (3)
1. 0.5mg qAM x 3d
2. Then 0.5 mg bid x 4d
3. Continue 1 mg bid x 12 wk ± additional 12 wk as maintenance
28
How to prescribe Describe Varenicline? (2)
* Decide on a quit date
* Continue to smoke for first wk of treatment and then completely stop
29
Name CI: Varenicline (1)
Caution with pre-existing psychiatric condition
30
Describe management for people willing to quit (3)
* provision of social support
* community resources (self-help, group, helpline, web-based strategies)
* combining counselling and smoking cessation medication is more effective than either alone
31
Describe approach for patients unwilling to quit? (5)
motivational intervention (5 Rs)
1. **Relevance to patient**
* relevant to patient’s disease status or risk, family or social situation (e.g. having children in the home), health concerns, age, gender 2.
2. **Risks of smoking**
* short-term: shortness of breath, asthma exacerbation, impotence, infertility, pregnancy complications, heartburn, URTI
* long-term: MI, stroke, COPD, lung CA, other cancers
* environmental: higher risk in spouse/children for lung CA, SIDS, asthma, respiratory infections
3. **Rewards**: benefits
* improved health, save money, food tastes better, good example to children
4. **Roadblocks**: fear of withdrawal, weight gain, failure, lack of support
5. **Repetition**: reassure unsuccessful patients that most people try many times before successfully quitting (average number of attempts before success is 7)
32
33
Highest relapse rate within ___ of quitting
3 mo
34
Describe approach to recent quitter (2)
* minimal practice:
* congratulate on success
* encourage ongoing abstinence
* review benefits and problems
* prescriptive interventions:
* address problem of weight gain
* negative mood
* withdrawal,
* ack of support
