Smoking Cessation Flashcards
(44 cards)
Important questions to ask during smoking cessation counseling
How much do you smoke?
When is your first cigarette of the day?
When/Why did you start smoking?
Are you ready to quit?
Have you tried to quit in the past?
- what products/techniques did you try?
Exclusions to smoking cessation self care
Serious heart disease
- recent MI
- irregular heartbeat
- stable angina
uncontrolled HTN
Pregnant/breastfeeding
< 18 yo
Active PUD
NRT dosage forms
Gum (OTC)
Lozenge (OTC)
Transdermal patch (OTC / Rx)
Nasal spray (Rx)
Inhaler (Rx)
Nicotine gum dosing
First cigarette > 30 min after waking
- 2 mg Q1-2H for 6 weeks
First cigarette < 30 min after waking:
- 4 mg Q1-2H for 6 weeks
Decrease to Q2-4H in weeks 7-9, and Q4-8H in weeks 10-12
Chew and park technique for nicotine gum
chew slowly ->
stop chewing at first sign of peppery taste or tingling sensation ->
park between cheek and gum ->
chew again once taste/tingle fades ->
wash rinse repeat until taste fully dissipates
Nicotine gum precautions/ contraindications
pregnant patients
recent MI, serious arrhythmias, and unstable angina pectoris
Nicotine gum ADE
- mouth soreness/irritation
- hiccups
- dyspepsia
what should patients avoid around using nicotine gum
acidic beverages (decreases absorption)
Nicotine gum advantages
- satisfy oral cravings
- may delay weight gain
- pts can titrate therapy to manage withdrawal symptoms
Nicotine gum disadvantages
- gum chewing may not be socially acceptable
- gum is difficult to use with dentures
- patients must use proper chewing technique to minimize ADE
Nicotine lozenge dosing
First cigarette > 30 min after waking
- 2 mg Q1-2H for 6 weeks
First cigarette < 30 min after waking:
- 4 mg Q1-2H for 6 weeks
Decrease to Q2-4H in weeks 7-9, and Q4-8H in weeks 10-12
Nicotine lozenge prescribing instructions
allow lozenge to completely dissolve
do not chew or swallow
avoid acidic beverages
Nicotine lozenge precautions/ contraindications:
Pregnant patients
Patients with recent MI, serious arrhythmias, and unstable angina pectoris
Nicotine lozenge ADE
- nausea
- dyspepsia
- HA
Nicotine lozenge advantages
- satisfy oral cravings
- easy to use and conceal
- pts can titrate therapy to manage withdrawal symptoms
Nicotine lozenge disadvantages
- GI adverse effects
Nicotine inhaler dosing
- 6-16 cartridges (24-64mg) per day for 3 months
- gradual reduction in dose over 6-12 weeks
- can be used for up to 6 months
Nicotine inhaler prescribing instructions
store at room temp
frequent puffing for best results
avoid acidic beverages
Nicotine inhaler instructions for use
- inhale into back of throat or puff in short breaths
- nicotine cartridges are depleted after about 20 minutes of puffing (does not have to be used all at once, open cartridge retains potency for 24hrs)
- mouthpiece is reusable; clean regularly with mild detergent
Nicotine inhaler precautions / CI
- Pregnant patients
- Patients with recent MI, serious arrhythmias, and unstable angina pectoris
- use with caution in patients with bronchospastic disease
Nicotine inhaler ADE
- local irritation in mouth and throat
- coughing
- rhinitis
Nicotine inhaler advantages
- pts can easily titrate therapy to manage withdrawal
- mimics the hand-to-mouth ritual of smoking
Nicotine inhaler disadvantages
- initial throat or mouth irritation can be bothersome
- cartridges should not be stored in warm conditions or used in cold conditions
- patients with underlying bronchospastic disease must use the inhaler with caution
Nicotine nasal spray dosing
1-2 0.5mg doses per hr increasing as needed for symptom relief
- MDD 40mg (80 sprays) or 5mg (10 sprays) per hr
Best results: at least 8 doses/day
Can be used up to 3 months
