Therapeutics - Smoking Cessation Part 2

Question 1

name 2 NON NICOTINE smoking cessation aids

Answer 1

bupropion and varenicline

Question 2

how does bupropion help with quitting smoking

Answer 2

decreases both the cravings and the withdrawal symptoms

Question 3

4 bupropion contraindications

Answer 3

-pts with seizure disorder
-pts already taking wellbutrin, OR on MAO inhibitors in past 14 days
-pts with current or past bulimia or anorexia
-pts that are abruptly d/cing alcohol or sedatives, like benzos

Question 4

bupropion warnings and precautions

what age range of patients are at the highest risk for these?

Answer 4

-mood changes
-homocidal ideation
-suicidal ideation

kids, young adults, and adolescents

these risks are NOT seen in patients 65 and older

Question 5

if a pt is taking bupropion SR and are experiencing mood symptoms, what do you counsel

Answer 5

stop taking and contact HCP immediately!!!

Question 6

bupropion should be used with caution in patients with underlying _______ conditions

Answer 6

neuropsych

Question 7

patients who have an elevated seizure risk should take bupropion with caution

name some patients that are at higher risk for seizure

Answer 7

severe head injury

taking other meds that lower the seizure threshold, such as TCA, antipsychotics, theophylline, or other bupropion products

severe hepatic impairment

Question 8

if a pt wants to use bupropion to stop smoking, WHEN should they start taking it?

Answer 8

1-2 weeks before their quit date

to ensure therapeutic plasma levels achieved at this time

Question 9

bupropion SR dosing

Answer 9

initial: 150mg qAM for 3 days

then 150mg BID for 7-12 weeks

(may CONSIDER 150mg up to 6 months after quit date for long term therapy)

NOT necessary to taper off

Question 10

common side effects of bupropion

Answer 10

insomnia (dont take at night!)
dry mouth

less common = tremor, rash, agitation

Question 11

patient counseling to minimize insomnia associated with bupropion

Answer 11

take earlier in the afternoon! also make sure doses are given at least 8 hours apart

Question 12

if a pt is attempting bupropion to help with smoking cessation, when is the therapy thought to likely be ineffective? what should be done in this case>

Answer 12

if no progress as been made toward abstinence by the 7th week of therapy

d/c treatment and reevaluate the pt and restart at a later date

Question 13

true or false

an advantage of bupropion SR is that it may delay weight gain

Answer 13

true

Question 14

can bupropion be used in combo with NRT agents

Answer 14

yes

Question 15

“partial nicotinic receptor agonist”

Answer 15

varenicline

Question 16

true or false

varenicline COMPETITIVELY inhibits the binding of nicotine

Answer 16

true

Question 17

HOW does varenicline help with smoking cessation

Answer 17

-decreased symptoms of withdrawal

-blocks dopaminergic stimulation that is responsible for the reward associated with smoking

Question 18

particular precaution for varenicline

Answer 18

neuropsych and suicidality - just like bupropion

Question 19

rare side effects of varenicline

Answer 19

seizure
enhanced alcohol effects
CV events
angioedema
skin reactions (srs)

Question 20

WHEN should patients begin varenicline therapy

Answer 20

1 week before their quit date

the dose is gradually increased to minimize nausea and insomnia!

Question 21

dose regimen varenciline

Answer 21

started 1 week prior to quit date

day 1-3 = 0.5mg QD
day 4-7 = 0.5mg BID
day 8-end (up to 12 weeks) = 1mg BID

Question 22

common side effects of varenicline

Answer 22

NV, constipation, flatulence
insomnia

Question 23

how should a patient take varenicline

Answer 23

after eating and with a full glass of water

Question 24

true or false

if a pt experiences nausea/vomiting on varenicline, this effect is likely permanent and they should try something else

Answer 24

FALSE - usually these are temporary side effects

Question 25

true or false a side effect of varenicline is unusual dreams

Answer 25

true

Question 26

when a pt is doing varenicline, smoking should be decreased by at least ____% from baseline within the first ____ weeks. the goal is to have NO SMOKING by.....

Answer 26

50% within the 1st 4 weeks no smoking by 12 weeks

Question 27

true or false clonidine/nortriptyline is considered 1st line

Answer 27

false - 2nd line

Question 28

true or false both clonidine and nortriptyline are NOT APPROVED by the FDA for smoking cessation

Answer 28

true used off label

Question 29

true or false the guidelines support accupuncture to help with smoking cessation

Answer 29

false but if the pt wants to try it, there's no harm

Question 30

true or false there are insufficient studies to promote the use of hypnosis for smoking cessation

Answer 30

true

Question 31

what "long term with short term (prn)" option IS approved by the FDA and which is not?

Answer 31

patch + bupropion is approved varenicline is NOT approved in combo with NRT bc of the nicotinic antagonistic properties of varenicline

Question 32

while the patch + bupropion is approved, what should we be cautious of

Answer 32

emergent hypertension

Question 33

true or false patch + other NRT is NOT APPROVED

Answer 33

true

Question 34

___ can sometimes be combined with nortriptyline off label

Answer 34

21 mg nicotine patch

Question 35

_____ + 2nd gen antidepressants like paroxetine and venlafaxine can sometimes be combined off label

Answer 35

21mg patch

Question 36

for pts with a history of depression, ___ and ____ appear to be effective

Answer 36

bupropion SR and nortriptylinr

Question 37

recommendations for pts with a history of CV disease

Answer 37

NRT therapies are safe! not been shown to cause adverse CV events

Question 38

true or false NRT therapies are not safe in patients with a HISTORY of CV disease

Answer 38

false - is safe

Question 39

the nicotine patch with either ___ or ____ increases long term abstinence rates (good)

Answer 39

gum or spray

Question 40

if the pt is willing to quit, when should you schedule contact

Answer 40

within the 1st week after the quit date

Question 41

true or false a concern for smokers and a reason they don't want to quit is that they will gain weight

Answer 41

true

Question 42

vapes are ______ tobacco products

Answer 42

noncombustible

Question 43

concern of using e-devices as NRT

Answer 43

lot of additives can cause issues - THC, cannaminoid oils, vitamin E, and other additives