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PDAT1 > 10 - Smoking Cessation > Flashcards

10 - Smoking Cessation Flashcards

1
Q

Low Doses of Nicotine causese what?

A

INCREASED

Alertness

Cognitive Function

Cholinergic agonist = ^^ BP / HR / O2 Consumption

stimulate respiratory system

relax skeletal muscle

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2
Q

HIGH doses of Nicotine does what?

A

Stimulates “REWARD” Center in limbic system

Nicotine -> Brain -> Nicotine receptors stimulated

Ventral Tegmental Area –> Nucleus Accumbens

–> Prefrontal Cortex –> DOPAMINE RELEASE

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3
Q

Physical WITHDRAWAL effects

A

Sweating / Cold-like Symptoms

Tingling in extremeties

Nausea + Headache

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4
Q

Emotional Withdrawal effects of Nicotine

A

Anxiety / Irritability

Insomnia / Depression

Confusion / Difficulty concentrating

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5
Q

Non-Pharmacologic Treatment for

Smoking Cessation

A

Education

Trigger Planning

Motivational Interviewing

THE 5 A’s

Ask / Advise / Assess / Assist / Arrange

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6
Q

Pharmacologic treament for

​Smoking Cessation

A

OTC Nicotine Replacement Therapy = NRT
Path / Gum / Lozenge

RX Medications

Buproprion SR = Zyban

Varenicline Tartrate = Chantix

Nicotine Inhaler

Nicotine Nasal Spray

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7
Q

Exceptions to Smoking Cessation Therapy

A

Pregnant / Adolescent

Light Smoker / smokeless tobacco users

Combo of meds + counseling is more effective than just 1

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8
Q

Rationale of NRT Therapy

A

Reduces PHYSICAL withdrawal from nicotine

Patient not exposed to carcinogens / toxic component of cigs

Use of NRT INCREASES QUIT RATES by ~2 Fold

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9
Q

Nicotine Patch Facts

A

Nicoderm CQ

Delivery to systemic circulation, avoids hepatic FIRST PASS metabolism

ONLY LONG ACTING NRT product
QD dosing

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10
Q

Nicotine Patch DOSING

A

_> 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

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11
Q

Nicotine Patch Administration

A

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

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12
Q

Nicotine Patch

Side Effects / Education

A

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*
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13
Q

Nicotine GUM + LOZENGE

Facts

A

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

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14
Q

Nicotine GUM / LOZENGE

DOSING

A

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

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15
Q

Nicotine GUM / LOZENGE

DOSING SCHEDULE

A
  • *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_

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16
Q

MAX DOSING

for Nicotine GUM

A

DO NOT EXCEED

24 GUM PIECES

PER DAY

17
Q

MAX DOSING for

Nicotine LOZENGES

A

DO NOT EXCEED

20 LOZENGES PER DAY
​or

5 Lozenges in a 6 hour period

18
Q

Chew and Park Method

for Nicotine Gum Admin

A

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
Q

Nicotine LOZENGE

Administration

A

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
Q

Side Effects of

NICOTINE GUM / LOZENGES

A

Hiccups / Flatulence

Nausea / Heartburn / Dyspepsia

Mouth Soreness / jaw ache from gum

Gum may stick to dental work
avoid in those with _dentures_

21
Q

Advantages of Nicotine GUM / LOZENGE

A

Might satisfy ORAL cravings

  • might* delay weight gain
  • 4-mg*

Patients can titrate therapy to manage withdrawal symptoms

22
Q

Nicotine INHALER

Counseling / Considerations

A

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
Q

Nicotine INHALER

Administration

A
  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
Q

Nicotine INHALER

DOSING

A

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
Q

Nicotine NASAL SPRAY

Counseling / Considerations​

Nicotrol NS (10mg/ml)

A

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
Q

Nicotine NASAL SPRAY

DOSING

Nicotrol NS (10mg/mL)

A

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
Q

Nicotine NASAL SPRAY

Dosing Schedule / Max Doses

A

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
Q

Varenicline

MoA / Effects

A

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
Q

Varenicline

DOSING

A

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
Q

Varenicline

RENAL DOSING

A

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

  • *Hemodialysis Dosing:
    0. 5mg QD**
31
Q

Varenicline = Chantix

SIDE EFFECTS

A

Nausea / Headache / Dry Mouth

Insomnia + Abnormal Dreams

Constipation

Suicide / Aggresiveness / Mood Changes

32
Q

Bupropion

MoA / Effects

A
  • *ZYBAN**
  • *Atypical antidepressant** thought to affect levels of:
  • *Dopamine + Norepinephrine**

Beneficial for Patients concerned with WEIGHT GAIN
helpful in patients with underlying depression, may increase anxiety

Reduce Craving for Cigarettes

Reduce SYMPTOMS of nicotine WITHDRAWAL

33
Q

Bupropion SR = Zyban

DOSING

A

150mg QD for 3 days

then, 150mg BID

Seperate doses by at least 8 hours

avoid taking second dose @ bedtime

May continue to smoke for first 1-2 weeks,
then select to quit by 2nd week

34
Q

Bupropion = Zyban

SPECIAL DOSING

A

CONTAINDICATED WITH SEIZURES

Hepatic Impairment : 150mg Every OTHER Day

Elderly or Renal Impairment: 150mg QD

Side effects with BID dosing –> 150mg QD

35
Q

Combination Pharmacotherapy

A

LONG-ACTING Formulation + Short Acting Formulation

LONG ACTING:
Bupropion SR / Nicotine Patch / Chantix
Produces relatively CONSTANT levels of nicotine

Short Acting:
NRT Gum + Lozenge / Nicotine Nasal Spray + Inhaler
Allows for ACUTE dose titration

36
Q

S/Sx of nicotine OVERDOSE

A

N/V/D

Headache / Ab-pain+cramps

Cold Sweats / Breathing difficulties

AGITATION / RAPID HR

Ringing in the ears

PDAT1 (27 decks)

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