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Clinical 1 (Part B) > 2 - Smoking Cessation > Flashcards

2 - Smoking Cessation Flashcards

1
Q

Some key questions to ask?

A
  • Do you smoke?
  • Are you thinking about quitting?
  • Are you ready to quit?
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2
Q

List the components of cigarettes.

A

Tar
Carbon monoxide
Nicotine

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3
Q

Describe Tar

A

contains > 4000 chemicals - increases risk of cancer, CV disease and pulmonary disease

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4
Q

Describe Carbon monoxide

A

reduces oxygen-carrying capacity of blood

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5
Q

Describe Nicotine

A

the addictive component (as strong as cocaine)

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6
Q

What CV problems can result from smoking cigarettes?

A
  • coronary heart disease
  • cerebrovascular disease (stroke)
  • peripheral vascular disease
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7
Q

What types of cancer can result from smoking cigarettes?

A
  • lung
  • pharynx
  • larynx
  • esophagus
  • pancreas
  • kidney
  • bladder
  • cervix
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8
Q

What type of respiratory problems can result from smoking cigarettes?

A
  • chronic obstructive pulmonary disease (COPD)
  • pneumonia
  • emphysema
  • bronchitis
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9
Q

How can cigarette smoking affect pregnant women?

A
  • low birth weight
  • stillbirths
  • miscarriage
  • sudden infant death syndrome (SIDS)
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10
Q

List some other impacts on health that smoking cigarettes have

A
  • peptic ulcer disease
  • osteoporosis
  • cataracts
  • macular degeneration
  • infertility
  • impotence
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11
Q

Second-hand smoke results in ____ lung cancer deaths

A

300

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12
Q

Second-hand smoke results in ____ deaths from coronary heart disease

A

700

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13
Q

Exposure to smoke increases your risk of lung cancer by ___%

A

25

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14
Q

Exposure to smoke increases your risk of heart disease by ___%

A

10

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15
Q 
Passive smoke (second-hand smoke) can adversely affect children's development of:
??
A
  • speech
  • language skills
  • intelligence
  • visual/spatial abilities
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16
Q

Second-hand smoke will worsen which childhood illnesses?

A
  • ear infections
  • asthma
  • bronchitis
  • tonsilitis
  • adenoid problems
  • pneumonia
  • allergies
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17
Q

Nicotine has ____ effects at low doses

A

stimulant

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18
Q

Describe the stimulant effects of nicotine at low doses

A
  • increases alertness
  • facilitates memory, attention
  • reduces irritability, aggression
  • suppresses appetite for sweets
  • increases energy expenditure
  • lowers likelihood of weight gain (because food doesn’t taste as good)
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19
Q

Nicotine has _____ effects at higher doses

A

reward

*via limbic system’s “pleasure system”

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20
Q

Immediate health benefits of quitting after 20 mins?

A
  • BP and pulse rate return to normal

- Body temp increases to normal

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21
Q

Immediate health benefits of quitting after 8 hours?

A

-Carbon monoxide levels in blood drop and oxygen levels return to normal

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22
Q

Immediate health benefits of quitting after 48 hours?

A
  • Sense of smell and taste improves

- The chances of having a heart attack start to go down

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23
Q

Immediate health benefits of quitting after 72 hours?

A

-Lung capacity increases

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24
Q

Long term health benefits of quitting after 2 weeks?

A

-Nicotine is gone from the body

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25
Q

Long term health benefits of quitting after 3 months?

A

-Circulation and overall energy increases

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26
Q

Long term health benefits of quitting after 6 months?

A

-Coughing, sinus congestion, tiredness and shortness of breath improve significantly

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27
Q

Long term health benefits of quitting after 1 year?

A

Risk of heart disease (CHD) goes down

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28
Q

Long term health benefits of quitting after 5 - 15 years?

A

-Risk of dying from lung cancer decreases by almost 1/2

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29
Q

Long term health benefits of quitting after 10-15 years?

A

-Risk of heart attack is equal to someone who has never smoked

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30
Q

When do physical nicotine withdrawl symptoms begin?

A

A few hours after quitting

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31
Q

When do physical nicotine withdrawl symptoms peak?

A

2-3 days

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32
Q

When do physical nicotine withdrawl symptoms usually resolve?

A

within about 2 weeks

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33
Q

So the immediate physical nicotine withdrawl symptoms are usually over in 2 weeks, up to how long can “Late” onset symptoms (milder symptoms) last?

A

6 months in rare cases

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34
Q

What are some nicotine withdrawl symptoms?

A
  • constipation
  • diarrhea
  • fatigue
  • headache
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35
Q

How can nicotine withdrawl symptoms be managed?

A

with nicotine replacement therapy (NRT) and behavioural treatment

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36
Q

How long does dizziness last?

A

1-2 days

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37
Q

How long does restlessness/anxiety last?

A

a few days or weeks

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38
Q

How long does cough/dry throat and mouth last?

A

a few days or weeks

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39
Q

How long does fatigue and increased appetite last?

A

2-4 weeks

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40
Q

How long does insomnia last?

A

1 week

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41
Q

How long does irritability, frustration, anger and headaches last?

A

1-2 weeks

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42
Q

How long does constipation, gas and bloating last?

A

1-2 weeks

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43
Q

The Fagerstrom Questionnaire measures what?

A

degree of ‘physical’ dependence

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44
Q

Fagerstrom Questionnaire scale:

<5 = ?

A

low nicotine dependence

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45
Q

Fagerstrom Questionnaire scale:

5 = ?

A

moderate nicotine dependence

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46
Q

Fagerstrom Questionnaire scale:

6-7 = ?

A

high nicotine dependence

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47
Q

Fagerstrom Questionnaire scale:

8-10 = ?

A

very high nicotine dependence

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48
Q

What are the 5 A’s?

A 
Ask about tobacco use
Advise to quit
Assess willingness to make a quit attempt
Assist in quit attempt
Arrange for follow-up
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49
Q

What is the formula for pack years?

A

(#cigs/day) x (# years smoked) / 20 = ____ pack years

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50
Q

Barriers to quitting?

A
  • lack of reason to change
  • emotional stress
  • social habits
  • discouragement bc of failure before
  • fear of withdrawl symptoms and cravings
  • attachments to smoking rituals
  • influence of others smoking
  • sense of loss in giving up cigs
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51
Q

Roughly how much savings after 5 yrs of quitting?

A

$$18,250

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52
Q

For patients to quit smoking successfully, they must: ?? (3)

A
  • overcome pharmacological nicotine dependence
  • cope with nicotine withdrawal
  • extinguish strong behavioural associates with smoking
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53
Q

Non-pharms for smoking cessation?

A
  • Set a target quit date
  • Get professional help
  • Enlist social support from friends and family
  • Use problem-solving methods of counselling to quit and remain smoke free
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54
Q

How long will cravings last?

A

only a few minutes (use coping methods to get through)

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55
Q

What are some coping methods?

A
  • manage cravings and triggers
  • stress relief
  • environmental control
  • social support
  • motivational thinking and rewards
  • handling withdrawl symptoms
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56
Q

How should you handle relapses?

A
  • remind patients that slip ups are normal
  • avoid “all or nothing” thinking
  • think of it as a learning opportunity (ask why it happened and think of what you can do in the future to prevent it from happening)
  • Remind patient that it’s not a lack of willpower but a lack of an effective strategy for that situation
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57
Q

List the Methods of Smoking Cessation

A

1) Cold Turkey - not effective at all if highly addicted

2) Self-Treatment Nicotine Replacement Therapy
- gum/lozenge/mouth spray
- transdermal patch
- inhaler

3) Prescription Therapy (oral/tablets)
- Bupropion
- Varenicline
- Nortriptyline/Clonidine (3rd line) - off label uses

4) Nonpharmacologic Aids
- behavioral interventions
- patient counselling
- nutritional advice

  • *Alternative methods (not very effective alone)
  • hypnotism
  • acupuncture
  • laser
  • herbal products
  • electronic cigs
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58
Q

Who do you need to refer to a doctor?

A

Pregnancy women and adolescents (under 18)

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59
Q

Why is nicotine replacement therapy (NRT) a cleaner form of getting nicotine?

A

There is no tar and no carbon monoxide, so you don’t get any gross chemicals, just pure nicotine.

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60
Q

After smoking a cigarette, it only takes ____ seconds for nicotine to get into the brain..

61
Q

Why do NRT’s have slower onset and absorption?

A

They are not absorbed through the lung.

62
Q

What can Mb pharmacists prescribe?

A
  • Varenicline (Champix)
  • As well as other NRT’s

*We cannot prescribe Bupropion

63
Q

What are the 2 brands of Nicotine Polarcrilex Gum?

A

Nicorette and Thrive

64
Q

Describe Nicotine Polarcrilex Gum

A

-one of the fastest delivery forms for nicotine other than smoking (time to peak is 20-30 min) via buccal mucosa, short duration of action

65
Q

Nicotine Polarcrilex Gum:

Half life ?

66
Q

Nicotine Polarcrilex Gum:

What strengths are available?

A

2mg or 4mg

67
Q

Nicotine Polarcrilex Gum:

Can it be used in combination with other NRTs or bupropion?

A

Yes, but with caution.

*I don’t think we are counselling on combination therapy in this lab.

68
Q

When do you recommend 2mg gum?

A

-If they smoke their first cigarette after more than 30 minutes after waking up
OR
-Fagerstrom score less than or equal to 6
OR
-Smoke less than 25 cigarettes/day

69
Q

When do you recommend 4mg gum?

A

-If they smoke their first cigarette in less than 30 minutes after waking up
OR
-Fagerstrom score greater than or equal to 7
OR
-Smoke 25 or more cigarettes/day

70
Q

What are the directions for using the Nicotine Polarcrilex Gum?

A
  • Chew one piece at a time, no more than 1 per hour
  • 10-12 pieces/day initially up to a max of 20/day
  • Chew and park between teeth and cheeks
  • Repeat chew every minute or so
  • Each piece lasts approximately 30 minutes
  • Use for 12 weeks (1 piece/hour PRN)
  • Taper off by one less piece per day each week!

*To reduce urges, best to use on a fixed schedule for the first month

71
Q

Describe the Nicotine Gum: Tapering Dosing Scheduele

A

2nd month: one piece every 2-4 hours

3rd month: one piece every 4-8 hours

  • Discontinue when using only 1 or 2 pieces of gum/day
  • Products should not be used beyond 12 weeks
  • If patient is still having difficulty (4th-6th month), Pt can chew one piece if urge to smoke returns
72
Q

When should they consult a physician?

A

If still using the product after 6 months

73
Q

What happens when nicotine gum is chewed too fast, too frequently, or using an incorrect chewing method?

A
  • Nicotine is released too quickly
  • Nicotine is then swallowed instead of absorbed through the buccal mucosa
  • Reduces efficacy/results in unpleasant taste
  • Leads to symptoms similar to over-smoking (nausea, hiccups, cough, light-headedness)
74
Q

Describe the Bite-Bite-Park Technique for Nicotine Gum

A

**Always instruct patients to read product insert for proper technique

  • Bite the gum gently (once or twice) to start the release of nicotine until a tingle is felt in the mouth
  • Park the nicotine gum between the cheek and the gums
  • After the tingle subsides (about 1 minute), bite again until the tingle returns, park the gum once again, repeat the process
  • After approximately 30 minutes, the tingle stops and you can discard the gum
75
Q

What are the 3 main indications for Nicorette gum?

A

1) Stop to Quit (most common)
- patients choose a quit date and initiate gum on that day to minimize withdrawal

2) Temporary Abstinence
- gum can be used in cases in which a smoker temporarily refrains from smoking (i.e. during long smoke-free flights)

3) Reduce to Quit (RTQ Method)
- the newest indication for users who are not ready or unable to quit abruptly

76
Q

List some important drug/food interactions associated with NRT

A
  • Avoid food/drink 15 minutes before and during use
  • Acidic beverages (coffee, alcohol, soda, citrus fruit juice) may interfere with bioavailability or absorption of nicotine (decreases absorption)
77
Q

Can you smoke while taking nicorette gum?

A
  • Smoking with the gum (or any other NRT) is no longer contraindicated - especially with the RTQ method
  • If patient decides to smoke while using an NRT, must monitor nicotine side effects and caution patient on nicotine toxicity
  • Obviously smoking while taking NRTs is not ideal, but it can be done.
78
Q

Why are NRTs not as addictive as cigarettes?

A
  • slower onset

- slower benefit

79
Q

What are some common side effects of NRT gum?

A
  • jaw pain, dental problems (CI’d in TMJ - temporomandibular joint disorders
  • gum sticking to denture
  • throat irritation, cough, hiccups
  • unpleasant taste or taste alteration
  • some dependence risk
  • CNS: headache, dizziness, insomnia, irritability
  • CV: chest pain, HTN, tachycardia
  • GI: indigestion, nausea, flatulence (CI’d in gastric ulcers)
80
Q

When is NRT gum CI’d?

A
  • TMJ (temporomandibular joint disorders)
  • gastric ulcers
  • hypersensitivity to drug or any ingredient in formulation (DUH DRENA)
  • Patients in the immediate post-myocardial infarction period, patients with life-threatening arrhythmias and pt with severe or worsening angina pectoris
  • pregnant women
  • breastfeeding mothers as nicotine is excreted in breast milk
  • non-smokers (LOL)
  • children under 18
81
Q

What are some warnings and precautions with NRT gum?

A

-oral or pharyngeal inflammation, active peptic ulcer, hyperthyroidism, pheochromocytoma, insulin-dependent diabetes, severe renal insufficiency, uncontrolled hypertension

82
Q

What are the 2 brands available for NRT lozenges?

A

Thrive

Nicorette

83
Q

When do the lozenges reach peak?

A

20-60 minutes

84
Q

Lozenges:

One main indication to quit?

A

stop to quit

85
Q

Lozenges:

Special instructions?

A

Do not eat or drink 15 minutes before (or during) lozenge use

86
Q

Lozenges:

Same side effects

87
Q

Lozenges:

Describe the dosing regimen

A

For 6 weeks: One lozenge every 1-2 hours
For 3 weeks: One lozenge every 2-4 hours
For 3 weeks: One lozenge every 4-8 hours

88
Q

Lozenges:

When do you discontinue?

A

when using 1 or 2 lozenges per day

89
Q

Lozenges:

Do you chew the lozenges?

90
Q

What strengths are available for Thrive lozenges?

A

1 or 2 mg (they last about 30 minutes)

91
Q

When would you suggest 1 mg Thrive lozenge?

A

If a person smokes less than 20 cigarettes per day (or less than a pack per day)

92
Q

When would you suggest 2 mg Thrive lozenge?

A

If a person smokes 20 or more cigarettes per day (or a pack or more per day)

93
Q

Lozenges:

What are the directions for use?

A
  • suck on lozenge until strong taste, then “park” lozenge between cheek and gum
  • when the taste diminishes, repeat
94
Q

Lozenges:

Max per day of 1 mg Thrive lozenges?

A

25 lozenges

95
Q

Lozenges:

Max per day of 2 mg Thrive lozenges?

A

15 lozenges

96
Q

What strengths are available for Nicorette lozenges?

A

2 and 4 mg strengths available (lasts about 10 mins)

97
Q

When would you recommend 2 mg Nicorette lozenge?

A

If first cigarette is > 30 minutes after waking

98
Q

When would you recommend 4 mg Nicorette lozenge?

A

If first cigarette is < 30 minutes after waking

99
Q

Special directions for Nicorette lozenges?

A
  • Once lozenge is in mouth, move intermittently from one side to other side of mouth.
  • Try to avoid swallowing while lozenge is in mouth.
100
Q

Max dose per day for nicorette lozenges?

A

15 lozenges for both strengths

101
Q

What is the conversion between Thrive and Nicorette lozenges?

A

Thrive 1mg = Nicorette 2 mg

Thrive 2 mg = Nicorette 4 mg

102
Q

Directions to use the NRT: Mouth Spray

A

**Max concentration reached after 13 mins

  • First time: point nozzle away and press top of dispenser several times until fine mist. May need to repeat if spray has not been used for 2 or more days.
  • Point nozzle towards open mouth, holding as close as possible
  • Press top of dispenser for release of one spray into mouth (avoid lips)
  • Do not inhale while spraying, avoid swelling for a few seconds after spraying
  • *contains ethanol
  • not for alcoholics
  • not for pregnant women
103
Q

Dose of Nicorette Quick Mist

A

1 or 2 sprays when you normally smoke a cigarette or having a craving to smoke. Use 1 spray first and if craving does not disappear within a few minutes, use second spray.
If 2 sprays needed, future doses may be delivered as 2 consecutive sprays.

Most smokers: 1-2 sprays every 30 minutes to 1 hour

104
Q

Max dose of Nicorette QuickMist?

A

2 sprays at a time, 4 sprays per hour, 64 sprays per day

105
Q

Dosing schedule of Nicorette: Quick Mist?

A
  • Use when a cigarette would have been smoked or if having a craving
  • During weeks 1-6, use prn up to 1-2 sprays every 20 mins
  • By weeks 7-9: decrease by 50% average number of sprays per day
  • By weeks 10-12: use 2-4 sprays per day
  • Discontinue after week 12
106
Q

When do nicotine levels of NRT transdermal patches peak?

107
Q

Nicoderm patches are _____-controlled

A

system

  • Nicotine release regulated by a rate-controlling membrane
  • Releases nicotine at a constant rate - predictable
  • Adhesive contains nicotine
108
Q

Habitrol patches are _____-controlled

A

skin

  • Nicotine release regulated by the rate at which the nicotine can cross the individual’s skin
  • Rate of release dependent on individual’s skin permeability
  • Adhesive does not contain nicotine

*Nicotine levels will change if person’s temp increases from exercise or showering, etc.

109
Q

Dosing schedule for Nicoderm patches?

A

21mg for 6 weeks
14mg for 2 weeks
7mg for 2 weeks

OR

14mg for 6 weeks
7mg for 2 weeks
*for those who smoke less than 10 cigarettes daily, those weighing less than 45 kg (100lbs), or those with cardiac/heart disease.

110
Q

Dosing schedule for Habitrol patches?

A

21mg for 4 weeks
14mg for 2 weeks
7mg for 2 weeks

OR

14mg for 6 weeks
7mg for 2 weeks
*for those who smoke less than 10 cigarettes daily, those weighing less than 45 kg (100lbs), or those with cardiac/heart disease.

111
Q

Patch application

A
  • Patch stays on for 24 hours
  • Patch site should be: clean, non-hairy, dry
  • Apply pressure to patch for 10 seconds on application
  • Apply every morning for 24 hour patch
  • Rotate sites frequently
112
Q

Common SE of the patch

A
  • local skin irritation

- sleep disturbances (remove at night if this occurs)

113
Q

CI of the patch

A
  • Patients with skin disorders
  • Immediate post-MI patients
  • Patients with life-threatening arrhythmias, and patients with severe angina pectoris
  • Pregnant women
  • Breast feeding mothers (nicotine is excreted in breast milk)
  • Non smokers or occasional smokers and those under 18
114
Q

Dosing with the nicotine inhaler ?

A
  • Each 10 mg cartridge delivers 4 mg nicotine (2 mg systemically absorbed)
  • One cartridge = one cigarette
  • 15 minutes to peak effect
  • One cartridge lasts 20 mins with frequent and continuous puffing
  • Can puff for 5-10 minutes at a time as you would a cigarette
  • Wash mouthpiece daily with soap and water
  • Cartridge food for 24 hours once punctured
115
Q

Dosing schedule for Nicotine Inhaler

A
  • First 6-12 weeks: use 1 cartridge as needed (whenever you get a craving)
  • Max # of cartridges is 6-12 per day
  • Dosing is gradually reduced to a few cartridges a day
  • Stop using inhaler when the daily use is reduced to 1-2 per day
116
Q

Common SE with nicotine inhaler?

A

cough
throat irritation
pharyngitis

117
Q

With nicotine inhaler: Avoid ??

A

drinking acidic beverages such as coffee, tea, soft drinks when using the inhaler

118
Q

Nicotine inhaler has same CI as nicotine patches: What are they?

A
  • Immediate post-MI patients
  • Patients with life-threatening arrhythmias, and patients with severe angina pectoris
  • Pregnant women
  • Breast feeding mothers (nicotine is excreted in breast milk)
  • Non smokers or occasional smokers and those under 18
119
Q

Safety precautions with NRTs?

A
  • store away from children and pets

- ensure proper disposal

120
Q

What combo therapies are options?

A

Combo of:

  • patch and gum or lozenge or inhaler
  • buproprion and an NRT
121
Q

Describe the MOA of bupropion in Smoking Cessation

A
  • Though to be independent of antidepressant activity.
  • Increases mesolimbic reward system Dopamine (DA) and Norepinephrine (NE) levels and blocks brain nicotinic receptors involved in tobacco addiction.
122
Q

Describe bupropion in Smoking Cessation

A
  • 150 mg SR tablets (Rx)
  • Dosing: 1 tablet daily for 3 days, then increase to 1 tab BID for the remaining 12 weeks (not to exceed 300mg/day), no tapering required
  • Slower onset: may take 1-2 weeks
  • Set quit date for 1 week after starting Tx
123
Q

Benefits of bupropion in Smoking Cessation

A
  • reduces withdrawl symptoms and cravings
  • less weight gain
  • cheapest alternative overall
124
Q

SE’s of buproprion

A

insomnia
agitation
Gi upset
dry mouth

125
Q

CI’s of buproprion

A
  • personal or family history of seizures or eating disorders, patients on MAOi agents (within 14 days)
  • excessive alcohol users
126
Q

Can bupropion be used in pregnancy?

127
Q

_____ is a non-nicotine agent

A

Champix - Varenicline

128
Q

Describe Champix - Varenicline

A
  • newest smoking cessation therapy
  • binds specifically to alpha4/beta2 receptors preventing binding of nicotine to these same receptors (mesolimbic system)
  • decreases the sense of satisfaction and reward that would normally come from nicotine (smoking)
129
Q

Describe the dosing of Champix - Varenicline

A

-slow onset of action/long acting

Dosing regimen:
Days 1-3: 0.5mg OD (3 tabs)
Days 4-7: 0.5mg BID (8 tabs)
Days 8-14: 1mg BID (14 tabs)
*Then continue til the end of treatment.

Set quit date 1-2 weeks after start of Tx

Total of 12 weeks generally

130
Q

Common SE’s of Champix - Varenicline

A

nausea
insomnia
fatigue

131
Q

Champix - Varenicline should not be combined with ____

132
Q

Describe Nortriptyline in smoking cessation

A
  • antidepressant
  • 3rd line agent - off label use for SC

75-100 mg OD
start 10-28 days before quitting and use for 12 weeks

133
Q

SE of Nortriptyline

A

sedation
dry mouth
blurred vission

134
Q

CI’s for Nortriptyline

A

ECG abnormalities

suicide/seizure risk

135
Q

Describe Clonidine in smoking cessation

A
  • 3rd line agent - off label use for smoking cessation
  • used for various addictions (narcotics, alcohol)
  • 0.15-0.45 mg/day PO for 12 weeks
  • may be useful in cardiac/HTN patients
136
Q

SE’s of clonidine

A

dry mouth
sedation
dizziness

137
Q

List some herbal or alternate therapies

A

1) Resolve - actually was withdrawn from market

  • contained cestemenol-350
  • potential health risks of liver, kidney or RBC damage

2) Hypnotherapy
and
3) Acupuncture
*may be useful for some patients as add-ons

**Evidence for herbal/alternate therapies is lacking

138
Q

Are eCigarettes helpful in quitting smoking?

A
  • We do not know
  • Hand to mouth motion may be beneficial
  • They are advertised as a healthier option to quitting smoking (less tar and chemicals) but are not approved by Health Canada as a smoking cessation tool.
139
Q

Describe the Immunization idea that is underway for smoking cessation

A
  • Goal is to stop all cigarette and nicotine cravings and therefore smoking cessation would be easy.
  • Biological effect is to be produced by causing an immunologic response to nicotine. It is then quarantined by nicotine-specific antibodies causing a reduction in available nicotine to have a response in the CNS and reduce response in the dopamine and reward pathway
140
Q

While quitting smoking, you have increased levels of _____

141
Q

Special populations in smoking cessation ?

A
  • pregnancy
  • high risk CVD
  • under 18
142
Q

Pregnant patients who want to quit smoking are an automatic ______

A

Referral dude

143
Q

What is smoking in pregnancy associated with?

A
  • low birth weight
  • spontaneous pregnancy loss
  • preterm delivery
144
Q

Can bupropion be used in CV patients?

A

No - raises BP

145
Q

Can clonidine be used in CV patients?

A

yes - lowers BP

*caution regarding rebound hypertension upon discontinuation

146
Q

Can varenicline be used in CV patients?

A

No - health canada warning

147
Q

How do we treat adolescents (under 18) for SC (smoking cessation)?

A
  • start with non-pharms always

- then refer to a physician for an NRT

148
Q

Does nicotine in the NRT products have the same addictive potential as nicotine in the cigarettes?

A
  • Nicotine’s addictive potential determined by rate and route of administration
  • Cigarettes are highly addictive because of rapid delivery of nicotine (10 seconds) to the mesolimbic reward pathways in brain
  • Rapid, intense, repeated brain exposure = addiction

-In general, NRT does not have the same addictive potential - much less (still caution with gum more so than the patch)

Clinical 1 (Part B) (11 decks)

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