Module 6: Unit C: Smoking Cessation

Question 1

Gum/Lozenge/
Transdermal Patch/
Nasal Spray/Oral inhaler
Examples

Answer 1

Nicoderm CQ
Nicorette
Nicotrol
Nicotrol NS
Nicotrol Inhaler

Question 2

MOA nicorette

Answer 2

Binds to various CNS and peripheral nicotinic-cholinergic receptors

Question 3

Safety/D2D/Cautions with nicoderm

Answer 3

Hypersensitivity to soy or soybean
Arrhythmias, severe
MI, acute within two weeks
Angina
Caution if: pregnancy, asthma or reactive airway, cardiovascular disease, mod-severe hepatic impairment, mod-severe renal impairment, hypothyroidism, diabetes, HTN, seizure history

D2D: CYP2A6 substrate. Caution advised with concomitant drugs; dose adjustments may be necessary; smoking cessation may alter the pharmacokinetics or pharmacodynamics of certain drugs.

Question 4

Nicotinic Receptor Agonist example

Answer 4

Chantix varenicline

Question 5

Chantix varenicline MOA

Answer 5

Agonizes and blocks alpha-4-beta-2 nicotinic acetylcholine receptors

Question 6

Caution/D2D Chantix varenicline

Answer 6

Caution if: CrCl < 30, psychiatric disorder, seizure hx, seizure risk, alcohol use, cardiovascular dx
D2D: lowers seizure threshold; Caution advised with concomitant drugs; dose adjustments may be necessary; smoking cessation may alter pharmacokinetics or pharmacodynamics of certain drugs

Cr at baseline; s/sx of depression, agitation, behavior changes, suicidality
Neuropsychiatric disorders, suicidality, depression, homicidal ideation, sleepwalking.

Question 7

Bupropion SR example

Answer 7

Wellbutrin bupropion hydrochloride

Question 8

Wellbutrin bupropion hydrochloride MOA

Answer 8

The exact mechanism of action in smoking cessation is unknown; it inhibits neuronal uptake of norepinephrine and dopamine (aminoketone)

Question 9

Safety/D2D Wellbutrin

Answer 9

MAO inhibitor use within 14 days
Seizure disorder
Bulimia/Anorexia
Abrupt alcohol, benzodiazepine, sedative, or antiepileptic discontinuation

Caution if: seizure threshold lowered, head injury, CNS infection, alcohol or drug abuse, psychiatric disorder, bipolar disorder, suicidal history, patients < 25 yo, elderly pts, renal impairment, hepatic impairment, cirrhosis, diabetes, glaucoma, recent MI, HTN

D2D:CYP2B6 substrate, SYP2D6 inhibitor, strong, hypertensive effects, interferes with radiolabeled norepinephrine analog effect, lowers the seizure threshold.

Caution advised with concomitant drugs; dose adjustments may be necessary; smoking cessation may alter pharmacokinetics or pharmacodynamics of certain drugs.

Question 10

Monitoring Wellbutrin

Answer 10

Cr at baseline, then in elderly pts continue Periodically; BP at baseline, then periodically; sx suicidality, unusual behavioral changes

Question 11

BBW wellbutrin

Answer 11

Suicidality

Neuropsychiatric Symptoms