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Stage toxico > Nicotine > Flashcards

Nicotine Flashcards

1
Q

Name: The 5 A’s for Patients Willing to Quit

A
  • Ask if the patient smokes
  • Advise patients to quit
  • Assess willingness to quit
  • Assist in quit attempt
  • Arrange follow-up
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2
Q

Name: The 2-3 Pattern of Smoking Cessation (5)

A
  • Onset of withdrawal is 2-3h after last cigarette
  • Peak withdrawal is at 2-3d
  • Expect improvement of withdrawal symptoms at 2-3 wk
  • Resolution of withdrawal at 2-3 mo
  • Highest relapse rate within 2-3 mo
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3
Q

How to Assist Patient in Developing Quit Plan? (4)

A

STAR

  • Set quit date
  • Tell family and friends (for support)
  • Anticipate challenges (e.g. withdrawal)
  • Remove tobacco-related products (e.g. ashtrays/lighters)
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4
Q

Describe tx for pregnant patients (4)

A
  • counselling is recommended as first line treatment
  • nicotine replacement therapy (NRT) should be made available to pregnant women who are unable to quit using non-pharmacologic methods
  • intermittent NRT use (lozenges, gum) is preferred over continuous dosing of the patch
  • no strong evidence that either major positive or negative outcomes were associated with gestational use of bupropion or varenicline; consider using only if benefits outweigh risks and consult Motherisk Helpline
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5
Q

Name possible pharmacologic therapy for nicotine (3)

A
  • Nicotine Replacement Therapy
    • reduces cravings and withdrawal symptoms without other harmful substances that are contained in cigarettes
  • Antidepressants (mechanism of action appears to be independent of antidepressant effect)
    • bupropion SR (Zyban®), similar effectiveness of NRT vs. bupropion
  • Varenicline (Champix®)
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6
Q

Nicotine Replacement Therapy use with caution when? (3)

A
  • immediately post-MI
  • worsening angina
  • arrhythmia
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7
Q
A
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8
Q

Describe: Varenicline (Champix®) (3)

A
  • partial nicotinic receptor agonist (to reduce cravings) and partial competitive nicotinic receptor antagonist (to reduce the response to smoked nicotine)
  • more effective than bupropion (23% abstinent from 9-52 wk with varenicline vs. 16% with bupropion vs. 9% with placebo)
  • significant side effects may lower patient compliance
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9
Q

Name Types of Nicotine Replacement Therapy (4)

A
  • Nicotine Gum (OTC)
  • Nicotine Patch (OTC)
  • Nicotine Inhaler (OTC)
  • Nicotine Nasal Spray (Rx)
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10
Q

Describe dosage: Nicotine Gum (OTC) (3)

A
  • 2 mg if <25 cig/d
  • 4 mg if >25 cig/d
  • 1 piece q1-2h for 1-3 mo (max 24 pieces/d)
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11
Q

How to use Nicotine Gum (OTC)? (2)

A
  • Chew until “peppery” taste then “park” between gum and cheek to facilitate absorption
  • Continue to chew-park intermittently for 30 min
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12
Q

Name side effets: Nicotine Gum (OTC) (5)

A
  • Mouth soreness
  • Hiccups
  • Dyspepsia
  • Jaw ache
  • Most are transient
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13
Q

Describe dosage: Nicotine Patch (OTC) (4)

A
  • Use for 8 wk
  • 21 mg/d x 4 wk
  • 14 mg/d x 2 wk
  • 7 mg/d x 2 wk
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14
Q

Describe usage Nicotine Patch (OTC) (2)

A
  • Start with lower dose if <10 cig/d
  • Change patch q24h and alternate sides
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15
Q

Name side effects: Nicotine Patch (OTC) (4)

A
  • Skin irritation
  • Insomnia
  • Palpitations
  • Anxiety
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16
Q

Describe dosage: Nicotine Inhaler (OTC) (1)

A

6-16 cartridges/d up to 12 wk

17
Q

Describe: Nicotine Inhaler (OTC) (1)

A

Nicotine inhaled through mouth, absorbed in mouth and throat not in lungs

18
Q

Name side effects: Describe: Nicotine Inhaler (OTC) (2)

A
  • Local irritation
  • Coughing
19
Q

Name side effects: Nicotine Nasal Spray (Rx) (2)

A

Local irritation Coughing

20
Q

Describe mechanism: Bupropion (1)

A

Inhibits re-uptake of dopamine and/or norepinephrine

21
Q

Name side effects: Bupropion (2)

A

insomnia, dry mouth

22
Q

Describe dosage: Bupropion (3)

A
  1. 150 mg qAM x 3 d
  2. Then 150 mg bid x 7-12 wk 3.
  3. For maintenance consider 150 mg bid for up to 6 mo
23
Q

Describe how to prescribe: Bupoprion (2)

A
    1. Decide on a quit date
    1. Continue to smoke for first 1-2 wk of treatment and then completely stop (therapeutic levels reached in 1 wk)
24
Q

Name CI: Bupoprion (4)

A
  • Seizure disorder
  • Eating disorder
  • MAOI use in past 14 d
  • Simultaneous use of bupropion (Wellbutrin®) for depression
25
Q

Desribe mechanism: Varenicline (2)

A
  • Partial nicotinic receptor agonist
  • and partial nicotinic receptor competitive antagonist
26
Q

Name side effects: Varenicline (8)

A
  • no/vo
  • constipation
  • headache
  • dream disorder
  • insomnia
  • increased risk of psychosis
  • depression
  • suicidal ideation
27
Q

Describe dosagE: Varenicline (3)

A
  1. 0.5mg qAM x 3d
  2. Then 0.5 mg bid x 4d
  3. Continue 1 mg bid x 12 wk ± additional 12 wk as maintenance
28
Q

How to prescribe Describe Varenicline? (2)

A
  • Decide on a quit date
  • Continue to smoke for first wk of treatment and then completely stop
29
Q

Name CI: Varenicline (1)

A

Caution with pre-existing psychiatric condition

30
Q

Describe management for people willing to quit (3)

A
  • provision of social support
  • community resources (self-help, group, helpline, web-based strategies)
  • combining counselling and smoking cessation medication is more effective than either alone
31
Q

Describe approach for patients unwilling to quit? (5)

A

motivational intervention (5 Rs)

  1. Relevance to patient
    • relevant to patient’s disease status or risk, family or social situation (e.g. having children in the home), health concerns, age, gender 2.
  2. Risks of smoking
    • short-term: shortness of breath, asthma exacerbation, impotence, infertility, pregnancy complications, heartburn, URTI
    • long-term: MI, stroke, COPD, lung CA, other cancers
    • environmental: higher risk in spouse/children for lung CA, SIDS, asthma, respiratory infections
  3. Rewards: benefits
    • improved health, save money, food tastes better, good example to children
  4. Roadblocks: fear of withdrawal, weight gain, failure, lack of support
  5. Repetition: reassure unsuccessful patients that most people try many times before successfully quitting (average number of attempts before success is 7)
32
Q
A
33
Q

Highest relapse rate within ___ of quitting

A

3 mo

34
Q

Describe approach to recent quitter (2)

A
  • minimal practice:
    • congratulate on success
    • encourage ongoing abstinence
    • review benefits and problems
  • prescriptive interventions:
    • address problem of weight gain
    • negative mood
    • withdrawal,
    • ack of support

Stage toxico (9 decks)

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