Nicotine Flashcards
Name: The 5 A’s for Patients Willing to Quit
- Ask if the patient smokes
- Advise patients to quit
- Assess willingness to quit
- Assist in quit attempt
- Arrange follow-up
Name: The 2-3 Pattern of Smoking Cessation (5)
- 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
How to Assist Patient in Developing Quit Plan? (4)
STAR
- Set quit date
- Tell family and friends (for support)
- Anticipate challenges (e.g. withdrawal)
- Remove tobacco-related products (e.g. ashtrays/lighters)
Describe tx for pregnant patients (4)
- 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
Name possible pharmacologic therapy for nicotine (3)
- 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®)
Nicotine Replacement Therapy use with caution when? (3)
- immediately post-MI
- worsening angina
- arrhythmia
Describe: Varenicline (Champix®) (3)
- 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
Name Types of Nicotine Replacement Therapy (4)
- Nicotine Gum (OTC)
- Nicotine Patch (OTC)
- Nicotine Inhaler (OTC)
- Nicotine Nasal Spray (Rx)
Describe dosage: Nicotine Gum (OTC) (3)
- 2 mg if <25 cig/d
- 4 mg if >25 cig/d
- 1 piece q1-2h for 1-3 mo (max 24 pieces/d)
How to use Nicotine Gum (OTC)? (2)
- Chew until “peppery” taste then “park” between gum and cheek to facilitate absorption
- Continue to chew-park intermittently for 30 min
Name side effets: Nicotine Gum (OTC) (5)
- Mouth soreness
- Hiccups
- Dyspepsia
- Jaw ache
- Most are transient
Describe dosage: Nicotine Patch (OTC) (4)
- Use for 8 wk
- 21 mg/d x 4 wk
- 14 mg/d x 2 wk
- 7 mg/d x 2 wk
Describe usage Nicotine Patch (OTC) (2)
- Start with lower dose if <10 cig/d
- Change patch q24h and alternate sides
Name side effects: Nicotine Patch (OTC) (4)
- Skin irritation
- Insomnia
- Palpitations
- Anxiety
Describe dosage: Nicotine Inhaler (OTC) (1)
6-16 cartridges/d up to 12 wk
Describe: Nicotine Inhaler (OTC) (1)
Nicotine inhaled through mouth, absorbed in mouth and throat not in lungs
Name side effects: Describe: Nicotine Inhaler (OTC) (2)
- Local irritation
- Coughing
Name side effects: Nicotine Nasal Spray (Rx) (2)
Local irritation Coughing
Describe mechanism: Bupropion (1)
Inhibits re-uptake of dopamine and/or norepinephrine
Name side effects: Bupropion (2)
insomnia, dry mouth
Describe dosage: Bupropion (3)
- 150 mg qAM x 3 d
- Then 150 mg bid x 7-12 wk 3.
- For maintenance consider 150 mg bid for up to 6 mo
Describe how to prescribe: Bupoprion (2)
- Decide on a quit date
- Continue to smoke for first 1-2 wk of treatment and then completely stop (therapeutic levels reached in 1 wk)
Name CI: Bupoprion (4)
- Seizure disorder
- Eating disorder
- MAOI use in past 14 d
- Simultaneous use of bupropion (Wellbutrin®) for depression
Desribe mechanism: Varenicline (2)
- Partial nicotinic receptor agonist
- and partial nicotinic receptor competitive antagonist
Name side effects: Varenicline (8)
- no/vo
- constipation
- headache
- dream disorder
- insomnia
- increased risk of psychosis
- depression
- suicidal ideation
Describe dosagE: Varenicline (3)
- 0.5mg qAM x 3d
- Then 0.5 mg bid x 4d
- Continue 1 mg bid x 12 wk ± additional 12 wk as maintenance
How to prescribe Describe Varenicline? (2)
- Decide on a quit date
- Continue to smoke for first wk of treatment and then completely stop
Name CI: Varenicline (1)
Caution with pre-existing psychiatric condition
Describe management for people willing to quit (3)
- 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
Describe approach for patients unwilling to quit? (5)
motivational intervention (5 Rs)
-
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.
-
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
-
Rewards: benefits
- improved health, save money, food tastes better, good example to children
- Roadblocks: fear of withdrawal, weight gain, failure, lack of support
- Repetition: reassure unsuccessful patients that most people try many times before successfully quitting (average number of attempts before success is 7)
Highest relapse rate within ___ of quitting
3 mo
Describe approach to recent quitter (2)
- 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
