Nicotine Dependence

Question 1

Bupropion (Zyban SR)

Answer 1

A) Selective Dopamine and Noradrenaline RE-uptake Inhibitor

B)
1. Nicotine dependence (aid to stop smoking)

C)
(Start taking at least 7 days before stopping smoking)
Start: 150 mg MANE for 3 days
Then: 150 mg BD for 7-9 weeks

D)

1. PSYCHIATRIC ** (anti-depressant effects - changes in mood or behaviour)
2. BP - (hypertension)
3. SEIZURES** (increased risk and more frequent)
4. Hypersensitivity (anaphylaxis, angioedema, Steven-Johnsons)
5. HEPATIC (use lower doses)
6. RENAL

E)
Labels: 5, 12+, 16+, A (swallow whole CR)
# Start taking this for AT LEAST A WEEK BEFORE you stop smoking because it takes this long for it to become effective
#Best if you start taking it in the MORNING for the first few days to minimise sleep disturbance
#Drink only small quantities of ALCOHOL as it can increase the risk of FITS and other UNPLEASANT effects
#You are more likely to quit successfully if you continue to take this for at least 7 weeks
**DR - Changes in MOOD or BEHAVIOUR
**DR - Signs of ALLERGIC reaction (rash, swelling of the lips or mouth, difficulty breathing)
S/E
*CNS (insomnia, nightmares, dizziness, concentration difficulties, headaches)
*PSYCH (agitation, anxiety, tremor)
*SKIN (fever, rash, itch)
*ANTI-CHOL (dry mouth, constipation)

Question 2

Nicotine

Answer 2

A) Nicotine Agonist

B)
1. Nicotine dependence (aid to stop smoking)

C)
FILM (max 15 daily)
Weeks 1-6: 1 every 1-2 hrs PRN
Weeks 7-9: 1 every 2-4 hrs PRN
Weeks 10-12: 1 every 4-8 hrs PRN

GUM (max 1 piece/hr)
High dependence: 4mg 6-10 pieces daily
-reduce at 4-8 weeks to 2mg
-reduce after 4 weeks to 0mg.
Mod. dependence: 2mg 8-12 pieces

INHALATION (max 6 cartridges daily)

• Use gradually according to cravings for 3 months
• reduce over next 2 months to 0.

LOZENGE (max 2+4mg x 15; max 1.5mg x 20)
-High (4mg); Low-Mod (1.5-2mg)
Weeks 1-6: 1 every 1-2 hrs PRN
Weeks 7-9: 1 every 2-4 hrs PRN
Weeks 10-12: 1 every 4-8 hrs PRN
Weeks 12-24: PRN with temptations

PATCH (12 weeks)
Mod-High: 21mg/24hrs or 15-25mg/16hrs
Low-Mod: 14mg/24hrs or 10-15mg/16hrs

SPRAY (max 64 sprays daily)
1-2 sprays PRN
max 4 sprays/hr
-6-12 weeks

D)
1. DURATION of treatment
2. NICOTINE DEPENDENCE
3. COMPLIANCE
4. TECHNIQUE
NO renal or hepatic

E)
#Use, dispose and store as described in the product leaflets
#Tell your pharmacist if you have UNPLEASANT effects whilst using NRT; may mean that dose adjustment is needed
S/E
(Minor and Transient)
Sleep disturbance, Dizziness, Weight gain and Headache

FILM
#Place on TONGUE, close your mouth and let your tongue gently press the film to the ROOF of mouth until the film DISSOLVES (3 mins)
#Do not chew or swallow
#Do not eat or drink during this time

GUM
#Chew gum slowly; BITE gum about 10 times, until TINGLING or BITTER taste
#PARK the gum between your CHEEK and UPPER GUM until TINGLING subsides; then CHEW AGAIN.
#Each piece usually last about 30mins
#Excessive chewing causes SALIVATION, which can cause INDIGESTION

LOZENGE
#DISSOLVE in mouth; try not to chew or swallow
#May take up to 30mins to dissolve complete; do not EAT or DRINK during this time

PATCH
#Apply to NON-HAIRY, CLEAN, DRY place on the UPPER BODY or outer part of the upper arm
#Use a difference application site each day
#Make sure you know how to DISPOSE of patches safely

SPRAY
#Point NOZZLE close to your OPEN MOUTH
#Aim for SIDE of CHEEK or UNDER TONGUE (avoid lips)
#Hold your breath and release spray
#Try not to swallow for a few seconds and allow the nicotine to be absorbed

Question 3

Varenicline (Champix)

Answer 3

A) Anti-smoking agent OR Partial Nicotinic agonist (blocks nicotine from binding)

B)
1. Nicotine dependence (aid to stop smoking)

C)
(start at least 7 days before stopping)
(Day 1-3) 0.5 mg ONCE daily
(Day 4-7) 0.5 mg TWICE daily
(Day 8 onwards) 1 mg TWICE daily (11-23 weeks)

D)
1. NEUROPSYCHIATRIC symptoms***
2. Changes in MOOD or BEHAVIOUR (suicidality)
3. NAUSEA (contact dr if severe)
4. NICOTINE WITHDRAWAL (after cessation)
5. RENAL (reduce dose)
NO hepatic

E)
Labels: 12, A (swallow whole), B (with FOOD)
#Set a TARGET DATE to stop smoking and start taking this medicine 7-14 days before this date
#You are more likely to quit smoking if you continue taking this for 12 weeks. Your doctor will tell you if you need to take another 12 week course
#Do not use NRT while taking this medicine; it will increase your liklihood of experiencing S/E
#After finishing this treatment, some people have found a temporary increase in cigarette craving, irritability and insomnia. It may be useful to have a fast-acting nicotine product at hand in case you have an overwhelming urge to smoke
**DR - Severe NAUSEA (may be improved with dose reduction)
**DR - Unusual or Serious Changes in MOOD
**DR - rash; chest pain; or swelling in the face, lips and tongue (rare angioedema, Steven-Johnsons)

S/E

• GIT (nausea, vomiting, dyspepsia, constipation, flatulence, abdo pain, increased appetite, weight increase)
• CNS (headache, insomnia, abnormal dreams, sleep disorder)