Nicotine Replacement Therapy

Question 1

What is the role of nicotine replacement therapy in therapy?

Answer 1

NRT relieves nicotine withdrawal symptoms (craving, anxiety, agitation, irritability, and hunger), allowing the smoker to concentrate on psychological aspects of quitting.

Question 2

What are 5 contraindications to nicotine replacement therapy?

Answer 2

1. Recent MI
2. Cerebrovascular event
3. Arrhythmias
4. Patients with dentures (Gum contraindicated).
5. Age < 16 years

Question 3

Does nicotine replacement therapy have a PSA Self-Care Card?

Answer 3

Yes:
1. Smoking
2. NRT

Question 4

What is the preferred option for nicotine replacement therapy?

Answer 4

Nicotine patches

Question 5

What are 3 non-preferred options for nicotine replacement therapy and why?

Answer 5

1. Nicotine lozenges (only treat cravings, do not reduce them)
2. Nicotine spray (only treats cravings, does not reduce them)
3. Nicotine gum (only treats cravings, does not reduce them; contraindicated in patients with dentures)

Question 6

When are 16-hour nicotine patches (Nicorette) preferred?

Answer 6

If patients experience sleep disturbances with a 24-hour patch

Question 7

When are 24-hour nicotine patches (Nicabate) preferred?

Answer 7

If patients experience morning cravings.

Question 8

What is the recommended use of nicotine patches in patients with moderate-high nicotine dependency (smoking over 20 cigarettes a day)?

Answer 8

Apply 1 patch daily of either 21 mg/24 hours OR 15 mg/16 hours. Stop within 12 weeks

Question 9

What is the recommended use of nicotine patches in patients with low-moderate nicotine dependency (smoking 10 to 20 cigarettes a day)?

Answer 9

Apply 1 patch daily of either 14 mg/24 hours OR 10 mg/16 hours. Stop within 12 weeks

Question 10

What is the recommended progression for using nicotine patches?

Answer 10

1. Step (21mg/24 hours) for 6 weeks
2. Step 2 (14mg/24 hours) for 2 weeks
3. Step 3 (7mg/24 hours) for 2 weeks.

Question 11

What is an important practice point to consider with nicotine patches?

Answer 11

Apply to a different skin site each day, on a non-hairy, clean, dry site on the upper body (away from the heart) or outer part of the arm.

Question 12

What is a precaution to consider with nicotine patches?

Answer 12

May cause local irritation (can be treated with topical corticosteroid)

Question 13

What is a contraindication of nicotine patches?

Answer 13

Patients with eczema.

Question 14

What is the first-line treatment for nicotine dependence in pregnancy/breastfeeding?

Answer 14

Behavioural therapy

Question 15

Describe the use of nicotine replacement therapy in pregnancy.

Answer 15

Nicotine replacement therapy products are in Categories C and D, but often the level of nicotine is less than from cigarettes

Question 16

How should you manage pregnant/breastfeeding nicotine replacement therapy?

Answer 16

Refer to doctor to determine the risk/benefit ratio.

Question 17

What are 5 Specific questions to ask before recommending nicotine replacement therapy?

Answer 17

1. Number of cigarettes smoked a day
2. When are they smoked (how soon after wakening?
3. Previous attempts to quit?
4. Confidence and motivation to quit.
5. Recent MI, cerebrovascular event, arrhythmias?

Question 18

What are 15 pieces of non-pharmacological advice to give with nicotine replacement therapy?

Answer 18

1. Contact support services such as Quitline or community-based groups for extra support and tips
2. Avoid situations which were previously associated with having a cigarette
3. Carry a pen or gum for hand- to-mouth movement
4. Carry small snacks such as carrot sticks or lollipops
5. Regular exercise may help you quit and avoid putting on weight
6. Smokers who plan before they quit and set a date are more successful
7. When you get the urge remember the 4, D’s; Do something else, Delay, Deep breathe, Drink water
8. If you have a cigarette, it is not the end of your quit attempt but rather a setback
9. Come back to the pharmacy if experience any unpleasant side effects as it may mean that dose adjustment is necessary.
10. Store and dispose of products carefully and out of the reach of children as can be fatal. Patches still contain nicotine and are dangerous to children and pets.
11. If patients have severe addiction or have failed previous therapy they can combine a patch with a PRN form of nicotine replacement therapy
12. Do not continue smoking whilst using these products as increased amount of nicotine can produce toxic effects, such as feeling sick, vomiting, palpitations, and chest pain
13. Strict dosing reduces cravings more than PRN doses.
14. Gum and lozenges contain large amounts of sodium
15. Continue for 12 weeks (6 to 8 weeks for most people), including the taper period. May require longer for some.