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Pulmonology 2 > Pharm Smoking Cessation > Flashcards

Pharm Smoking Cessation Flashcards

1
Q

ID a drug product as nicotine replacement product

A

Nicotine gum - Nicorette®, Thrive®, Nicorelief®

Nicotine lozenge - Commit®, Nicorette®

Nicotine nasal spray - Nicotrol NS®

Nicotine oral inhaler - Nicotrol®

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2
Q

ID the 5 As that clinicians should employ when advising a patient who smokes

A
  • Ask
  • Advise
  • Assess
  • Assist
  • Arrange
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3
Q

Ask

A

ask about tobacco use: ID and document status for each patient at each visit

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4
Q

Advise

A

urge every tobacco user to quit

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5
Q

Assess

A

assess the willingness to quit

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6
Q

Assist

A

assist in quit attempts: by providing cessation therapies (behavioral + pharmacotherapy)

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7
Q

Arrange

A

arrange f/u w/i the first week after the quit date to evaluate meds for efficacy and adverse effects

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8
Q
  • For patients who are unwilling to quit, provide interventions to increase future quit attempts
  • this falls under “assist”
  • What are the 5 Rs?
A
  • relevant
  • risks
  • rewards
  • roadblocks
  • repeat
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9
Q

ID the benefits and place in therapy for behavioral counseling for smoking cessation

A
  • providing 4-7 + sessions increase cessation rates
  • longer sessions (>10min) are associated w/ increased success
  • the more formats you provide, the higher the quit rates (QUIT line; pamphlets not as effective)
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10
Q

Contraindications for nicotine gum

A
  • TMJ - vigorous chewing can exacerbate
  • Dental appliances - can be damaged by gum or cause difficulties
  • Poor dentition - difficulty chewing to get max effect
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11
Q

When to use the 2mg dose of nicotine gum

A
  • <25 cigs/day

- if you smoke your first cig more than 30 mins after waking up

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12
Q

When to use the 4mg dose of nicotine gum

A
  • > or equal to 25 cigs/day

- if you smoke your fist cig w/i 30 min of waking up

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13
Q

What is the recommended dosing schedule for nicotine gum?

A
  • 1st 6 weeks: 1 piece every 1-2 hrs
  • next 3 weeks: 1 piece every 2-4 hrs
  • additional 3 weeks: 1 piece every 4-8 hrs
  • then dc
  • max benefit from scheduled use vs. waiting for craving
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14
Q

what is the daily max number of pieces of nicotine gum?

A

24

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15
Q

What is the appropriate chewing technique for nicotine gum

A
  • “chew and park”
  • chew gum until you taste a peppery/minty flavor then park b/w gum and cheek for 30 min. to help w/ absorption
  • repeat until taste is gone
  • avoid food/drink 15 min. before or during treatment
  • avoid acidic beverages before and during use
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16
Q

Adverse effects of nicotine gum

A
  • mouth soreness
  • dyspepsia
  • hiccups
  • jaw ache
  • n/v
  • abdominal pain
  • constipation
  • excessive salivation
  • mouth ulcers/irritation
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17
Q

based on smoking hx, how do you select the correct dose for a nicotine lozenge?

A

same as for the gum

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18
Q

recommended dosing schedule for nicotine lozenge

A
  • weeks 1-6: 1 lozenge every 1-2 hrs
  • weeks 7-9: 1 lozenge every 2-4 hrs
  • weeks 10-12: 1 lozenge every 4-8 hrs
19
Q

adverse effects of nicotine lozenges

A
  • heartburn
  • hiccups
  • coughing
  • n/v/d
  • HA
  • abdominal pain
20
Q

what is the daily max number of nicotine lozenges?

A

do not use more than 5 lozenges in 6 hours or more than 20 lozenges per day

21
Q

What NRT has the most rapid onset and most closely mimics the nicotine concentrations in the brain?

A

nicotine nasal spray

22
Q

Which NRT has the highest dependence potential?

A

nicotine nasal spray

23
Q

What should you avoid before using the NRT products orally?

A

food and drink

24
Q

contraindications for the nicotine nasal spray

A

reactive airway dz (asthma)

25
Q

adverse effect associated w/ nicotine nasal spray

A

moderate to severe nasal irritation

26
Q

adverse effects associated w/ the nicotine inhaler?

A
  • local mouth irritation
  • coughing
  • rhinitis
27
Q

directions with the nicotine patch

A
  • worn for 24 hrs, removed and replaced each morning
  • apply patch as soon as you wake up
  • remove old patch and apply new one to hairless location b/w neck and waist
28
Q

how to manage skin irritation secondary to the nicotine patch

A
  • rotate patch site

- use 1% hydocortisone cream

29
Q

how to manage insomnia secondary to the nicotine patch

A

-remove patch prior to bedtime

30
Q

dosing strategy for varenicline (Chantix)

A
  • days 1-7 before quit date: 0.5mg daily X 3 days, 0.5 mg BID X 4 days
  • maintenance dose (starting day 8): 1 mg BID x 11 weeks
31
Q

side effects of varenicline (Chantix)

A
  • CNS side effects: insomnia, abnormal dreams, HA, suicidal ideation, depression, irritability, anxiety, agitation
  • GI: nausea (very high occurrence), constipation, dysguesia, abdominal pain
  • CVS: chest pain, angina
32
Q

dosing strategy for buproprion (Zyban)

A
  • begin 1-2 weeks before quit date
  • 150 mg PO daily x 3 days, increase to 150mg BID for 7-12 weeks
  • consider maintenence of 150mg BID x 6 mos
  • can be used w/ or w/o NRT
33
Q

side effects of buproprion (Zyban)

A
  • insomnia
  • dry mouth
  • tremor
  • rash
  • HA
34
Q

how to manage insomnia secondary to buproprion (Zyban)

A

take evening dose earlier

35
Q

contraindications to buproprion (Zyban)

A

avoid in patients w/ a hx of seizures, eating disorders or use of MAOI w/i 14 days

36
Q

special populations

A
  • should always receive behavioral modification
  • includes:
  • light smokers (<10 cigs/day)
  • pregnant/breastfeeding
  • psychiatric illness
  • CVD
  • adolescents
  • pts concerned w/ weight gain
  • hospitalized pts
37
Q

light smokers

A
  • little evidence supporting effectiveness of therapies

- may need dosing adjustments

38
Q

pregnant/breastfeeding

A
  • to be be encouraged to quit w/o pharmacotherapy
  • the earlier the better
  • use smallest effective dose but consider risk vs. benefit
  • safety date for NRT is variable but less nicotine is delivered to fetus than w/ cigs
  • buproprion may cause miscarriage and congenital anomalies in 1st trimester
  • no data for varenicline
39
Q

psychiatric illness

A
  • higher smoking prevalence
  • greater tobacco related morbidity and mortality
  • greater risk of relapse during cessation attempts
  • many psych meds interact w/ smoking cessation
  • options: NRT; reasonable success w/ buproprion; can consider varencicline but monitor
40
Q

CVD

A
  • NRT: overall safe, may consider lower dose; patch generally safe but not recommended in recent MI
  • buproprion: safe and effective
  • varenicline: small increased risk of certain CV ADRs - weigh benefit vs. risk
41
Q

Adolescent/peds

A
  • behavioral modification is mainstay
  • patch or gum has shown to be safe
  • in the US a prescription is required to allow people under 18 to buy patches or gum
42
Q

pts concerned w/ wight gain

A
  • no tx prevents it
  • lozenge, gum and buproprion may delay it
  • general gain is fewer than 10 pounds but can be up to 30
  • be honest about it
  • encourage exercise and healthy diet - make referrals if needed
43
Q

hospitalized patients

A
  • unique opportunity - smoke free hospital policy and possible motivation to quit d/t illness that led to hospitalization
  • combo counseling and transdermal patch have been used
  • post-hospitalization f/u is key

Pulmonology 2 (17 decks)

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