Pharmacotherapy for Smoking Cessation Flashcards
What strategy is use of nicotine patch/gum/e-cigarette? What is the goal of use?
Harm reduction: Replaces harmful inhaled tobacco smoke with nicotine (full agonist replaced with a full agonist) The goal is prevent withdrawal and make withdrawal easier. Side effects are similar to smoking too many cigarettes at one (activating).
What antidepressant can be used for smoking cessation? How does it work? What are side effects?
Bupropion. Blocks neuronal reuptake/recycling of NE and DA. Generally increases alertness, attention, motivation. Common side effects: Dry mouth, insomnia, nausea, tremor, rash. Serious side effects: Boxed Warning for psych worsening, depression, agitation, anziety, suicidality < 25 yrs old, seizures (in those with epilepsy or eating disorder), inducing mania.
What is the most effective smoking cessation drug? MOA? Side effects? Caveat?
Varenicline. Partial nicotine receptor agonist (replace a full agonist–nicotine–with a partial agonist: “some of the rush, but not all”). Side effects: Abnormal dreams! Insomnia, vomiting, constipation, suicid, HAs, agitation, depression, psychosis. Caveat: Cardiovascular effects may not be reduced…
What is combination therapy? Does it work?
Adding support sessions definitely improves outcomes of medical management. Also, combo drug regiments (varenicline + higher nicotine replacement therapy) can be helpful.
