PULM - smoking cessation

Question 1

nicotine replacement therapy delivery methods

Answer 1

gum, lozenge, patch, inhaler, spray; all bypass gut because low oral bio & nicotine is a gastric irritant

Question 2

nicotine pharmacokinetics

Answer 2

rapidly abs, abs from skin & mucous membranes, half life 1-2hrs, metabolized by CYP2A6, major metabolite is cotinine (used as a marker because 15hr half life)

Question 3

varenicline MOA, Tx duration, SE, use with which population

Answer 3

partial nicotine agonist; BID x12wks, target quit date 1wk after starting; nausea, depression, agitation, hostility, behavioural changes, suidicality; use in pt with CV disease (small incr in CV risk)

Question 4

nicotine MOA (PD)

Answer 4

a nicotinic receptor agonist, incr dopamine release (stimulates reward pathway), also incr release of ACh, NE, serotonin, beta-endorphin, GABA; chronic exposure leads to nicotinic receptor upregulation

Question 5

nortriptyline drug type, MOA, SE

Answer 5

antidepressant (anticholinergic); inhibit reuptake of serotonin and NE; anticholinergic SE

Question 6

non-pharm smoking cessation therapy

Answer 6

cognitive behavioural therapy, acupuncture, hypnosis

Question 7

nicotine withdrawal Sx

Answer 7

sleep disturbance, decr concentration, irritability, depression, restlessness, incr appetite

Question 8

bupropion MOA, Tx duration, SE

Answer 8

inhibit reuptake of dopamine and NE, may also act as nicotinic receptor antagonist; BID x7-12 wks, target quit date in 2nd wk; insomnia, dry mouth, nausea, seizures! contraindicated in pt with seizures; impulsive/suicidal behaviour in youth

Question 9

comment on effectiveness of NRT, bupropion, and varenicline

Answer 9

varenicline > NRT = bupropion (no trials compared varenicline with bupropion)