Pulmonary Conditions & Tobacco cessation: Tobacco Cessation Flashcards
pack-year smoking history calculation
cigarette packs per day X number of years smoked
Who is recommended behavioral counseling over medication to quit smoking?
pregnant women
adolescents
smokeless tobacco users
light smokers = < 10 cigs/day
which enzyme does nicotine induce?
CYP450 1A2
will have supra therapeutic lvls of caffeine if intake stays same and reduce smoking
Women > 35yrs old who smoke should not take what type of birth control?
estrogen-containing oral contraceptives
Which NRT therapy is more effective than mono therapy
using long acting such as patch with short acting like hum or lozenge
NRT warnings
avoid immediate post MI period, life threatening arrhythmia, severe or worsening angina and pregnancy
NRT side effects
insomnia
Vivid dreams = patch
mouth/throat irritation = inhaler
nasal irritation = nasal spray
NRT patch notes
remove before MRI, highest adherence rate
NRT Gum/Lozenge notes
4mg ca reduce or delay weight gain
acidic food/bev decrease absorption, dont eat/drink 15min before or during use
Nicotine inhaler dosing
6-12 cartridges.day for 12 weeks, then taper frequency over 6-12 wks
use up to 6 months
Nicotine patch dosing schedule if > 10 cig/day
21mg X 6 wk
14mg X 2wk
7mg X 2 wk
Nicotine patch dosing schedule if < 10 cig/day
14mg X 6 wk
7mg X 2 wk
Nicotine gum/lozenge schedule if 1st cig < 30min after waking
4mg Q1-2h X 6wk
4mg Q2-4h X 3wk
4mg Q4-8h X 3wk
Nicotine gum/lozenge schedule if 1st cig > 30min after waking
2mg Q1-2H X 6wk
2mg Q2-4H X 3wk
2mg Q4-8H X 3wk
Bupropion should be started before
1 week before quit date
Bupropion for smoking dosing
150mg QAM X 3 days, then 150mg BID
MAx Dose: 300mg/day
use up to 6 months
Bupropion boxed warning
inc risk of suicidal thinking and behavior in children, adolescents, and young adults on antidepressants
Bupropion CI
seizure disorder
hx of anorexia/bulimia
concurrent use of MAOi, Linezolid or IV methylene blue
Bupropion Warnings
serious neuropsychiatric events
Bupropion Side effects
Dry mouth
insomnia
tremors
weight loss
How to delay weight gain with bupropion
take 1st dose when wake up, 2nd dose 8hrs after
Varenicline should be started…
1 week before quit date
Varenicline warnings
serious neuropsychiatric events, seizures
Varenicline side effects
nausea, insomnia, abnormal dreams, headaches
Varenicline notes
to dec nausea, take after eating with full glass of water
to dec insomnia, take 2nd dose before bedtime
if cant quit smoking on day 8, dec smoking by 50% in 1st 4 weeks, then 50% in weeks 5-8, then complete stop 12 wks
Varenicline dosing
Day 1-3 = 0.5mg QD
Day 4-7 = 0.5mg BID
Day 8+ = 1mg BID
If CrCl < 30, then 0.5mg BID max doseW
which meds should be avoided in seizures?
Bupropion and Varenicline
Which med should be used in depression
Bupropion
If weight gain, which med should be used
gum, lozenge, and bupropion = all delay weight gain
If getting vivid dreams from patch then it should be removed….
remove before bed time, put new one on in the morning so wear ~ 16yrs/day
Nicotine patch notes
dont cut patch
never wear more than 1
rotate sites, try to not use same site until 1 week after
