smoking cessation

Question 1

name nicotine replacement drugs

Answer 1

nicotine, varenicline, buproprion

Question 2

MOA of nicotine replacement drugs

Answer 2

• In CNS activates nicotinic Ach receptors, increasing NT levels and causing euphoria and relaxation.
• this also prevents withdrawal symptoms by maintaining receptor activation.
• varenicline = partial agonist of nicotinic receptor = reduces withdrawal and rewarding effects of smoking by preventing binding of tovacco derived nicotine to receptors
• bruproprion increases conc of NA and dopa in synapse by stopping reuptake

Question 3

SE nicotine replacement drugs

Answer 3

• local irritation or GI upset if oral
• palpitations and abnormal dreams
  varenicline = nausea, headache, insomnia and abnormal dreams. rare = suicidal ideattion

buproprion = dry mouth, GI upset, neuro and psych effects e.g. headache, low conc, dizzy, insomnia, depression, agitation
- hypersensitviity

Question 4

Nicotine replacment therapy caution use where?

Answer 4

• heamodynamically unstable e.g. post MI
• both used carefully if at risk of seizures - e.g. hx, head injury, alcohol use as threshold lowered
• careful in psych disease due to suicidal ideation
• careful in hepatic and renal impairment

Question 5

what enzyme is buproprion metabolised by

Answer 5

• cyp450

Question 6

what interactions does buproprion have

Answer 6

• if used with MOA-i/TCA = increased SE

Question 7

What is the indication for continuous release patch vs immediate release

Answer 7

• continuous to prevent cravings

- immediare - stops urge to smoke

Question 8

when should you start NRT ?

Answer 8

• before cessation attempt or when stopped smoking.

Question 9

dosage of NRT

Answer 9

If smoke > 10/day = rx high dose patch for 6-8 weeks, then wean to medium, then low dose patch for 2 weeks beach before stopping

Question 10

when to start buproprion or varenicline

Answer 10

• 1-2 weeks before target quite date .

- low start dose, titrate over 1st week and continue 9-12 weeks. stop if attemp of cessation fails

Question 11

should you wear NRT patch overnight

Answer 11

no - causes insomnia

Question 12

where to apply NRT patch

Answer 12

dry hairless patch, rotate site each time

Question 13

if patient has smoking cessation drugs on NHS and fails. then how long after can they get another prescription

Answer 13

6 months