Smoking Cessation Flashcards
therapy OTC
Nicorette : gum
Nicotine patch : Nicoderm CQ, Habitrol
Nicotine Lozenge : Commit Nicorette
Rx therapy
Nicotine Inhaler : nicotrol
Nicotine Nasal Spray : Nicotrol NS
Sustained release Bupropion ( zyban )
Varenicline ( Chantix ) : RX
Nicotine Gum
Short acting
Peaks 20 mins after starting to chew ( chew and park ) lasts for about 30 mins ( dont eat or drink 15 mins before or after)
Pregnancy category D
I smoke a pack a day: 20 cigarettes: 2 mg gum recommended = if smokes < 25 cigs per day
4 mg = if > 25 cigs per day
1 gum q 1-2 hours x 6 weeks, then 1 gum q 2-4 hours x3weeks then 1 gum q 4- 8 hours x3weeks
Max 24 pieces /day up to 12 weeks
SE: dyspepsia, hiccups, mouth soreness, arrhythmias
Nicotine patch
Simplest therapy
Can wear 24 hours a day or take it off before bed to prevent sleep insomnia
If they wake up at night with urge. Can use a gum or lozenge for that period of time
If they smoke >10 = 21 mg / 24 x4wk, 14 mg x2wk, 7 mg x2wk
If ≤ 10 <45 kg follow 8 week plan
14mg x 6wk, 7 mg x2wk
SE: local skin rxn, insomnia, vivid dreams.
Dont cut patch and remove patch before MRI
Lozenge
Not a gum dont chew. Dont eat drink 15 mins before or during. Dont use if you have dentures
2 or 4 mg
If first cig within 30 mins of awakening use 4 mg
If 1st cig after 30 min of awakening use 2 mg
Wk1-6: 1 lozenge 1-2 hours ( 6 wk)
Wk 7-9 one lozenge q 2-4 Hr ( 3 wks)
Wk 10 -12 : one lozenge every 4- 8 hours ( 3 wks)
Max 5 lozenges q 6 hours or 20 lozenges per day
Nicotine inhaler
Rx only
Short acting. Flexible dosing
Frequent continuous puffing ( 20 mins )
Preg D
Nicotine nasal spray
Rx
Fast abs: potential for abuse
Just like gum, lozenge, inhaler flexible dosing
Preg D
Nasal max of 40 doses ( 80 sprays per day )
Every dose is 2 sprays, 1 spray in each nostril
SE: nasal irritation, arrhythmia
SR buproprion
Zyban
Worry about seizures
Bulemia (they have electrolyte imbalance higher seizure risk ) , alcoholic , elliptic, : not a good recommmendation
Zyban is activating : dont give to anxious patients
dosage start 1 - 2 weeks before quit date
150 mg q am for 3 days then 150 mg BID
7-12 weeks for up to 6 months for maintenance
SE: insomnia , dry mouth
Pregnancy category C
Varenicline
Chantix
MOA: partial neuronal alpha 4 and b2 nicotinic receptor agonist. Decreases craving / withdrawal, prevents nicotine stimulation of Mesolimbic dopamine system associated with nicotine addiction
Yes you can use in patients with cardiovascular disease.
• start 1 week before set quit date for 12 weeks total. ( can choose quit date up to 35 days after starting Chantix )
Days 1-3: 0.5 qd
Days 4-7 : 0.5 mg BID
Days 8- end tx: 1 mg BID
* additional 12 weeks if failed to quit after 12 weeks
Caution: renal ( CrCl < 30 ) : you would dose adjust. Max 0.5 mg BID max
Seizure ( D/C)
Pregnancy category insufficient ( dont recommend )
Cigarette smoking induces Cyp1a2
Cyp1a2 substrates theophylline, olanzapine, clozapine, fluvoxamine ( Luvox ). These may need a higher dose.
Caffeine is a cyp1a2 substrate. Counsel patients to reduce caffeine as they decrease smoking
