Smoking Cessation

Question 1

Nicotine gum dosing

Answer 1

24 cigarettes per day use 4 mg gum up to 24 daily

Question 2

Duration for nicotine gum

Answer 2

12 wks

Question 3

Nicotine inhaler dosing and duration

Answer 3

6-16 cartridges per day

6 months duration

Question 4

Nicotine nasal spray dosing and duration

Answer 4

1-2 sprays per hour, max is 10 sprays per hours and 80 sprays per day

Question 5

Nicotine patch ADRs

Answer 5

Local skin reaction, insomnia, inc HR, vasodilation

Question 6

Nicotine lozenge dosing

Answer 6

If 1st cigarette smoked within 30 mins of waking use 4mg lozenge, otherwise use 2mg lozenge
1 lozenge q1-2 hrs x 6wks then
1 lozenge q2-4 hrs x 3 wks then
1 lozenge q4-8 hrs x 3 wks

Question 7

Bupropion MOA

Answer 7

Antidepressant that helps with withdrawal symptoms by inhibiting uptake of serotonin, NE and dopamine

Question 8

Bupropion precaution

Answer 8

Seizure risk especially if eating disorder

Question 9

Bupropion ADRS

Answer 9

Insomnia dry mouth HTN

Question 10

Bupropion dosing

Answer 10

Start 2 wks before quit date, can use up to 6 months

Question 11

Varenicline MOA

Answer 11

Partial nicotinic receptor agonist reduces craving and withdrawal sxs, takes pleasure out of smoking

Question 12

Varenicline precautions

Answer 12

Nausea, take with full glass of water

Question 13

Varenicline ADRs

Answer 13

GI, sleep disturbance, abnormal dreams, anxiety, irritability, depression, angry outbursts, suicidal ideation

Question 14

Dosing Varenicline

Answer 14

Start one week before quit date and continue for 12 wks

Question 15

Second line agents not FDA approved

Answer 15

Clonidine

Nortryptiline

Question 16

What can NRT not be combined with?

Answer 16

Varenicline- nicotinic receptors already blocked

Question 17

Pharmacokinetics of nicotine

Answer 17

Well absorbed in mucus membranes
Widely distributed crosses BBB and placenta
Inhibits MAO
Can induce metabolism of beta blockers BDZ opioids and theophylline