Smoking cessation

Question 1

Smoking cessation

Answer 1

Counseling and medications are more effective than both alone.

the more frequent the counseling the more the success

Question 2

1st line for smoking cessation

Answer 2

Long acting + Short acting nicotine replacement therapy
or
Nicotine patch with bupropion SR

Question 3

Ecigs

Answer 3

Not recommended as alternative

Question 4

Smoking + Drug interactions

Answer 4

Induces CYP1A2 and Women >35 who smoke should not be taking oral contraceptives

Question 5

Exceptions to drug treatment

Answer 5

Pregnant women, adolescents, and light smokers (less than 10 cigs).

Instead, use behavioral counseling.

Question 6

Vaccines in smokers

Answer 6

Smokers age 19-64 should receive PPSV23 and annual flu shot.

Question 7

Nicotine Patch

Answer 7

NicoDerm CQ
LA NRT
Dose: over 10 cigs start with 21mg for wk 1-6, then 14mg wk 7-8, then 7mg wk 9-10

less than 10 cigs start with 14mg for wk 1-6 then 7mg wk 7-8

SE: Vivid dreams (remove patch after 16 hours)
Remove before MRI

Question 8

Nicotine products

Warnings, Notes

Answer 8

Warnings: Avoid in post-MI period, w/ arrhythmias, angina and pregnancy

ID required to purchase nicotine products over 18

Question 9

Nicotine polacrilex gum

Answer 9

Nicorette
Short acting NRT
1st cigarette w/in 30min: start with 4mg
1st cigarette after 30min: start with 2mg

Dosing (wait 15 minutes after eating or drinking):
wk 1-6 = 1 q 1-2 h
wk 7-9 = 1 q 2-4 h
wk 10-12 = 1 q 4-8 h
Chew slowly tine tingle then park and repeat

Min: 9 pieces/day for first 6 weeks
Max: 24 pieces/day

Reduces or delay weight gain

Question 10

Nicotine polacrilex lozenges

Answer 10

Nicorette, Nicorette Mini
Short acting NRT
1st cigarette w/in 30min: start with 4mg
1st cigarette after 30min: start with 2mg

Dosing:
wk 1-6 = 1 q 1-2 h
wk 7-9 = 1 q 2-4 h
wk 10-12 = 1 q 4-8 h

Min: 9 pieces/day for first 6 weeks
Max: 20 pieces/day

Reduces or delay weight gain

Question 11

Nicotine inhaler

Answer 11

Nicotrol Inhaler
Warnings: bronchospastic or reactive airway disease

each cartridge provides about 20min of continuous puffing (short frequent breaths) clean mouth piece

Question 12

Nicotine Nasal Spray

Answer 12

Nicotrol NS
Warnings: bronchospastic or reactive airway disease

Tilt head back and spray. DO NOT INHALE. wait 5 minutes before driving

Question 13

Bupropion

Brand, Dosing, BBW, CI, SE

Answer 13

Zyban (Smoking cessation), Aplenzia XL (Seasonal affective disorder)
DNRI
Dosing: 150mg qam x3 then 150mg bid (at least 8 hrs apart) (MAX: 300mg/day) Start 1 wk prior to quit date

BBW: Risk of suicide thinking and behavior in children, adolescents, and young adults taking Anti-depressants.

CI: Seizure hx, bulimia/anorexia, and MAO i within 14 days

SE: Dry mouth, insomnia, agitation, HA

Question 14

Varenicline

Answer 14

Chantix
Partial a4b2 nictonic receptor agonist

Warnings: neuropsychiatric events, seizures, Increased alcohol effects, amnesia(blacking out), sleep walking.

Dose: Day 1-3: 0.5mg qd, then day 4-7 0.5mg bid. then day 8 (quit date and beyond) 1mg bid

SE: Nausea, insomnia, HA

Can use for another 123 weeks to maintain success