Smoking Cessation

Question 1

What’s the best approach to quitting, if no CI?

Answer 1

Use a combo of 2 nicotine pdts

Question 2

Which pdt shouldn’t be used with Nicotine products? Why?

Answer 2

Varenicline (shouldn’t be used with nicotine pdts)

Due to increased SE

Question 3

What’s the “5 A’S” model for treating tobacco use & dependence?

Answer 3

Ask about tobacco use

Advise to quit

Assess

Assist

Arrange

Question 4

Smoking and CYP 450 system? Effect once smoker quits?

Answer 4

Smoking causes an induction of some isoforms of CYP450 system.

T/4, smokers who quit can experience SEs from SUPRAtherpeutic drugs levels of caffeine, estrogens (oral), theophylline, Fluvoxamine, Olanzapine and clozapine

Question 5

List drugs that a recently quit smoker may experience SEs from?

Answer 5

Caffeine

Estrogen (oral)

Theophylline

Fluvoxamine

Olanzapine

Quetiapine

Clozapine

Question 6

Vaccinations req for smokers?

Answer 6

Pneumococcal (Pneumovax 23)
If >= 65 yrs + > 5 yrs since last vaccine, a 2nd dose is needed

Annual flu vaccine

Question 7

Which nicotine pdts are preg cat C? Other non-nicotine?

Answer 7

Gum and lozenge

Bupropion - cat. C

Question 8

List nicotine replacement therapies (NRT)

Answer 8

OTC
Nicotine gum (Nicorette, Nicorelief, Thrive)

Nicotine patch (NicoDerm CQ)

Nicotine Lozenge (Commit, Nicorelief, Nicorette)

Rx
Nicotine inhaler (Nicotrol inhaler)

Nicotine nasal spray (Nicotrol NS)

Question 9

MOA of Bupropion?

Answer 9

Blocks neural re-uptake of dopamine and/or NE and blocks acetylcholinergic receptors

Question 10

Moa of Varenicline?

Answer 10

Partial neuronal alpha4-beta2 nicotinic receptor agonist

Question 11

Brand name of Bupropion SR?

Answer 11

Zyban

Buproban

Question 12

CI to Bupropion SR (Zyban, Buproban)?

Answer 12

Seizure disorder

Pts receiving other dosage forms of bupropion

Question 13

Warnings associated with Bupropion SR (Zyban, Buproban) use?

Answer 13

Caution in pts with underlying psychiatric disorders

Accidents have occurred while driving or operating machinery

Avoid use in pilots, air traffic controllers, commercial truckers, bus drivers

Question 14

SEs of Bupropion SR (Zyban, Buproban)?

Answer 14

Dry mouth

Insomnia

Tremors/seizures (dose-related)

Question 15

Bupropion SR (Zyban, Buproban) and sexual dysfunction?

Answer 15

No effects on 5HT (serotonin) => NO sexual dysfunction

Question 16

Max daily dose of Bupropion SR (Zyban, Buproban)? Why?

Answer 16

Don’t exceed 450 mg/d

Dut to seizure risk

Question 17

Whats req when dispensing Bupropion SR (Zyban, Buproban) & Varenicline (Chantix)?

Answer 17

MedGuide

Question 18

Brand name of Varenicline?

Answer 18

Chantix

Question 19

How do u start Bupropion SR (Zyban, Buproban) and Varenicline (Chantix)?

Answer 19

Start taking them 1 week B4 quit date

Question 20

Warnings associated with Varenicline (Chantix)?

Answer 20

Angioedema

Serious skin rxn

Caution in pts with underlying psychiatric disorders

Avoid in pilots, air traffic controllers, commercial truckers, bus drivers

Question 21

SEs of Varenicline (Chantix)?

Answer 21

Nausea (~30% and dose dependent)

Insomnia

Abnormal dreams

Constipation

Flatulence

Vomiting

Question 22

How do u reduce nausea from Varenicline (Chantix)?

Answer 22

Can lower dosage and/or take with food + a full glass of water

Question 23

How do u reduce insomnia from Varenicline (Chantix)?

Answer 23

Take 2nd dose at dinner rather than bedtime

Question 24

How do u use nicotine gum?

Answer 24

Chew gum slowly, until a “peppery” or “flavored” taste emerges

Then park gum btw cheek to facilitate nicotine absorption thru oral mucosa

Cont to slowly and intermittently chewed and parked for about 30 mins or until taste dissipates

Question 25

Nicotine gum; nicotine lozenge and acidic beverages?

Answer 25

Avoid acidic beverages (coffee, juices, soft drinks) and eating for 15 mins B4 or during chewing

Bcuz they interfere with buccal absorption of nicotine

Question 26

What’s the dose of nicotine gum and lozenge?

Answer 26

At least 1 piece Q1-2hrs

Question 27

How do u use Nicotine inhaler (Nicotrol inhaler) - rx only?

Answer 27

Freq, continuous puffing for 20 mins is advised with each cartridge

Question 28

How long is Nicotine inhaler (Nicotrol inhaler) good for once opened?

Answer 28

1 day only

Question 29

Storage of Nicotine inhaler (Nicotrol inhaler)?

Answer 29

Store above 40 degrees F

Delivery of nicotine from inhaler declines significantly below
40 degrees F

Keep in inside pocket or other warm area in cold weather

Question 30

How do u use nicotine lozenge?

Answer 30

Should be allowed to dissolve in mouth

Don’t chew or swallow it

Question 31

Howz Nicotine nasal spray (Nicotrol NS) used?

Answer 31

Best delivered with head tilted slightly back

Question 32

How long does it take for Bupropion SR (Zyban, Buproban) and Varenicline (Chantix) to start working?

Answer 32

About 1 wk

Question 33

When do u dose adjust Chantix (Varencline)?

Answer 33

Renal dysfunction (CrCl < 30ml/min)

Question 34

What age is NRT approved for?

Answer 34

> = 18 yrs

Question 35

What strength of gum is recommended for use if < 25 cigarettes/day is used? > 25 cigs/day?

Answer 35

< 25 cigs/day = 2 mg

> 25 cigs/day = 4 mg

Question 36

There’s a strong correlation btw counseling intensity and quitting success?

Answer 36

T

Counseling sessions should be > 10 mins in length
+
number of sessions should be >= 4