Smoking Cessation Flashcards
• Cigarette smoking remains the greatest
single cause of
preventable illness and
premature death
In the United States, smoking kills more
n 443,000 adults each year; this is
about 1 of every 5 deaths
“5 A’s” Model for Treating
Tobacco Use and Dependence
• Ask (screen all patients for tobacco use)
• Advise tobacco users to quit
• Assess willingness to make a quit attempt
• Assist with quitting (offer medication and
provide or refer to counseling)
• Arrange follow-up contacts, beginning
within the first week after the quit date
Initial Therapy Selection - First line
nicotine replacement therapy,
varenicline, and bupropion
Initial Therapy Selection - AIM
reduce symptoms of nicotine
withdrawal
Initial Therapy Selection
- choices based on
patient preference with
some contraindications to certain drugs
Initial Therapy Selection - Most recommended
varenicline or a
combination of 2 NRT products
gum doubles
the cessation success rate
gum ADR
Mouth and throat
soreness, jaw muscle ache, eructation
(belching), and hiccups
gum use
Chew the gum slowly and intermittently for
about 30 minutes
gum education - avoid
Avoid eating or drinking while chewing and
for 15 minutes before chewing
Nicotine Lozenges ADR
Adverse effects: Mouth irritation,
dyspepsia, nausea, and hiccups
Nicotine Lozenges use
Allow lozenge to dissolve in mouth over 20
to 30 minutes
Nicotine Lozenges no eating or drinking for
• No eating or drinking for 15 minutes before
dosing and while the lozenge is in the
mouth
Nicotine Lozenges do not
chew or swallow the lozenge
NicoDerm CQ and Nicotrol ADR
Adverse effects: Short-lived erythema,
itching, and burning occur under the patch
NicoDerm CQ and Nicotrol applied
Applied once a day to clean, dry, nonhairy
skin of the upper body or upper arm
NicoDerm CQ and Nicotrol application site
Application site should be changed daily
and not reused for at least 1 week
Nicotine Inhaler ADR
Adverse effects: Dyspepsia, coughing,
throat irritation, oral burning, and rhinitis
Nicotine Inhaler frequent puffing over
20 min
Nicotine Inhaler should not be used with
patients with
asthma
Nicotine Nasal Spray ADR
• Adverse effects: Rhinitis, sneezing,
coughing, watering eyes, and nasal and
throat irritation
Nicotine Nasal Spray levels
rise rapidly
Nicotine Nasal Spray provides some of the
subjective
pleasure associated with cigarettes
Bupropion SR [Zyban,
Buproban] class
atypical antidepressant
Bupropion SR [Zyban,
Buproban] reduces
Reduces the urge to smoke and some
symptoms of nicotine withdrawal, such as
irritability and anxiety
Bupropion SR [Zyban,
Buproban] adr
Dry mouth and insomnia
Bupropion SR [Zyban,
Buproban] less effect than
combination NRT or
varenciline
Varenicline [Chantix, Champix] is a
• Partial agonist at nicotinic receptors
Varenicline [Chantix, Champix] most effective
Most effective aid for smoking cessation
Varenicline [Chantix, Champix] class
Atypical antidepressant
Varenicline [Chantix, Champix] ADR
Adverse effects: Nausea, sleep disturbances,
headaches, abnormal dreams, constipation, dry m
Varenicline [Chantix, Champix] serious
• Serious neuropsychiatric effects
Varenicline [Chantix, Champix] can have
Cardiovascular events
Varenicline [Chantix, Champix] us athorits have banned
U.S. authorities have banned the use of varenicline by
truck drivers, bus drivers, airplane pilots, and air traffic
controllers
Products Not Recommended
• Naltrexone • Silver acetate • Beta blockers • Benzodiazepines • Antidepressants other than bupropion SR and nortriptyline • Electronic cigarettes (e-cigarettes)
Follow-up
• Follow-up in-person or by phone in 1 to 2 weeks after initiation of any therapy to monitor for adverse effects, reinforce adherence to medication, and provide support
