SmokingCessationFC Flashcards
general tx algorythm for tobacco
- use one singe agent
- Use 2 nicotine products
- Use nicotine product +buproprion
- 2 nicotine products plus bupoprion.
required vaccines for smokers
pneumococcal (23) and Flu each fall
The 5 A’s
Ask about tobacco use
Advise to quit
Assess (ready to quit? / challenges)
Assist (w/ meds)
Arrange (F-)
Nicoderm CQ
that is th patch
habitrol
nicotine patch
Commit
nicotine lozenge
nicorelief and Nicorrette
nicotine gum or lozenge
Nicotine Replacement Therapy (NRT) routes
Nicotine gum THRIVE
Nicotine inhaler
Nicotine nasal spray
Nicotine patch Nicoderm CQ
Nicotine lozenge (COMMIT) BRAND NAME
what are the OTC NRT brands
Nicorette, Nicorelief, Thrive
SE OF OTC brands of NRT
Side effects: dyspepsis, mouth soreness, hiccups, jaw aches
CI OF OTC brands of NRT
-CI: recent MI (within 2 weeks), life-threatening arrhythmia, severe or worsening angina, pregnancy
what dose of nicotine to use if pt > 25 cig/day
-Use 4mg if smoke >25 cigs/day
advantage of brands of OTC NRT
Reduces or delays weight gain
Counseling for Gum (THRIVE)
how to chew park
what types of food interefere
-Gum should be chewed slowly until “peppery” or “flavored” taste emerges, then “parked” between cheek and gum to facilitate nicotine absorption through the oral mucosa (30 mins)
-Acidic beverages interfere with the buccal absorption of nicotine, so eating and drinking anything except water should be avoided for 15 mins before and after
how ofte should patients be using the gums?
-Patient often do not use enough gum to obtain optimal clinical effects. Instruct to use at least 1 piece q1-2h
nicotrol inhaler OTC or RX ?
Rx
why is it good? The nicotrol inhaler?
mimics the smoking action and provides coping mechanism
SE of nicotrol inhaler
Side effects: local irration in the mouth and throat, coughing, rhinitis, headache
CI to nicotrol inhaler
-CI: recent MI (within 2 weeks), life-threatening arrhythmia, severe or worsening angina, pregnancy
Counseling for nicotrol inhaler
-Frequent, continuous puffing for 20 mins
-Only good for one day. 1 cartridge= 1 day
Clean mouthpiece with soap and water regularly
in cold weather, the inhaler and cartridge should be kept in an inside pocket or other WARM areas
-Acidic beverages interfere with the buccal absorption of nicotine, so eating and drinking anything except water should be avoided for 15 mins before and after
Nicotrol Nasal Spray
adr
ci
adv fastest or slowest?
avoid in
RX
Side effects: nasal irritation, nasal congestion, changes in taste and smells
CI: recent MI (within 2 weeks), life-threatening arrhythmia, severe or worsening angina, pregnancy
Fastest delivery system (rapid relief)
Avoid in severe reactive airway disease
Counseling for Nasal Spray
Patient should not sniff, swallow, or inhale through the nose while administering doses, as this increases irritating effects
the spray is best delivered with the head tilted slightly back
Nicotine Patch
Se
ci
Dose
how to change dose if sleeping issues
OTC or Rx
Side effects: local skin reactions, insomnia, vivid dreams
CI: recent MI (within 2 weeks), life-threatening arrhythmia, severe or worsening angina, pregnancy
Use 21mg if smoke >10 cigs/day
-Worn for 24 hours, or for 16 hours to avoid insomnia
Counseling for Patch
as soon as Patient wakes in morning, place the patch on a relatively hairless area, typically between the neck and waist, rotating the site to reduce irritation
use hydrocortisone or triamcinolone for skin irriation
Nicotine Lozenge
Se
Ci
not shown to be effective in whom
dose?
OTC (COMMIT)
Side effects: nausea, hiccups, heartburn
-CI: recent MI (within 2 weeks), life-threatening arrhythmia, severe or worsening angina, pregnancy
not shown to be effective in pregnant smokers
Use 4mg if 1st cig is <30 mins after waking
Counseling for Lozenge
Allow lozenge to dissolve in the mouth
-Acidic beverages interfere with the buccal absorption of nicotine, so eating and drinking anything except water should be avoided for 15 mins before and after
-Patients should use 1 lozenge every 1-2 hours
which brand of buproprion is for smoking cessation?
zyban
which brand of buproprion is for depression?
wellbutrin
Buproprion moa
can use in combo w/
bbw
ci
adr
Blocks reuptake of dopamine and/or norepinephrine and Blocks nicotinic receptors
Can be used in combo with NRT
BBW: serious neuropsychiatric events
Contraindications: seizures, eating disorders, abrupt withdrawal of EtOH, BZDs, barbs, or AEDs
Warnings: Avoid use in pilots, air traffic controllers, commercial truckers, bus drivers
Side effects: tachycardia, dry mouth, insomnia, tremors/seizures, NO sexual dysfunction
Counseling for Bupropion
how long to start working
max dose
-Takes about 1 week for medication to start working. Set a date to stop smoking during the second week of starting bupropion
-Do not exceed 450 mg/day
Contact healthcare provider if noticeable changes in agitation, hostility, depression, or behavior occurs
Varenicline (Chantix)
moa
bbw
adr
dose adjust in
Partial neuronal alpha4-beta2 nicotinic receptor agonist
not recommended in combo with NRTs
BBW: serious neuropsychiatric events
-Warning: angioedema, hypersensitivity, serious skin reactions, and avoid use in pilots, air traffic controllers, commercial truckers, bus drivers, cardiac issues even MI, DREAMS
Side effects: nausea, abnormal dreams, constipation, flatulence, vomiting
Dose adjust if CrCl <30
Counseling for Vareniciline
how long to work
w/ or w/o food
-Takes about 1 week for medication to start working. Set a date to stop smoking during the second week of starting vareniciline
Take after eating and with a full glass of water
Contact healthcare provider if noticeable changes in agitation, hostility, depression, or behavior occurs
Caution about serious skin reactions
use Caution driving or operation machinery
dosing nictoine gum THRIVE
25 cigg- 4 mg gum
6 weeks:1 q 1-2 hrs
3 weeks 1 gum q 2-4 hrs
3 weeks: 1 gum 4-8 hrs
max nicotine piece
24
gum based on cut off
25 ciggs- week interval 6, 3, 3
nioine nasal spray dose
1 spray in each nostril per hr.
nicotine patch dosing
> 10 cigs use 21 mg x 6 weeks
14 mgs x 2 weeks
7 mgs x 2 weeks
< 10 mg
14 mg x 6 week
7 mg x 2 weeks
nicotine patch dosing cut off
10 ciggs
more 21 x 6, 14 mg x 2, 7 mg x 2
less only last part
nicotine lozenge based on
when you wake up and smoke
< 30 mins: 4 mg lozenge
> 30 mins: 2 mg lozenge
nicotine lozenge dose max amt
20 lozenges daily.
MINIMUM 9 lozenge
max pieces of gum
24
you have to show what before buying products
identification of age
gum cause weigt gain?
nope reduce or lose infact.
which two do you start before the quit date
bupropion SR and varenicline (chantix)
varenicline dosing
dosing will increase from 0.5 mg daily to 1 mg BID in 8 days.
which combos are okay?
patch + (GUM, NASAL SPRAY, LOZENGE)
17 year old smoker- ADVICE
CANNOT USE NICOTINE OTC PRODUCTS FDA PROHIBITS- do nicotine counseling.
BBW for sucidal issues
Varencycline and bupropion (zyban)
pregnancy
ACOG recommends bupropion (pregnancy category C) and other sources recommend nicotine replacement (which is not thought to be very effective in pregnancy).
