tabocco cessation

Question 1

pack-year smoking history

Answer 1

cigarette packs/day x number of years smoked

Question 2

smoking is an inducer when stopped

Answer 2

supratherapeutic levels of caffeine, theophylline, fluvoxamine, olanzapine, clozapine, and R- isomer of warfarin less potent, etc.

smoking women should not take estrogen-containing oral contraceptives- increased risk of CV event

Question 3

Nicotine patch

Answer 3

nicoderm cq
OTC

Question 4

nicotine gum
nicotine lozenge

Answer 4

Nicorette OTC
Nicorette mini OTC

Question 5

Nicotine replacement therapy
warnings

Answer 5

avoid in immediate post-MI, life-threatening arrhythmias, severe or worsening angina, and prego

Question 6

Nicotine replacement therapy
SE

Answer 6

insomnia
patch: vivid dreams
inhaler: mouth and throat irritation
nasal spray, nasal irritation

Question 7

Nicotine replacement therapy
notes

Answer 7

prohibits sale to <18
combo therapy NRT to reduce cravings
patch: highest adherence create, remove before MRI!!
Gum and lozenge: 4mg strength can reduce or delay weight gain do not eat/drink 15 min before or during use

Question 8

patch dosing
cigarette packs per day >10

Answer 8

21mg x6 weeks, then 14mg x2 weeks, 7 mg x 2 weeks

Question 9

patch dosing
cigarette packs per day <=10

Answer 9

14mg x 6 weeks, then 7mg x 2 weeks

Question 10

gum/lozenge dosing
1st cigarette timing after waking
<=30min

Answer 10

4mg q1-2h x 6 weeks
then
4 mg q2-4hx 3 weeks,
then
4mg q4-8h x 3 weeks

Question 11

gum/lozenge dosing
1st cigarette timing after waking
>30min

Answer 11

2mg q1-2h x 6 weeks then
2 mg 2-4h x 3 weeks then
2 mg q4-8h x 3 weeks

Question 12

bupropion and varenicline

Answer 12

bupropion blocks: reuptake of dopamine and norepi
varenicline is a partial nicotinic receptor agonist

both drugs reduce surges of dopamine so reduce cravings, start before the quit date
no need to tapper when D/C

Question 13

bupropion

Answer 13

zyban
contra: seizures, history of anorexia/bulimia, concurrent use of MAO inhibitors, linezolid or IV methylene blue, abrupt D/c of ethanol or sedatives
stimulating so take in the morning…

Question 14

varenicline

Answer 14

chantix
warning: serious neuro psych event, seizures, CVD risk

SE: insomnia, abnormal dreams, headache, nausea

to avoid nausea, take after meals w/ glass of water

Question 15

tx consideration
weight gain

Answer 15

gum, lozenge, and bupropion SR

Question 16

tx consideration
depression

Answer 16

bupropion SR

Question 17

tx consideration
dentures

Answer 17

avoid gum

Question 18

tx consideration
asthma/COPD

Answer 18

avoid inhaler or spray

Question 19

tx considerations
skin conditions

Answer 19

avoid patches

Question 20

tx considerations
seizures

Answer 20

avoid bupropion, varenicline

Question 21

nicotine patch admin

Answer 21

• admin start of each day, save pouch to throw away used patch
• apply to dry and hairless areas, and press firmly 10 seconds
• wear 24 hrs, especially if cravings early morning, if vivid dreams or trouble sleeping, remove prior to sleeping
• discard in the original pouch and trash
• rotate the site, do not use the sem site for at least one week!
• never cut or wear more than one patch at a time

Question 22

how to chew nicotine gum

Answer 22

• chew slowly until there is a tingle or peppery flavor in the mouth
• park in between the cheek and gum
• when the tingle or flavor goes away, begin chewing slowly again until it returns then park the gum again
• repeat until most flavor or tingle is gone (30 min)
• do not eat or drink 15 min before or during chewing