Test 3 Nicotine / Smoking Cessation Flashcards
What happens to nicotine when it gets in the body?
it gets metabolized into cotinine (has half-life of 16hrs)
effects of nicotine on the body
– Pleasure – Arousal, enhanced vigilance – Improved task performance – Anxiety relief – ↑ Heart rate – ↑ Cardiac output – ↑ Blood pressure – Coronary vasoconstriction – Cutaneous vasoconstriction – Appetite suppression – Increased metabolic rate – Skeletal muscle relaxation
Which chemicals are involved with the effects of nicotine?
- dopamine
- NE
- acetylcholine
- glutamate
- serotonin
- β-endorphin
- GABA
dopamine causations
- pleasure
- appetite suppression
NE causations
- arousal
- appetite suppression
acetylcholine causations
- arousal
- cognitive enhancement
glutamate causations
- learning
- memory enhancement
serotonin causations
- mood modulation
- appetite suppression
β-endorphin causations
reduction of anxiety and tension
GABA causations
reduction of anxiety and tension
withdrawal effects of nicotine
- Irritability / frustration / anger
- Anxiety
- Difficulty concentrating
- Restlessness / impatience
- Depressed mood/depression
- Insomnia
- Impaired performance
- Increased appetite/weight gain
- Cravings
time period of symptoms
- Most symptoms manifest within the first 1–2 days
- peak within the first
week and subside within 2–4 weeks
the 5 A’s used in tobacco cessation
- ask about tobacco use
- advise quitting
- assess readiness to quit
- assist with quitting
- arrange follow up care
assessing Readiness to quit
- relevance
- risks
- rewards
- roadblocks
- repetition
brief counseling intervention
- ask about tobacco use
- advise quitting
- refer to other resources
What are the types of nicotine replacement?
- gum
- patch
- lozenge
- nasal spray
- inhaler
- bupropion SR
- varenicline
What are precautions to keep in mind with NRT?
patients with underlying cardiovascular disease
nicotine gum
contains buffering agents to enhance buccal absorption of nicotine
dosing of nicotine gum
- if TTFC is within 30 min = 4mg
- if TTFC is more than 30 min = 2mg
- wk 1-6: 1 piece q 1-2 hr
- wk 7-9: 1 piece q 2-4 hr
- wk 10-12: 1 piece q 4-8 hr
- want to use 9 pieces per day to be successful but no more than 24 pieces per day
warning / precaution of nicotine gum
- don’t drink coffee, tea, or soda before or during this because they are acidic and will decrease absorption
- don’t consume anything 15 min before or during use
adverse effects of nicotine gum
\+ if chewing too rapidly or continuously: - nausea / vomiting - lightheadedness - irritation of throat and mouth - hiccups - indigestion \+ other side effects: - mouth soreness - hiccups - dyspepsia - jaw muscle ache
nicotine lozenge
- contains buffering agents to enhance buccal absorption of nicotine
- delivers 25% more nicotine than gum dose
dosing of nicotine lozenge
- if TTFC is within 30 min = 4mg
- if TTFC is more than 30 min = 2mg
- wk 1-6: 1 piece q 1-2 hr
- wk 7-9: 1 piece q 2-4 hr
- wk 10-12: 1 piece q 4-8 hr
- want to use 9 pieces per day to be successful but no more than 20 pieces per day
- will completely dissolve in 20-30 min
- do not chew
- rotate to different areas of mouth
warning / precaution of nicotine lozenge
- don’t drink coffee, tea, or soda before or during this because they are acidic and will decrease absorption
- don’t consume anything 15 min before or during use
adverse effects of nicotine lozenge
- nausea
- hiccups
- cough
- heartburn
- headache
- flatulence
- insomnia
nicotine patch
- avoids hepatic first-pass
- alleviate symptoms of withdrawal
- less likely to lead to dependence (with respect to NRT)
dosing of nicotine patch
- for pts who smoke <= 10 cig a day, start on 14mg patch for 6 weeks, then taper down to 7mg patch for 2 weeks
- for pts who smoke > 10 cig a day, start on 21mg for 6 weeks, then 14mg for 2 weeks, then 7 mg for 2 weeks
warning / precaution of nicotine patch
- apply patch to different area each day
- do not use same area again for at least 1 week
- do no leave patch on for more than 24 hours
- not recommended for use by patients with dermatologic conditions
adverse effects of nicotine patch
- vivid dreams sleep disturbances - headache - mild itching - burning - tingling
nicotine nasal spray
- 50mcL spray delivers 0.5mg of nicotine
- rapid absorption across nasal mucosa
dosing of nicotine nasal spray
- one spray in each nostril daily
- start with 1-2 doses per hour
- increase prn to mas dose at 5 doses per hour or 40mg daily
- first 6-8 weeks best results if pt uses at least 8 doses per day
- taper down next 4-6 weeks
warning / precaution of nicotine nasal spray
- avoid contact with skin, eyes, and mouth
- wait 2-3 min before blowing nose
- not recommended for use by patients with chronic nasal disorders or severe reactive airway disease
adverse effects of nicotine nasal spray
- hot peppery feeling in back of throat or nose
- sneezing
- coughing
- watery eyes
- runny nose
nicotine inhaler
- elivers 4 mg nicotine vapor
- absorbed across buccal mucosa
dosing of nicotine inhaler
- start with at least 6 cartridge per day during first 3-6 wks
- increase pen for max of 16 cartridge per day
- in general, use 1 cartridge every 1-2 hr
- use for 3 months
- reduce dosage over 6-12 wks
- cartridge depleted 20 min after activation
- open cartridge retains potency for 24 hours
- using inhaler for longer and more often helps control cravings
adverse effects of nicotine inhaler
- mild irritation of mouth or throat
- cough
- headache
- rhinitis
- dyspepsia
warning / precaution of nicotine inhaler
- use in environments with temp. > 60°F; cold temp decreases bioav.
- do NOT eat or drink for 15 minutes BEFORE or while using the nicotine inhaler
bupropion SR
- cessation aid
- SR antidepressant
- blacks dopamine and EPI uptake
- leads to ↓ craving for cig
- leads to ↓ symptoms of withdrawal
- if no progress by 7th wk, prob not successful
- excreted in breast milk; do not use if breastfeeding
warning / precaution of bupropion SR
- neuropsychiatric symptoms and suicide risk
- changes in mood
- agitated
- depressed
- contraindicated in pts who has elevated risk for seizures and bipolar disorder
dosing of bupropion SR
- being 2 wks prior to quit date
- 150mg qAM for 3 days
- then 150mg BID for 7-12 wks administered 8 hrs apart
- do not exceed 300mg/day -> will increase seizure risk
adverse effects of bupropion SR
- insomnia
- dry mouth
varenicline
- cessation aid
- partial nicotinic receptor agonist
- binds with high affinity and selectively at α4β2 neuronal nicotinic acetylcholine receptors
- leads to ↓ symptoms of withdrawal
- blocks dopaminergic stimulation
warning / precaution of varenicline
- neuropsychiatric symptoms and suicide risk
- changes in mood
- agitated
- depressed
- somnabulism (sleep walking)
- cardiovascular events
- angioedema
- serious skin reactions
dosing of varenicline
- being 1 wk prior to quit date
- dose is gradually increased to minimize treatment-related nausea and insomnia
- day 1-3, take 0.5mg QD
- day 4-7, take 0.5mg BID
- day 8 to end, take 1mg BID (can last up to 12 wks)
- take after eating with a full glass of water
adverse effects of varenicline
- nausea / vomiting
- sleep disturbances (insomnia, abnormal dreams)
- constipation
- flatulence
adverse effects of tobacco on fetus
- Premature birth
- Low birth weight
- Increase in oral clefts by 30%
- Sudden Infant Death Syndrome
- Cognitive, emotional, behavioral problems in children
