Test 3 Nicotine / Smoking Cessation Flashcards

1
Q

What happens to nicotine when it gets in the body?

A

it gets metabolized into cotinine (has half-life of 16hrs)

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2
Q

effects of nicotine on the body

A
– 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
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3
Q

Which chemicals are involved with the effects of nicotine?

A
  • dopamine
  • NE
  • acetylcholine
  • glutamate
  • serotonin
  • β-endorphin
  • GABA
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4
Q

dopamine causations

A
  • pleasure

- appetite suppression

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5
Q

NE causations

A
  • arousal

- appetite suppression

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6
Q

acetylcholine causations

A
  • arousal

- cognitive enhancement

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7
Q

glutamate causations

A
  • learning

- memory enhancement

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8
Q

serotonin causations

A
  • mood modulation

- appetite suppression

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9
Q

β-endorphin causations

A

reduction of anxiety and tension

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10
Q

GABA causations

A

reduction of anxiety and tension

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11
Q

withdrawal effects of nicotine

A
  • Irritability / frustration / anger
  • Anxiety
  • Difficulty concentrating
  • Restlessness / impatience
  • Depressed mood/depression
  • Insomnia
  • Impaired performance
  • Increased appetite/weight gain
  • Cravings
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12
Q

time period of symptoms

A
  • Most symptoms manifest within the first 1–2 days
  • peak within the first
    week and subside within 2–4 weeks
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13
Q

the 5 A’s used in tobacco cessation

A
  • ask about tobacco use
  • advise quitting
  • assess readiness to quit
  • assist with quitting
  • arrange follow up care
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14
Q

assessing Readiness to quit

A
  • relevance
  • risks
  • rewards
  • roadblocks
  • repetition
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15
Q

brief counseling intervention

A
  • ask about tobacco use
  • advise quitting
  • refer to other resources
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16
Q

What are the types of nicotine replacement?

A
  • gum
  • patch
  • lozenge
  • nasal spray
  • inhaler
  • bupropion SR
  • varenicline
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17
Q

What are precautions to keep in mind with NRT?

A

patients with underlying cardiovascular disease

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18
Q

nicotine gum

A

contains buffering agents to enhance buccal absorption of nicotine

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19
Q

dosing of nicotine gum

A
  • 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
20
Q

warning / precaution of nicotine gum

A
  • 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
21
Q

adverse effects of nicotine gum

A
\+ 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
22
Q

nicotine lozenge

A
  • contains buffering agents to enhance buccal absorption of nicotine
  • delivers 25% more nicotine than gum dose
23
Q

dosing of nicotine lozenge

A
  • 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
24
Q

warning / precaution of nicotine lozenge

A
  • 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
25
adverse effects of nicotine lozenge
- nausea - hiccups - cough - heartburn - headache - flatulence - insomnia
26
nicotine patch
- avoids hepatic first-pass - alleviate symptoms of withdrawal - less likely to lead to dependence (with respect to NRT)
27
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
28
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
29
adverse effects of nicotine patch
``` - vivid dreams sleep disturbances - headache - mild itching - burning - tingling ```
30
nicotine nasal spray
- 50mcL spray delivers 0.5mg of nicotine | - rapid absorption across nasal mucosa
31
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
32
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
33
adverse effects of nicotine nasal spray
- hot peppery feeling in back of throat or nose - sneezing - coughing - watery eyes - runny nose
34
nicotine inhaler
- elivers 4 mg nicotine vapor | - absorbed across buccal mucosa
35
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
36
adverse effects of nicotine inhaler
- mild irritation of mouth or throat - cough - headache - rhinitis - dyspepsia
37
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
38
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
39
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
40
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
41
adverse effects of bupropion SR
- insomnia | - dry mouth
42
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
43
warning / precaution of varenicline
- neuropsychiatric symptoms and suicide risk - changes in mood - agitated - depressed - somnabulism (sleep walking) - cardiovascular events - angioedema - serious skin reactions
44
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
45
adverse effects of varenicline
- nausea / vomiting - sleep disturbances (insomnia, abnormal dreams) - constipation - flatulence
46
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