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OU PharmCare Fall 2017 > Test 3 Nicotine / Smoking Cessation > Flashcards

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
Q

adverse effects of nicotine lozenge

A
  • nausea
  • hiccups
  • cough
  • heartburn
  • headache
  • flatulence
  • insomnia
26
Q

nicotine patch

A
  • avoids hepatic first-pass
  • alleviate symptoms of withdrawal
  • less likely to lead to dependence (with respect to NRT)
27
Q

dosing of nicotine patch

A
  • 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
Q

warning / precaution of nicotine patch

A
  • 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
Q

adverse effects of nicotine patch

A 
- vivid dreams 
sleep disturbances 
- headache 
- mild itching 
- burning 
- tingling
30
Q

nicotine nasal spray

A
  • 50mcL spray delivers 0.5mg of nicotine

- rapid absorption across nasal mucosa

31
Q

dosing of nicotine nasal spray

A
  • 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
Q

warning / precaution of nicotine nasal spray

A
  • 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
Q

adverse effects of nicotine nasal spray

A
  • hot peppery feeling in back of throat or nose
  • sneezing
  • coughing
  • watery eyes
  • runny nose
34
Q

nicotine inhaler

A
  • elivers 4 mg nicotine vapor

- absorbed across buccal mucosa

35
Q

dosing of nicotine inhaler

A
  • 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
Q

adverse effects of nicotine inhaler

A
  • mild irritation of mouth or throat
  • cough
  • headache
  • rhinitis
  • dyspepsia
37
Q

warning / precaution of nicotine inhaler

A
  • 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
Q

bupropion SR

A
  • 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
Q

warning / precaution of bupropion SR

A
  • neuropsychiatric symptoms and suicide risk
  • changes in mood
  • agitated
  • depressed
  • contraindicated in pts who has elevated risk for seizures and bipolar disorder
40
Q

dosing of bupropion SR

A
  • 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
Q

adverse effects of bupropion SR

A
  • insomnia

- dry mouth

42
Q

varenicline

A
  • 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
Q

warning / precaution of varenicline

A
  • neuropsychiatric symptoms and suicide risk
  • changes in mood
  • agitated
  • depressed
  • somnabulism (sleep walking)
  • cardiovascular events
  • angioedema
  • serious skin reactions
44
Q

dosing of varenicline

A
  • 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
Q

adverse effects of varenicline

A
  • nausea / vomiting
  • sleep disturbances (insomnia, abnormal dreams)
  • constipation
  • flatulence
46
Q

adverse effects of tobacco on fetus

A
  • Premature birth
  • Low birth weight
  • Increase in oral clefts by 30%
  • Sudden Infant Death Syndrome
  • Cognitive, emotional, behavioral problems in children

OU PharmCare Fall 2017 (22 decks)

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