Tobacco - Block 3 Flashcards
What are the causes for tobacco dependence?
- Tolerance
- Withdrawal sx
- Cravings
- Self regulation
What is the DSM 5 criteria for TUD?
Considered an addiction if 2 or more apply:
1. Withdrawl sx
2. Tolerance
3. Desire or efforts to cut down/control use
4. Great time spent in obtaining/using
5. Reduced occupational, recreational activities
6. Use despite problems
7. Larger amounts consumed than intended
8. Cravings
What are the role of a pharmacist on tobacco use?
Ask about tobacco use and secondhand exposure
Advise to quit
Assess readiness to quit
Assist in quit attempt (counseling, referral)
Arrange for patient to quit
DDI for smokin
- Induces P450
- Affects how the body metabolizes meds
- Interacts with antipsychotics, antidepressants
Tx goals for chronic relapse?
Treat for as long as it takes and eliminating withdrawal sx
What is the 2 part problem with tobacco dependence?
What is the neurotransmitter activity of nicotine?
Dopamine: pleasure, appetitie suppression
NE: arousal, appetite suppression
Ach: arousal, cognitive enhancement
Glutamate: learning, memory enhancement
Seratonin: mood modulation, appetite suppression
Endophins” reduction of anxiety, tension, pain
GABA (decrease): reduction in ax, tension, enhance reinforcing effects of nicotine
What are the sx of nicotine withdrawal?
- Irritability
- Ax
- Difficulty concentrationg
- Restlessness
- Depression
- Insomnia
- Impaired performance
- Increased appetite
- Craving
What are the approved cessation products?
- Bupropion
- Varenicline
- Nicotine patch
- Nicotine gum
- Nicotine lozenges
- Nicotine inhaler
- Nicotine nasal spray
What is 2nd line cessation med?
Off label: Nortriptyline, clonidine
Nicotine vaccine (under development)
Benefits of using NRT?
- Improves chances of quitting
- Makes indiivduals more comfortable while quitting
- Allows consumers to focus changig behaviors
- No harmful toxins
What are OTC nicotine TX?
Pathc: 7mg, 14mg, 21 mg
Gum: 2mg, 4mg
Lozenge: 2mg, 4mg
Prescription nicotine tx?
Inhaler and nasal spray
What are the ADRs of nicotine?
- HA/N/DZ
- Vivid dreams
- Insomnia
- Application site rx
- Oral sores and ulcers
- nasal tract inrritation
- Diarrhea
- Dyspepsia
CI of nicotine cessation?
- Arrhythmia
- Unstable angina
- Pregnancy (safe)
- Uncontrolled HTN
- COPD (inhaler)
DDI of nicotine tx?
- Buproprion SR (unlikely)
- Caffeine increases metabolism
- Insulin
- Antipsychotics
Counseling for nicotine patch?
- Absorbed in skin
- Can take up to 6H to reach peak
- Wear above waist, non hairy
- DOn’t cut
- Wear and reapply Q24H
- ADR: JA, N, DZ, skin irritation at site
- Don’t apply heat
- Remove if undergoing radiological procedures
- Apply upon waking
- Move patch each day to reduce ADR
- Can remove at night if bothersome