Tobacco Cessation

Question 1

Short term benefits of tobacco cessation?

Answer 1

• B/P returns to pre-smoking level w/I 20 minutes
• CO level drops w/I hours
• huge $$ savings
• sense of smell/taste return w/i days

Question 2

Long-term benefits of tobacco cessation?

Answer 2

• lung function improves up to 30% within 2-3 months
• risk of CHD decreases by 50%
• risk of stroke is similar to non-smoker w/I 5-15 years

Question 3

• Most commonly used adjuvant to smoking cessation
• better compliance, easier to use, less patient education and OTC
• three brand: Nicoderm CQ, habitrol, nicotrol
• AE: contact dermatitis, HA, dizziness, nightmates, GI upset, Care with CAD!

Answer 3

Transdermal patches

Question 4

directions for transdermal patches?

Answer 4

• apply 1 patch to upper extrimity x 24 hours- romve next morning prior to shower, was area. Apply new patch to opposite extremity after shower, repeat

Question 5

• 2mg piece on fixed dose schedule. chew until peppery taste/ tingling sensation. Place gum near gingiva for absorption. Repeat Q 15-30’
• One piece of gum Q 1-2 hours
• start with 4mg piece if > pack/day, thos that smoke without waking
• AE: bad taste, hiccups, sore throat
• C/I: Dentures, TMJ disease, dizziness

Answer 5

Nicotine Gum

Question 6

• 2nd line after failure of others
• one 0..5mg spray each nostril every one hour
• max 5 sprays/hour or 40 sprays per day

Answer 6

nicotine spray

Question 7

• 2mg PO q1-2h x 6wk, then q2-4 hours x 3wk, then q4-8h x 3 wk:
• max 5/6h, 20/24h

Answer 7

Nicotine lozenge

Question 8

• max: 16 cartridges/day. Use continuous puffing x2o min
• improved rate due to fulfills the hand to mouth oral fixation

Answer 8

nictoine inhaler

Question 9

• antidepressant belived to work on dopaminergic receptors
• 150mg daily x 3 days, then BID. Start 1-2 weeks prior to quit date to reach steady state
• AE: dry mouth, insomnia, rash, decreased concentration, constipation, decreased seizure threshold
• as with all forms of treatment, must have counseling throughout quitting effort

Answer 9

Buproprion (wellbutrin)

Question 10

• Partial agonists at alpha4, beta2 neuronal nicotinic acetylcholine receptors
• 0.5mg daily x 3 days, then BID for 4 days, then 1mg BID. Start 1-2 weeks prior to quit date to reach steady state
• continue for 12 weeks, may add 12 more weeks if patient needs the help for success
• helps with the rewarding effects of nicotine
• AE: suicidal thoughts, vivid dreams, mood changes, nausea/GI effects

Answer 10

Varenicline (chantix)