Tobacco Cessation Flashcards
What are the 7 FDA-approved medications for smoking cessation?
- nicotine gum
- nicotine lozenge
- transdermal nicotine patch
- nicotine oral inhaler
- nicotine nasal spray
- bupropion SR
- varenicline (chantix)
What strengths do the gum and lozenges come in?
- 2 mg
- 4 mg
What are the pros of the gum/lozenges?
- oral sub for tobacco
- can titrate to manage withdrawal symptoms
- might delay weight gain
- used in combo with other agents
- inexpensive
What are the cons for lozenges?
- frequent dosing –> poor adherence
- GI side effects
short-acting
What are the cons of the gum?
- frequent dosing –> poor adherence
- GI side effects
- Dental work / jaw issues impede use
- requires proper chewing technique
What strength does the nicotine patch come in?
- 21 mg
- 14 mg
- 7 mg
What are the pros of the patch?
- once-daily dosing
- can be used in combo
- consistent level over 24 hrs
- discrete method
- inexpensive
What are the cons of the patch?
- can’t be acutely titrated for withdrawal symptoms
- not recommended for use with dermatologic conditions
What strength does the inhaler come in?
- 10 mg cartridge that delivers 4 mg
Rx only
What are the pros of the inhaler?
- oral substitute
- can titrate to manage withdrawal
- mimics hand-to-mouth ritual
- can be used in combo
What are the cons of the inhaler?
- frequent dosing –> poor adherence
- cartridges are less effective in cold environments ( < 60 F)
- costly
What strength does the nasal spray come in?
- 10 mL bottle
- 0.5 mg per spray
Rx only
What are the pros of the nasal spray?
- can titrate to more closely manage withdrawal symptoms
- can use in combo
What are the cons of the nasal spray?
- frequent dosing –> poor adherence
- nasal irritation
- not recommended for use w nasal disorders
- costly
What strength is the bupropion SR?
150 mg
What are the pros of bupropion?
- twice daily oral dosing
- might be beneficial in pts w depression
- can use in combo with NRT
- relatively cheap
What are the cons of bupropion?
- seizure risk is increased
- several contraindications and precautions / more extensive screening
- patients must be monitored for potential neuropsychiatric symptoms
What are the strengths of varenicline?
- 0.5 mg
- 1 mg
What are the pros of varenicline?
- twice daily oral dosing
- offers a different mechanism of action than other options
- most effective agent for cessation when used as monotherapy
What are the cons of varenicline?
- nausea (28%)
- insomnia/sleep disturbances
- patients must be monitored for neuropsychiatric symptoms
- costly
What are the 5 A’s?
- ask about tobacco use
- advise tobacco users to quit
- assess readiness to quit
- assist with the quit attempt
- arrange follow-up care
When do withdrawal symptoms manifest?
1 to 2 days
When do withdrawal symptoms peak?
within the first week
When do withdrawal symptoms subside?
2-4 weeks
