Tobacco dependence

Question 1

what does nicotine affect?

Answer 1

the dopaminergic system!!

acts as a CNS stimulatn

Question 2

what does nicotine cause?

Answer 2

restlessness, insomnia, anxiety, increased GI motility

Question 3

tobacco uses report what?

Answer 3

impoved attention, improved mood, decreased tension

Question 4

what is cigarette smoking and prego associated w/

Answer 4

low birth weight

persistent pulmonary hTN of newborn!

Question 5

nicotine w. drawal sx

Answer 5

• intense craving
• dysphoria
• anxiety
• increased appetiti
• irritability
• insomina

Question 6

tx of nicotine addiction

Answer 6

-behavioral, meds

Question 7

5 A’s molde for smoking cessation

Answer 7

• Ask
• Advise
• Assess
• Assist
• Arrange for f/u

Question 8

Fagerstrom Test

Answer 8

The higher the score on this questionnaire, the higher the level of dependence.

-score of 7 is indicative of high dependence

Question 9

first line tx

Answer 9

NRT (patch, gum, lozenge, Nasal spray, inhaler)

• bupropion (Zyban)
• Varenicline (Chantix)

Question 10

2cd line tx

Answer 10

nortripyline (pamelor)

clonidine (Catapres)

Question 11

contraindicated to tx

Answer 11

prego, smokeless tobacco, light smokers, adolescents

Question 12

NRT MOa

Answer 12

provides slower release of nicotine- less than cigs and releived physiologicala nd psychomotor w/drwal sx

Question 13

NRT abuse potential?

Answer 13

little, bc they dont produce the pleasurable effects

Question 14

NRT rationale

Answer 14

• relieved w/d sx

- allows pt to focus onn behavioral and psyhcolocial aspects of tobacco cessation

Question 15

NRT precautions

Answer 15

pts w/ underlying CVD

• recent MI ( past 2 wks)
• serious arrhythmias
• serious or worsening angina
• must be prescribd by a provider

Question 16

what is NRT absolutely CI in?

Answer 16

preg -reserved for women who are unable to quit nonpharmacologically (use gum, inhaler, or nasal spray bc patch is more potent)

lactation

Question 17

FDA approval in kids/adolescents?

Answer 17

nope

Question 18

Nicotine Transdermal Patch

MOA

Answer 18

nicotine diffusively at a constant rate through the skin and Bloodstream- avoids first pass

Question 19

Patch education

Answer 19

apply patch qd, dry hairless area

• rotate sites
• wash hands
• pts can get wet w/ path on
• Don’t cut patch to adjust dose
• remove pt before MRI

Question 20

how does the patch work?

Answer 20

contains a drug reserviour sandwiched bw a non-permeable back layer and a permeable adhesive layer that attches to the skin

Question 21

patch ADR

Answer 21

localized skin irriation (erythema, pruritis, burningg)

• insomnia
• nightmares, vivid dreams

Question 22

nicotine gum MOA

Answer 22

absorbed via buccal mucosa

Question 23

treatment period for nicotine gum?

Answer 23

2-3 mths, should be gum free by 6-12 mnths

Question 24

when do nicotine plasma levels increase/peak?

Answer 24

peak at 30 mins after chwing

Question 25

how much gum per day?

Answer 25

one piece every 1-2 hours

Question 26

pt education/instructions

Answer 26

- effectiveness may be reduced by some foods and drinks (acidic ph is below what is needed for optimal buccal absorptions) - dont' eat or drink 15 mins before, during or after - always park in a diff part of the mouth

Question 27

gum ADR?

Answer 27

N/V, abdominal pain, hiccups, - tongue, moth, throat irriation - sore jaw - unpleasant tast

Question 28

gum relative CI?

Answer 28

- TMJ - poor dentition - dentures

Question 29

nicotine lozenge MOA

Answer 29

oral mucosa absorption

Question 30

what s the lozenge does dependent on/

Answer 30

time to first cigarette

Question 31

lozenge ADR

Answer 31

mouth irritation/ulcers abdominal pain, N, V, D HA, palpitations

Question 32

Lozenge Pt education

Answer 32

avoid acidic drinks, rotate site

Question 33

nicotine mini-lozenge

Answer 33

mini!!! dissolves up to 3 X faster

Question 34

Oral inhaler MOA

Answer 34

absorbed bia oral and pharyngeal mucosa

Question 35

dose of inhaler

Answer 35

each puff lasts about 20 minutes

Question 36

pt education for inhaler

Answer 36

not meant to be inhlaed by moth to lungs

Question 37

when in the inhaler not recommended?

Answer 37

severe airways reactivity

Question 38

how does the temp affect the inhaler?

Answer 38

- Under colder conditions (<59F), less nicotine is delivered per puff. Conversely, under warmer conditions more nicotine is released per puff. Best results are achieved with frequent continuous puffing over 20 minutes. The inhaler should be used longer and more often at first to help control cigarette cravings. Less nicotine per puff is released from the inhaler compared to a cigarette.

Question 39

nicotine nasal spray moa

Answer 39

provides a nicotine bolus mimicking nicotine burst from cig

Question 40

duration of trx (nasal spray?)

Answer 40

3 mnths

Question 41

ADR of nasal spray

Answer 41

local nasopharyngeal irritation | runny nose, sneezing, cough,, thraot and eye irriations, HA

Question 42

disadvantages of nasal spray

Answer 42

o Difficult to administer o Unpleasant taste o Poor compliance o Potential for abuse / harm

Question 43

What to expect the first week using nasal spray?

Answer 43

``` hot peppery feeling in back of throat/nose o Sneezing o Coughing o Watery eyes o Runny nose ```

Question 44

summary of NRT?

Answer 44

- NRT should be offered to all smokers who are prepared to quit - All forms of NRT are effective and should be personalized to reflect patient needs - Combination NRT products are more efficacious than single NRT therapy - NRTs increase the rate of quitting 50-70%, regardless of setting

Question 45

Bupropion | MOA

Answer 45

Zyban | inhibits NE and DA uptakes, block nicotinic acetycholinergic receptors

Question 46

Bupropion pt education

Answer 46

start 1 wk prior to quit date | -if pt not made significant progress toward abstinence by 7th week- unlikely to quit and tx should be discontinued

Question 47

adr of bupropion

Answer 47

insomina, dry mouth, suicide risk!!!

Question 48

bupropion CI

Answer 48

pts w/ sz disorder - hx of anorexia/bulemia - pts undergoing abrupt discontinuation of ethanol or sdative

Question 49

VareniclineMOA

Answer 49

nicotinic acetylcholine receptor partional agonist -partially stimulates nicotine receptors in the brain to diminish craving and w/drwal sx -blocks the effects of nicotine by occupying receptor sites-reducing the rewarding and reinforcing effects of smking ch

Question 50

chantix dose duration

Answer 50

12 wks

Question 51

what to monitor when taking chantix?

Answer 51

renal

Question 52

pt eduction of chantix

Answer 52

- Nausea (titrate) - Visual disturbances - Insomnia, abnormal dreams - Driving / operating machinery - Suicide risk – advise / document - Cardiovascular risk – advise / document

Question 53

Nortriptyline MOA

Answer 53

Tricyclic antidepressant

Question 54

nortriptyline ADR

Answer 54

dry mouth, sedation

Question 55

nortriptyline pt education

Answer 55

take at bedtime

Question 56

Clonidine moa

Answer 56

alpha adrenergic agonist

Question 57

clonidine ADR

Answer 57

dry mouth, sedation, Hypotension, dizzy