Tobacco dependence Flashcards
what does nicotine affect?
the dopaminergic system!!
acts as a CNS stimulatn
what does nicotine cause?
restlessness, insomnia, anxiety, increased GI motility
tobacco uses report what?
impoved attention, improved mood, decreased tension
what is cigarette smoking and prego associated w/
low birth weight
persistent pulmonary hTN of newborn!
nicotine w. drawal sx
- intense craving
- dysphoria
- anxiety
- increased appetiti
- irritability
- insomina
tx of nicotine addiction
-behavioral, meds
5 A’s molde for smoking cessation
- Ask
- Advise
- Assess
- Assist
- Arrange for f/u
Fagerstrom Test
The higher the score on this questionnaire, the higher the level of dependence.
-score of 7 is indicative of high dependence
first line tx
NRT (patch, gum, lozenge, Nasal spray, inhaler)
- bupropion (Zyban)
- Varenicline (Chantix)
2cd line tx
nortripyline (pamelor)
clonidine (Catapres)
contraindicated to tx
prego, smokeless tobacco, light smokers, adolescents
NRT MOa
provides slower release of nicotine- less than cigs and releived physiologicala nd psychomotor w/drwal sx
NRT abuse potential?
little, bc they dont produce the pleasurable effects
NRT rationale
- relieved w/d sx
- allows pt to focus onn behavioral and psyhcolocial aspects of tobacco cessation
NRT precautions
pts w/ underlying CVD
- recent MI ( past 2 wks)
- serious arrhythmias
- serious or worsening angina
- must be prescribd by a provider
what is NRT absolutely CI in?
preg -reserved for women who are unable to quit nonpharmacologically (use gum, inhaler, or nasal spray bc patch is more potent)
lactation
FDA approval in kids/adolescents?
nope
Nicotine Transdermal Patch
MOA
nicotine diffusively at a constant rate through the skin and Bloodstream- avoids first pass
Patch education
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
how does the patch work?
contains a drug reserviour sandwiched bw a non-permeable back layer and a permeable adhesive layer that attches to the skin
patch ADR
localized skin irriation (erythema, pruritis, burningg)
- insomnia
- nightmares, vivid dreams
nicotine gum MOA
absorbed via buccal mucosa
treatment period for nicotine gum?
2-3 mths, should be gum free by 6-12 mnths
when do nicotine plasma levels increase/peak?
peak at 30 mins after chwing
how much gum per day?
one piece every 1-2 hours
pt education/instructions
- 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
gum ADR?
N/V, abdominal pain, hiccups,
- tongue, moth, throat irriation
- sore jaw
- unpleasant tast
gum relative CI?
- TMJ
- poor dentition
- dentures
nicotine lozenge
MOA
oral mucosa absorption
what s the lozenge does dependent on/
time to first cigarette
lozenge ADR
mouth irritation/ulcers
abdominal pain, N, V, D
HA, palpitations
Lozenge Pt education
avoid acidic drinks, rotate site
nicotine mini-lozenge
mini!!! dissolves up to 3 X faster
Oral inhaler MOA
absorbed bia oral and pharyngeal mucosa
dose of inhaler
each puff lasts about 20 minutes
pt education for inhaler
not meant to be inhlaed by moth to lungs
when in the inhaler not recommended?
severe airways reactivity
how does the temp affect the inhaler?
- Under colder conditions (<59F), 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.
nicotine nasal spray
moa
provides a nicotine bolus mimicking nicotine burst from cig
duration of trx (nasal spray?)
3 mnths
ADR of nasal spray
local nasopharyngeal irritation
runny nose, sneezing, cough,, thraot and eye irriations, HA
disadvantages of nasal spray
o Difficult to administer
o Unpleasant taste
o Poor compliance
o Potential for abuse / harm
What to expect the first week using nasal spray?
hot peppery feeling in back of throat/nose o Sneezing o Coughing o Watery eyes o Runny nose
summary of NRT?
- 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
Bupropion
MOA
Zyban
inhibits NE and DA uptakes, block nicotinic acetycholinergic receptors
Bupropion pt education
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
adr of bupropion
insomina, dry mouth,
suicide risk!!!
bupropion CI
pts w/ sz disorder
- hx of anorexia/bulemia
- pts undergoing abrupt discontinuation of ethanol or sdative
VareniclineMOA
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
chantix dose duration
12 wks
what to monitor when taking chantix?
renal
pt eduction of chantix
- Nausea (titrate)
- Visual disturbances
- Insomnia, abnormal dreams
- Driving / operating machinery
- Suicide risk – advise / document
- Cardiovascular risk – advise / document
Nortriptyline MOA
Tricyclic antidepressant
nortriptyline ADR
dry mouth, sedation
nortriptyline pt education
take at bedtime
Clonidine moa
alpha adrenergic agonist
clonidine ADR
dry mouth, sedation, Hypotension, dizzy
