SMOKING CESSATION

what is the leading preventable cause of disease, disability, and death in the US?

smoking

how much does smoking increase the risk of coronary heart disease and stroke by?

2-4 times

what are the harms in temrs of lifestyle of smoking?

"

increases the risk of coronary heart disease and stroke by 2 to 4 times

decline in overall health

increases work absences and health care utilization and cost

"

what medication should we avoid giving to women who smoke?

estrogen or hormonal contraception

what is the NRT patch? what are its names?

it provides continous release of nicotine throughout the day. its names are Nicoderm and Habitrol

what is the MOA of the NRT patch (Nicoderm and habitrol)?

nicotine binds to nicotinic cholinergic receptors leading to a reward effect

if someone smokes more than 10 cigarettes per day how should we dose the NRT patch (nicoderm and habitrol)?

they can do 21 mg/day for 6 weeks, then 14 mg/day for 2 weeks, then 7 mg/day for 2 weeks 

if someone smokes less than or equal to 10 cigarettes per day then what is the dose for the NRT patch (nicoderm and habitrol)?

14 mg/day for 6 weeks ans then 7 mg/day for 2 weeks

what are the steps for administration of the NRT patch?

apply patch to non hairy clean dry skin on the upper body or upper outer arm. apply immedietly after removing back from patch and press it onto skin for 10 seconds

what are side effects for the NRT patch?

headache, sleep disturbances, local skin reactions like burning, and nicotine effects like nausea, tremor, increase BP and palpitations

when does someone put on the NRT patch and how long must they wear it for?

must keep it on for 16 hours and put it on in the morning

when do we refer someone when they are using a NRT patch?

when they have eczema, rash, or other skin allergy, adhesive tape allergy, symotoms of nicotine overdose, and allergic reaction

after how many days of skin redness from the NRT patch do we refer someone?

after 4 days of skin redness

what are advantages of the NRT patch?

it is easy to use and discrete, steady nicotine level, and can use with short acting NRT

what is the disadvanatge of the NRT patch?

we cant alter the dose for cravings

what is the name of the NRT gum?

nicorette

if someone smokes a cigarette less than 30 minutes before waking up what strength of NRT gum do we use?

use the 4 mg strength

if someone smokes a cigarette more than 30 minutes after getting up what strength nrt gum do we use?

2 mg strength

what is the max amount of nrt gum someone can have per day?

no more than 24 pieces per day

what is the dosing over time for nrt gum?

weeks 1 to 6 chew 1 piece every 1 to 2 hours, weeks 7 to 9 chew 1 piece every 2 to 4 hours, and week 10 to 12 chew 1 piece every 4 to 8 hours

what are side effects of the nrt gum?

mouth and throat irritation, jaw muscle soreness or ache, hiccups, gi compains, unpleasant taste

when do we refer someone when they are using nrt gum?

when mouth, teeth, or jaw problems occur or if they are on a sodium restricted diet

what is first line therapy for smoking?

NRT patch

what is the advantages of nrt gum?

user controls nicotine dose, helps with oral fixation, and can use with nrt patch

what are disadvantages of nrt gum?

no food or drink 15 minutes before or during use, difficult to use with denatures or can damage dental work 

what is the name of a nrt lozenge?

nicorette

what is the dosing for nrt lozenge?

dosed the same way as the gum

what patients should you avoid nrt lozenge in?

patients with soy allergy

when are side effects usually seen in nrt lozenge?

usually seen when chewing it which is bad

what are side effects of nrt lozenge?

mouth and throat irritation, gi complaints, hiccup, lightheadness

when do we refer someone when taking nrt lozenge?

if mouth problems, persistent indigestion, or if severe sore throat or a sodium restricted diet 

what is an important guideline for nrt lozenges?

no food or drink 15 minutes before or during use

what is the name of the nrt nasal spray?

nicotrol ns

what is the mg of nicotine per spray of nrt nasal spray?

0.5 mg nicotine per spray

what is one dose of the nrt nasal spray?

one dose is 2 sprays so one in each nostril

what is 1 dose of the nasal spray equal to?

1 mg of nicotine

what is the initial dose of the nrt nasal spray (nicotrol ns)?

1 to 2 doses per hour while awake for 6 to 8 weeks 

what is the max amount of doses per hour of the nrt nasal spray (nicotrol ns)?

max 5 doses (10 sprays) per hour or 40 mg/day (80 sprays)

what is the administration technique of the nicotine nasal spray?

blow nose prior to use, tilt head back slightly and insert tip of bottle into nostril, breathe through mouth and spray once in each nostril

what are the side effects of the nrt nasal spray (nicotrol ns)?

throat irriatoin, eye irritation, sneezing, allergy symptoms

what patients should you avoid nrt nasal spray?

patients with chronic nasal disorders

what are advantages of nrt nasal spray?

user controls nicotine dose, most rapid delivery of nicotine, and can use with nrt patch 

what are the disadvantages of nrt nasal spray?

most adverse effects of all nrt products and you have to prime the device

what is the main side effect of varenicline?

nausea