Smoking Cessation

gum, patches, lozenges, inhaled cartridge, nasal spray

Nicotine Replacement Products

Bupropion, Varenicline

Non-nicotine smoking cessation aids (agents)

smoking cessation

What is the best way to improve asthma/COPD?

20, monoxide, heart attack, 9, coronary, stroke, 10, 15

Smoking Cessation Timeline

• __ minutes - heart rate drops

• 12 hours - Carbon ________ level in blood returns to normal

• 2 weeks to 3 months - _____ ______ risk drops, lung function improves

• 1-_ months - coughing and SOB decrease

• 1 year - increased of _________ disease over baseline halved

• 5-15 years - _____ risk reduced to baseline, mouth/throat/esophagus cancer ½ of a smoker’s

• __ years - Risk of lung cancer death and bladder cancer half that of a smoker, cervical/kidney/larynx/pancreas cancer decreases

• __ years - risk of coronary disease reduced to baseline

nicotine replacement

What is the mainstay of therapy and first line option for smoking cessation?

No

Can patients overlap nicotine replacement therapy with cigarette use?

abdominal, palpitations, insomnia

Nicotine Replacement - General ADRs

• __________ pain

• NVD

• Headache

• ___________ (higher doses)

• __________

skin irritation, insomnia, nausea, vomiting, dizziness

Nicotine Patch ADRs

Patches

What form of nicotine replacement can be used as a baseline therapy, with other forms added PRN for break through cravings?

nicotine, park, 30

How to use Nicotine Gum

• Chew until ________ taste starts (peppery)

• “____” in cheek - re-chew after taste disappears, repark, discard @ __ minutes

6, 3

Nicotine Gum

• Self taper over second _ weeks, total plan to quit at _ months

bad taste, esophageal irritation

Nicotine Gum ADRscan include a temporary

Nicotine Gum

Which product has this food-drug reaction?

• acidic food/beverages reduce nicotine efficacy by affecting oral cavity pH

6, 3

Lozenges

• Reduce subjectively over final _ weeks, total _ months

gum

Nicotine replacement lozenges have similar ADRs and Food-Drug Reactions to which other product?

Nicotine Cartridge

• Use PRN - come as one strength

• Use 6-16 per day for the first 6-12 weeks, then subjectively taper over 6-12 weeks

  • Pro - mimics hand-to-mouth training of addiction

  • Con - mimics hand-to-mouth training of addiction

mouth/throat irritation, bronchospasm

Nicotine cartridge ADRs

reactive airway disease (bronchospasm)

What are the contraindications for nicotine cartridges?

PRN, hour, 10, 80, irritation, rhinitis, tearing

Nasal Spray

• Use ___, comes as one strength

• 1-2 sprays per ____ for about 3 months, max __ sprays per hour, max __/day

• Very Common ADR: nose/throat __________ VERY common and therapy limiting

• Other ADRs - _________, sneezing, _______

Varenicline

MoA - Competitive partial AGONIST for alpha-4-beta-2 nicotinic receptors

Prevents withdrawal and binding of nicotine

Yes

Can you overlap smoking with the use of neuropsych therapy?

Varenicline

What drug has these ADRs?

• Common

  • Constipation

  • Insomnia

  • Dream issues

  • Flatulence

• Significant

  • Angina

  • MI

  • CV accidents

  • neuropsych issues

no (high risk of ADRs)

Can you combine the use of varenicline with the use of nicotine replacement products?

renal

What kind of dose adjustment does varenicline have?

Bupropion

Slows dopamine/NE breakdown, creating relatively higher dopamine (like nicotine)

Yes

Can you combine Bupropion with nicotine replacement products?

yes

Can you overlap smoking with the use of Bupropion during initial treatment?

Bupropion

ADRs

• insomnia

• dry mouth

• weight loss

seizures, bulimia/anorexia, MAOI

Bupropion Contraindications

• _________

• Dx of ________/________

• ____ use w/in 14 days

suicidal ideation, worsening depression

What is the black box warning for bupropion?

renal

What kind of dose adjustment does bupropion need?