PHA 335 - Nicotine Replacement Therapy and Vaping Dangers L17

Risks and consequences of smoking

Lung cancer; other cancers; COPD; respiratory disease; coronary heart disease; peripheral arterial disease; aneurysm; peptic ulcer disease; cataracts; osteoporosis; periodontal disease; reduced fertility and poor pregnancy outcomes

Dangers of vaping

Highly addictive especially in youth; contains carcinogens and harmful chemicals; associated with lung injury and deaths; marketed with appealing flavors

Pathophysiology of nicotine dependence

Nicotine stimulates dopamine reward pathway → pleasurable effects → continued use and dependence

Clinical presentation of nicotine withdrawal

Begins 1–2 days after quitting; peaks within first week; resolves over 2–4 weeks; increased appetite and weight gain may persist months

5 A’s technique

Ask about use; Advise to quit; Assess readiness; Assist with quitting; Arrange follow-up

Pack-year calculation

Packs/day × years smoked; used to assess lung cancer risk

Goals of therapy (smoking cessation)

Complete long-term abstinence from all nicotine products; best achieved with pharmacotherapy + counseling

Exclusions for self-treatment

Serious heart disease (recent MI, arrhythmia, severe angina); uncontrolled HTN; pregnancy/breastfeeding;

OTC smoking cessation agents

Nicotine replacement therapy (gum, lozenge, patch)

Mechanism of NRT

Provides controlled nicotine to reduce withdrawal symptoms and cravings and allows gradual tapering

Nicotine gum (Nicorette)

Onset 30–60 min; strengths 2 mg, 4 mg; ADR: headache, mouth irritation, dry mouth, insomnia, dyspepsia; rare bronchospasm, overdose

Nicotine gum dosing

≤30 min to first cigarette: 4 mg; >30 min: 2 mg; chew Q1–2 hr x6 weeks then taper; max 24 pieces/day; minimum 9/day first 6 weeks

Nicotine gum counseling

Chew and park method; avoid food/drink 15 min before/during; unpleasant taste if chewed too fast; keep accessible

Nicotine lozenge (Nicorette)

Onset 30–60 min; strengths 2 mg, 4 mg; ADR similar to gum; dissolve slowly; do not chew or swallow

Nicotine lozenge dosing

Same as gum based on time to first cigarette; max 20/day; no more than 5 in 6 hours

Nicotine lozenge counseling

Rotate in mouth; do not eat/drink 15 min before; allow to dissolve completely

Nicotine patch (Nicoderm CQ)

Onset 3–12 hr; strengths 7 mg, 14 mg, 21 mg; ADR: rash, vivid dreams, insomnia, headache; rare overdose

Nicotine patch dosing

>10 cigarettes/day: 21 mg x4–6 weeks → 14 mg → 7 mg; ≤10/day: 14 mg → 7 mg

Nicotine patch counseling

Apply to clean dry skin; rotate sites; do not cut; remove before MRI; wear 24 hr or 16 hr if sleep issues

Combination NRT

Patch + gum or lozenge is most effective

Special populations – pediatrics

Special populations – pregnancy/lactation

Behavioral counseling only; avoid NRT

Special populations – geriatrics

Use caution with cardiovascular disease; monitor adverse effects

Special populations – conditions

Dermatologic conditions: avoid patch; dentures/TMJ: avoid gum; ulcers/diabetes: avoid gum/lozenge

Lifestyle modifications (smoking cessation)

Avoid triggers; use substitutes (gum, candy, water); avoid smokers; build support system

Case-based treatment (JK)

Avoid patch (skin issues) and gum (dentures); use nicotine lozenge 4 mg Q1–2 hr x6 weeks (max 20/day)

Counseling pearls (smoking cessation)

Combine medication + counseling; set quit date; follow up at 1 week and 1 month; use quit line 1-800-QUIT-NOW