Self Care Exam 2

weak base

nicotine is a ____________ and absorption is pH dependent

acidic

nicotine will not be well absorbed in an _________________ environment

alkaline media

nicotine is more absorbed in ___________________ (aka pipes, cigars, spit tobacco, oral nicotine products)

nicotine patches

nicotine is best absorbed through ________________

brain

nicotine hits the ________ first (within 10 seconds) which is why it is so addicting

cotinine

inactive metabolite of nicotine, what is tested in a drug test (bc it has a longer half life)

nicotine excretion

Through kidneys (pH dependent)

Breast milk

nicotinic receptors

the site of where nicotine binds in the body, causes a stimulatory effect

CNS nicotine effects

-pleasure

-arousal

-improved task performance

-anxiety relief

CV nicotine effects

-increased HR

-increased cardiac output

-increased BP

-vasoconstriction

metabolic nicotine effects

-appetite suppression

-increased metabolism

dopamine

_____________ is the main neurotransmitter involved in the positive effects people feel from nicotine

2-4 weeks

most nicotine withdrawal symptoms go away after ______________

6 months or longer

increased appetite, weight gain, and cravings (nicotine withdrawal symptoms) typically last _________________

minimum serum nicotine concentration

concentration of nicotine required throughout the day to prevent withdrawal symptoms, maintain pleasure, and stabilize mood

factors leading to tobacco (nicotine) use

-psychiatric issues

-weight loss

-conditioned stimuli

-genetic predisposition

physiological

the ADDICTION of nicotine is _____________________ and medications can be used to treat

behavioral

the HABIT of using nicotine is _______________ and the treatment is lifestyle changes

physiological and behavioral

treatment of nicotine addiction should address BOTH _____________________ aspects

behavioral treatment

______________________________ is preferred for nicotine cessation in pregnant women and children (under 18)

"light" smoker

less than 10 cigarettes per day

otc nicotine cessation

-gum (Nicorette)

-lozenge (Nicorette)

-patches (NicoDerm-CQ)

rx only nicotine cessation

-nasal spray (Nicotrol)

-Bupropion SR

-Varenicline (Chantix)

nicotine cessation therapy benefits

-reduces physical withdrawal symptoms

-eliminates the immediate "high" from normal nicotine devices

-allows patients to focus on changing behavior

NO nicotine cessation OTC for these patients

-recent myocardial infarction (within the past 2 weeks)

-serious arrhythmias

-serious or worsening angina

nicotine gum and lozenge dose

2mg and 4mg

nicotine lozenges

____________________ provide more nicotine than gum. This is why the max doses per day differ.

time to first cigarette (TTFC)

dose of nicotine gum and lozenge is based on the ____________________________ as an indicator of nicotine dependence

2mg nicotine gum/lozenge

used if first cigarette of the day is smoked MORE THAN 30 MINUTES after waking up

4mg nicotine gum/lozenge

used if the first cigarette is smoked WITHIN 30 MINUTES of waking up

weeks 1-6 nicotine gum/lozenge dose

1 piece every 1-2 hours

weeks 7-9 nicotine gum/lozenge dose

1 piece every 2-4 hours

weeks 10-12 nicotine gum/lozenge dose

1 piece every 4-8 hours

9 pieces/day

begin with a MINIMUM of _________________ when nicotine gum/lozenge is used as monotherapy for smoking cessation

chewed slowly

nicotine gum should be _________________ until a tingling feeling appears then should place between cheek and gums

dissolve slowly

nicotine lozenges should be placed in the mouth and allowed to ________________, DO NOT chew or swallow

15 minutes

do NOT eat or drink for _____________ before or while using nicotine gum/lozenges

things that will decrease effectiveness of nicotine gum/lozenge

-coffee

-juice

-wine

-soft drinks

incorrect use of nicotine gum/lozenge can cause:

-lightheaded/dizziness

-nausea and vomiting

-hiccups

-throat/mouth irritation

adverse effects of nicotine gum

-jaw muscle aches

-may stick to dental work

nicotine patch for light smokers (<10 cigarettes/day)

14mg x 6 weeks

then

7mg x 2 weeks

nicotine patch for heavy smokers (>10 cigarettes/day)

21mg x 6 weeks

then

14mg x 2 weeks

then

7mg x 2 weeks