Use LEFT and RIGHT arrow keys to navigate between flashcards;
Use UP and DOWN arrow keys to flip the card;
H to show hint;
A reads text to speech;
34 Cards in this Set
- Front
- Back
Signs of nicotine dependence?
|
Depressed mood, insomnia, irritability, anxiety, difficulty concentrating, restlessness, decreased heart rate, increased appetite or weight gain
|
|
Nicotine Dependence
|
Daily use of nicotine for at least several weeks that is followed by S&S after 24 hours of cessation
|
|
Nicotine Dependence Treatment
|
Nicotine replacement therapy
Bupropion Varenicline Clonidine Nortriptyline |
|
Non-pharmacological recommendations for Nicotine Dependence Treatment
|
Smoke-free environment
Family/friends support Avoid dieting Support groups Use sugar-free suckers, carrot sticks, as a substitute for "hand to mouth activity" |
|
Last line treatment for nicotine dependence therapy due to rebound HTN
|
Clonindine
|
|
2nd line treatment for nicotine dependence treatment
|
Nortriptyline
|
|
Nicotine Replacement Therapy
|
Nicotine gum, spray, lozenges, inhaler, & patches
|
|
Nicotine replacement therapy 1 year quit rates
|
11-34%
|
|
Dosage of nicotine replacement therapy
|
Based on ppd smoked
Started high initially & weaned at specific time intervals |
|
Total time treatment for nicotine replacement therapy
|
8-12 weeks
|
|
Bupropion (Zyban) drug class
|
Dopamine & norepi reuptake inhibitor
|
|
Bupropion MOA
|
Inhibits dopamine, norepi, and minimal serotonin reuptake
|
|
Bupropion ADEs
|
HTN, tachyarrhythmias, pruritis, changes in weight, constipation, xerostomia, confusion, dizziness, h/a, insomnia, tremor, anxiety, dysrhythmias, seizures (lowers threshold), psychosis, & vivid dreams
|
|
How is Bupropion distributed?
|
Highly bound to protein
|
|
How is Bupropion metabolized?
|
p450 pathway (hepatic)
|
|
How is Bupropion eliminated?
|
Renal & fecal
|
|
1/2 life of bupropion?
|
12-30 hours
|
|
Bupropion drug interactions
|
MAOIs, linezolid, systemic steroids (may lower seizure threshold)
|
|
Reduce risk of seizures with Bupropion by...
|
Avoiding in pts w/ hx of seizures or head trauma
|
|
How often is bupropion dosed?
|
Every 12 hours b/c it is a controlled release formulation
|
|
Do patients quit smoking "cold turkey" with bupropion use?
|
No, they set a quit date 1-2 weeks after they start the drug therapy (so they have a steady state of the drug in system)
|
|
Do they begin with a full dose on the first day of tx of bupropion?
|
No, dose is titrated up over 7 days
|
|
How long are patients treated with bupropion?
|
12 weeks
|
|
1 year quit rate of bupropion
|
35.5%
|
|
Chantix MOA
|
Binds to nicotinic acetylcholine receptors
|
|
Chantix ADEs
|
N/V/C, dream disorder, h/a, insomnia
|
|
Chantix absorption
|
Complete systemic
|
|
Chantix elimination
|
Renal
|
|
Chantix DIs
|
None ID'd yet
|
|
Chantix dosing
|
Titrated over 7 days
Continue for 12 wks May continue for 12 additinal weeks (can increase the likelihood of long-term quitting) |
|
Combination therapy options
|
Long-term nicotine patch + other NRT (gum or spray)
Nicotine patch + inhaler Nicotine patch + bupropion SR |
|
Which drug should be used to combat weight gain in nicotine dependence treatment?
|
Bupropion SR or nicotine gum or lozenge
|
|
What should be combined with pharmacologic therapy to increase quit rates?
|
Behavioral changes & psychosocial treament
|
|
What should you do if there is no response from initial treatment?
|
1.Continue the same agent for longer
2. Switch to a different 1st-line agent 3. Combine 2 agents |