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66 Cards in this Set
- Front
- Back
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what special populations do you not treat pharmacologically
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smokeless tobacco users
people who smoke <10 cigs a day adolescents (NRT for >=18 yrs otherwise need Rx) |
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what is the dosing of Nicotine gum if you smoke <25 cigs
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2mg
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what is the dosing of Nicotine gum if you smoke >25 cigs
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4mg
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what is the dosing schedule for Nicotine gum weeks 1-6
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1 piece q 1-2 hrs
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what is the dosing schedule for Nicotine gum weeks 7-9
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1 piece q 2-4 hrs
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what is the dosing schedule for Nicotine gum weeks 10-12
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1 piece q 4-8 hrs
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what are the directions for Nicotine gum use
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chew SLOWLY
stop chewing once you feel tingle or peppery taste (~15 chews) "Park" gum between cheek and gum Resume slow chewing when taste or tingle fades When taste or tingle returns, stop and park gum in different place in mouth Repeat chew/park steps until most of nicotine is gone (~30 mins) |
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how many times must you use Nicotine gum to improve chances of quiting
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9 pieces daily
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what will reduce the effectiveness of Nicotine gum and lozange
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coffee
juices wine soft drinks |
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when should you not eat while using nicotine gum or lozange
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15 mins before or while using gum or lozange
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will chewing nicotine gum or using lozange provide the same rapid satisfaction as smoking
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no
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what can happen if you chew the nicotine gum too rapidly
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lightheadedness
N/V irritation of throat and mouth hiccups indigestion |
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what are SE of nicotine gum
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mouth sourness
hiccups dyspepsia jaw muscle ache **nicotine gum may also stick to dental work |
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read about Advantages/Disadvantages of nicotine gum
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pg 19 i'm too lazy
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what is the dosage of nicotine lozenges based on
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time to first cigarette (TTFC)
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what is the dosing for nicotine lozanges
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2mg if you smoke >30 mins after waking
4mg if you smoke within 30 mins of waking |
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what is the dosing schedule for Nicotine lozanges week 1-6
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1 lozenge q1-2hrs
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what is the dosing schedule for Nicotine lozanges week 7-9
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1 lozenge q 2-4hrs
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what is the dosing schedule for Nicotine lozanges week 10-12
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1 lozenge q 4-8 hrs
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what is the max amount of lozenges per day
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20
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what is the max amount of Nicotine gum per day
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24 pieces
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what are the directions for using nicotine lozenges
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use according to recommended dosing schedule
place in mouth to allow to dissolve slowly (nicotine release may cause warm, tingling sensation) DO NOT CHEW OR SWALLOW LOZENGES occasionally rotate to different areas of the mouth standard lozenges dissolve w/in 20-30 mins. nicorette mini lozenge dissolves w/in 10 mins |
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what must you do to improve chances of quiting while using nicotine lozenges
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use atleast 9 lozenges daily for the first 6 weeks
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what are SE of nicotine lozenge
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nausea
hiccups cough heartburn headaches flatulence insomnia |
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read about advantages/disadvantages of Nicotine lozenge
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pg 20
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what strength of nicotine lozenges/gum will delay weight gain
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4mg
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what are advantages of transdermal nicotine patch
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nicotine is well absorbed across the skin
avoids 1st pass metabolism plasma nicotine levels are low and fluctuate less than with smoking |
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read about the directions for transdermal nicotine patch
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pg 21
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what SE do you expect within the 1st hours with transdermal nicotine patch and what additional SE may you experience
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Within 1st hour:
mild itching burning tingling Additional possible SE: vivid dreams or sleep disturbances headache |
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After patch removal, skin may appear red for __ hours.
if skin stays red for more than __ days or if it swells or rash appears contact health care provider, DO NOT APPLY NEW PATCH |
After patch removal, skin may appear red for 24 hours.
if skin stays red for more than 4 days or if it swells or rash appears contact health care provider, DO NOT APPLY NEW PATCH |
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read about advantages and disadvantages of transdermal nicotine patch
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pg 22
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pt with what dermatological reactions should not use the patch
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psoriasis
eczema atopic dermatitis |
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what is an advantage of nicotine nasal spray
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rapid absorption across mucosa
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how much nicotine is in a dose of Nicotine nasal spray
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1 mg (2 sprays, one 0.5mg spray in each nostril)
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what is the dosing for nicotine nasal spray
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start with 1-2 doses per hours
increase prn to MAX DOSAGE OF 5 DOSES PER HOUR or 40 MG daily (80 sprays) |
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how many doses should a pt take for best results using Nicotine nasal spray
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8 doses daily for first 6-8 weeks
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when you want to stop using nicotine nasal spray what do you do
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gradual tapering over additional 4-6 weeks
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read about nicotine nasal spray directions
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pg 23
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what should pt expect within the 1st week of nicotine nasal spray use
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hot peppery feeling in back of throat or nose
sneezing coughing water eyes runny nose SE lessen over a few days and regular use build tolerance to irritant effects. if SE don't d/c within a week contact Dr. |
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what form of NRT can you not titrate the dose to manage withdrawl symptoms
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nicotine transdermal patch
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what is the dosing for the nicotine inhaler
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start with 6 cartridges/day during first 3-6 weeks of treatment
increase prn to MAXIMUM OF 16 CARTRIDGES/DAY |
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what is the max amount of nicotine inhaler cartridges a day
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16
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what is the maximum amount of nicotine nasal spray daily
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40 mg daily (80 sprays)
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how long is a open nicotine cartridge good for
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24 hrs
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how many minutes of active puffing does it take to deplete nicotine in cartridges
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20 mins
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what are SE of nicotine inhaler
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mild irritation of mouth or throat
cough headache rhinitis dyspepsia |
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when are best results achieved when using nicotine inhaler
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frequent continuous puffing over 20 minutes
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what are the clinical effects Bupropion and what NT does it affect
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clinical effects:
decrease craving for cigarettes decrease symptoms of nicotine withdrawal affects dopamine and norepinephrine levels |
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what drugs are CI someone from using Bupropion
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Wellbutrin
MAO inhibitors preceding 14 days |
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what patients are CI from using Bupropion
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patients with a seizure disorder
patients with current/prior diagnosis of anorexia or bulimia patients who abruptly stopped taking alcohol or sedatives (BZD also) |
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read bupropions warnings and precautions
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pg 26
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what is the Bupropion SR dosing
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150 mg po qam for 3 days
then: 150 mg po bid duration 7-12 weeks |
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when should pts begive Bupropion therapy
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1-2 weeks PRIOR to their quit date to ensure that therapeutic plasma levels of drug are achieved
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what are SE of Bupropion
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Insomnia (common SE)
Dry Mouth (common SE) Tremor Skin rash |
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is dose tapering necessary with bupropion when stopping tx
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no
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with Bupropion if you don't see progress towards abstinence by what week should you D/C use
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seventh week
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what is the mechanism of action of Varenicline
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Binds to nicotinic acetylcholine Rc\
-low level agonist -competitively inhibits binding of nicotine |
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what are the clinical effects of Varenicline
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decrease symptoms of nicotine withdrawl
blocks dopaminergic stimulation responsible for reinforcement and reward associated with smoking |
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is Varenicline absorption affected by food, what's its half life. and how is it eliminated
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absorption not affected by food but doses should be taken after eating with a full glass of water
renal elimination 24hr half life |
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aside from Neuropsychiatric symptoms and suicidiality what are other warnings and precautions with Varenicline use
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CV adverse events in pt with exisitng CVdisease
hypersensitivity reaction serious skin reactions accidental injury nausea |
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when should pts begin therapy with Varenicline
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1 week prior to their quit date
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what is the dosing for varenicline
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day 1-3 0.5mg qd
day 4-7 0.5mg bid day 8-end 1mg bid |
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what are the AE of varenicline
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nausea
insomnia abnormal dreams flatulance vomiting constipation |
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read the pt education and advantage/disadvantages of varenicline
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pg 28
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what are the 2nd line pharmacologic therapies
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clonidine (catapres transdermal or oral)
nortriptyline (pamelor oral) |
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what are the combination pharmacotherapy options
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Combination NRT
-long acting formulation (patch) + shor acting formulation (gum, lozange, nasal spray) bupropion SR + nicotine patch |
