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61 Cards in this Set
- Front
- Back
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is nicotine acidic or basic? |
it is a weak base |
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how do you get more nicotine absorption? |
add more base to keep it in the unionized form, this permits greater absorption |
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compare physiological pH and nicotine absorption |
nicotine is well absorbed at physio pH |
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where is most nicotine absorbed? |
through the respiratory epithelium and small intestine, but is quickly metabolized in the first pass effect |
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what cyp does nicotine go through? |
2A6 |
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what kind of receptors does nicotine bind to? |
nicotinic cholinergic receptors |
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what are the effects of endorphin and GABA? |
reduce anxiety and tension |
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what NT effects mood and appetitie? |
serotonin |
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what NT is associated with cognitive enhancement? |
Ach |
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what are the two parts of nicotine dependence? |
physiological= addiction to nicotine behavioral- the habit of using it |
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Name some side effects of withdrawl. |
depression, insomnia, anxiety, weight gain, difficulty concentrating |
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what is the name of the pleasure reward center? |
nucleus accumbens |
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where does the dopamine come from? |
mesolimbic tracts |
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what are the two types of nicotinic receptors? which one has high sensitivity to nictone? what type of receptors are these? |
a4b2 and a7 a4b2 ligand gated ion channel |
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what receptors are up regulated from nicotine use? |
a4b2 and dopamine receptors |
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what are the forms of nicotine replacement? |
gum, lozenge, transdermal, nasal spray, inhaler |
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why should nicotine replacement be used? |
reduces withdrawal, patient can focus on behavioral and psychological aspects of cessation |
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what 4products are non-nicotine and used to treat addiction? |
bupropion and varenicline and clonidine and nortiptyline
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MOA of zyban? what does each part do? |
dopamine and norepinephrine reuptake inhibitor dopamine reward and nore prevent withdrawal. |
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MOA of Chantix? |
partial agonist of a4b2 which prevents cravings and as a competitive antagonist to prevent reward |
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what is unique about partial agonists? |
the act as an agonist or as a competitive antagonist and their action depends on other endogenous or exogenous agonists at the same receptor |
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MOA of clonidine? |
acts as a a2 AR agonist that decreases release of nore, this reduces autonomic withdrawal symptoms |
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MOA of nortripltyline? |
blocks reuptake of NE and serotonin |
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what are the symptoms of tobacco withdrawal? how long until these are maximazed after quiting? how long could they last? |
sleep disturbances, poor concentration, cravings, irritability, depression, increase appetite 7 days a lifetime |
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what questions are in the 5-A? |
ask about use advise they quit assess willingness assist to quit arrange follow up |
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what are the steps of willingness to quit? |
pre-contemplation contemplation preparation action maintenance relapse |
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the average craving lasts how long? how many times until you quit for good? |
3-5 minutes 7 times |
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what populations is medication for cessation contraindicated in? |
pregnant smokers, smokeless tabocco users, adolescents, light smokers
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name all the nicotine replacement formulations |
patches, gum, lozenge, inhaler, nasal spray |
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what is used second line? |
clonidine and nortriptyline |
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what is contraindicated for NRT? |
heart attack within 2 weeks, angina, arrhythmias |
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unique side effects of gum and lozenge? |
heartburn and hiccups |
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directions for gum? |
chew gum until tingle/taste, then park between gum and teeth for 30 minutes, no acidic drink 15 minutes before |
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what is the only drug interaction of the nicotine drugs? |
nicotine patch and cimtidine >600mg |
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anything with tiotropium has the possiblity of being a respimat |
lol |
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what is the dosing of gum? |
>25 cigs/day then 4 mg <25 cigs/day then 2mg |
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what is the dosing of lozenges? |
1st cig within 30 minutes of waking= 4mg 1st cig later in the day= 2mg |
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Starting dose using the patch? |
>10cigs/day use 21 mg < or equal to 10 cigs/day use 14mg |
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max dose for nasal spray? Min dose? |
40doses/day 8doses/day |
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inhaler max and min dose? |
6-16 cartridges/day |
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what nicotine formulations should you be careful with after 6 months of use? |
the inhaler and nasal spray |
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when do you step down a therapy? |
if cravings subside at current dose |
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what is the maintence dose for zyban? how do you get there? |
150mg qd for 3 days then increase to BID, start 1- 2 weeks before quit date |
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contraindications for zyban |
seizure, eating disorder, maoi past 14 days |
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drug interactions of zyban |
2d6, maoi 14 days after use |
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important monitoring factor of zyban? |
HR and BP |
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what is the goal dose of varincline |
1mg BID |
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major precaution of varenicline? |
psychiatric illness |
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side effects of chantix? |
dreams, nausea, suicide thoughts, headache |
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drug interactions of varenicline? |
quinolone, h2 antagonist |
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what is clonidine usually used for? |
withdrawal symptoms |
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is there a difference between clonidine patch and tablets? |
yes the patch has less side effects |
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what medication can you not stop abruptly? why? |
clonidine, rebound hypertension |
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what is unique about the dosing of nortriptyline? |
start 1 month prior to quit date |
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contraindication of nortirplyline? |
recent MI |
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what antidepressent should you use if the patient has seizures? |
nortriplyline |
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major side effect of nortriplyline? |
qt prolongnation, do an EKG if necessary |
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drug interactions with nortripltyline? |
antiarhythmics, quinolones, maoi |
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what drug combo for smoking cessation is never used together? |
chantix with any other NRT |
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what drugs affect the patients heart? |
zyban, nortripltline, clonidine |
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wsdf |
dg |
