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5 Cards in this Set
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Nicotine replacement reduces smoking by 50% -70% Behavioural therapy for 8-24 weeks Offer pharmacological agents to people who smoke more than 10 cigarettes per day and wish to quit |
Varenicline first to patients Combining NRT patch with as needed gums, inhaler etc more effective than individual products because it provides a steady level with blouses for flexibility and treatment of cravings |
Pharmacotherapy not shown to provide additional benefits in adolescents |
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Standard duration of NRT 8-12 weeks , extend to 24 weeks for maximum benefits Long and intense exercises increase nicotine absorption through patches and predisposes to nicotine toxicity Apply patch after exercise and limited to upper body |
Varenicline nicotinic receptor partial agonist Neuropsychiatric side effects so watch out for mood changes and suicidal thoughts Use with caution in patients wi to previous or current psychiatric illness (studies says safe in stable schizophrenia Caution in CV disorder |
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Bupropion blocks reuptake of dopamine serotonin and NE Combination of patch and bupropion more effective than it alone NB adding bupropion to NRT did not increase effect of NRT Monitor for self harm |
Second line clonidine and nortriptyline Cystine Limit combination therapy to people in whom mono therapy was unsuccessful or severe nicotine addiction |
Post quiting weight gain Bupropion less weight gain due to its anorexiant properties Manage cravings by eating low calorie snacks or sugar free candy and gum |
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Smoking induces cyp1a2 and increases clearance of caffeine, olanzapine, clozapine, warfarin, nifedipine, diazepam, estrogens, fluvoxamine, methadone, theophylline, rasagiline, trifluoperazine |
First pregnancy, first trimester, sharing a home with non smokers, higher education, not depressed, low dependence helps successful quiting |
Use CBT and NRT Male smokers quit smoking 3 months prior to conception to allow for replacement of abnormal sperm Use nicotine gum at lowest possible dose for 8-12 weeks Reserve patch for heavy smokers and unresponsive to gums. Pally for 16 hours and remove at night Use bupropion if accompanying depression Use NRT and bupropion postpartum |
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Switch therapy if no effect after 4 weeks Start clonidine 3 days or on day of quiting Start Varenicline or bupropion 1-2 weeks before quiting Start nortriptyline 1-4 weeks before quiting Avoid bupropion and MAOI Avoid clonidine and TCAs Varenicline side effects ; nausea drink water, reduce dose or ,take after food ; insomnia, suicidal thoughts and thoughts of harm Start .5mg bdcontinuation 1mg .5mg bd effective as 1mg bd use with caution in CV events Start with Varenicline Avoid clonidine with TCA, additive effects with cns depressants and anti hypertensive Bupropion causes insomnia take at dinner time |
Patch don not use habitrol while exercising and don’t cut Nicoderm can be used during exercises and can be cut NRT are contraindicated in life threatening arrhythmia severe angina pectoris, history of recent stroke, within 2 weeks of MI temporal mandibular joint disease. For patch severe skin disorders Caution hyperthyroidism uncontrolled HTN, active peptic ulcer disease, phaechromocytoma, insulin dependent DM. |
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