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76 Cards in this Set

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What is the etiology of nicotine addiction?
Nicotine stimulates dopamine release >> pleasurable feelings >> repeated administration >> tolerance develops
What are the pharmacodynamic effects of nicotine on the CNS?
pleasure, arousal, enhanced vigilance, improved task performace, anxiety release
What is the pharmacodynamic effects of nicotine on the cardiovascular system?
increase heart rate, increased cardiac output, increased blood pressure, coronary vasoconstriction, cutaneous vasoconstriction
What are the pharmacodynamic effects of nicotine on appetite?
supression
What are the pharmacodynamic effects of nicotine on metabolic rate?
increase
What are the pharmacodynamic effects of nicotine on skeletal muscle?
relaxation
What are the risks associated with smoking?
Cardiovascular, COPD, cancer, delayed healing and recovery after surgery, cataracts, sexual dysfunction, osteoporosis, periodontal disease
What are the risks associated with second hand smoke?
developmental effects (fetal growth retardation, sids), carcinogenic effects (lung ca, nasal sinus cancer),CV effects (heart disease mortality, acute and chronic CHD morbidity), respiratory effects (peds: accuts lower RTI, asthma induction and exacerbation, middle ear infection; adults: eye and nasal irritation)
What are the health risks associated with smoking during pregnancy?
miscarriage, stillbirth, preterm delivery, low birth weight
What are the 5 As?
Ask pt whether they are a smoker, advise tobacco users to quit, assess the patients readiness to quit (decision to quit is in the hands of the pt), assist pt with quitting, arrange follow-up care
What are the appropriate counseling techniques for those ready to quit?
Strong advise to quit, provide information, ask noninvasive questions (identify reasons for tobacco use), raise awareness of heath consequences, demonstrate empathy, foster communication, leave decisions up to the patient (let them known you are there to help when they're ready to quit)
What are the inappropriate counseling techniques for those not ready to quit?
Don't persuade, "cheerlead", tell patient how bad tobacco is in a judgmental manner, provide a treatment plan
What are the methods to increase motivation in patients not ready to quit?
Five Rs: relevance, risks, rewards, roadblocks, repetition
What are the withdrawl symptoms of smoking cessation?
anger/irrability, anxiety, cravings, difficulty concentrating, hunger/weight gain, impatience, restlessness, constipation, drowsiness fatigue, impaired task performance, nervousness, sleep disturbances
How long till most withdrawl symptoms pass?
most within 2-4 weeks after quiting
How long till cravings pass after quitting smoking?
cravings can last several months to years
What cognitive changes can aid in smoking cessation?
Review of commitment to quitting, distractive thinking, relaxation through imagery, mental rehearsal and visualization, "alert mentality: you are a nonsmoker"
What are behavior changes that can aid in smoking cessation?
smoke free home and workplace, alter or remove cues to tobacco use, modify behaviors that you associate with tobacco (when, what, where, how, with whom), actively avoid trigger situations, substitutes for smoking (water, gum, hard candies), take a walk, self massage, disphragmatic breathing, rely on social support
What are the pharmacologic treatments for smoking cessation?
NRT, Zyban, Chantix
What is the generic for Chantix?
varenicline
What is the generic for zyban?
bupropion
What forms does NRT come in?
gum, patch, lozenge, nasal spray, inhaler
What is the moa of NRT?
works on nicotine receptors
What are the precautions when using NRT?
patients with underlying CV disease, active TMJ (gum), pregnancy, lactation
What is the dose for NRT gum?
>=25 cigs/d = 4mg ; <25 cigs/d =2mg
What is the dosing schedule of NRT gum?
Weeks 1-6 tk 1 q 1-2 h; weeks 7-9 tk 1 q 2 to 4 h, weeks 10-12 tk 1 q 4 to 8 h; DO NOT exceed 24 per day; use at least 9 pieces per day for most success
What should you not do before using NRT gum?
eat or drink 15 mins before using
What are the side effects of NRT gum?
mouth soreness, hicups, dyspepsia, jaw muscle ache
What are the side effects of NRT gum if chewed too quickly?
lightheadedness, NV, irritation of throat and mouth, hiccups, indigestion
What pregnancy category is NRT gum?
C
What is the dosing for NRT lozenge?
1st cig <= 30 mins after waking = 4mg; 1st cig > 30 mins after waking = 2mg
What is the dosing schedule for NRT lozenge?
Weeks 1-6 1q1-2h, weeks 7-9 1q2-4h, weeks 10-12 1q4-8h; DO NOT exceed 20/d
What are the directions for use for NRT Lozenge?
allow to dissolbe slowly in mouth (will dissolve in 20-30 min), may have warm tingle when nicotine is released, do not chew or swallow lozenge, rotate lozenge to different areas of the mouth, do not eat or drink for 15 min before or while using lozenge, use at least 9 loz/d for first 6 weeks to be successful
What are the side effects of NRT lozenges?
nausea, hiccups, cough, heartburn, flatulence, insomnia
What is the pregnancy category of NRT lozenges?
C
What is the length of delivery of Nicotrol?
16h
What is the length of delivery of Nicoderm CQ?
24h
What is the length of delivery of generic NRT patch?
24h
What are the directions for use for NRT patch?
use an area of skin on the upper body or the upper outer part of the arm, make sure the skin is clean dry and hairless, do not shave as it can irritate the skin, do not apply to inflamed burned or irritated skin as it can affect absorption, the same area should not be used again for at least 1 wk
What is the proper application of the NRT patch consist of?
peel off half of the backing from the patch, apply adhesive side of patch to skin, peel off remaining protective covering, press firmly with palm of hand for 10 seconds, make sure patch sticks well to skin (especially around edges), wash hands (nicot can get into eyes and nose and cause irritation), do not leave on for more than 16 h (nicotrol) or 24h (nicoderm or generic), adhesive can be removed with rubbing alcohol or acetone
How does one dispose of a used nrt patch?
by folding onto itself completely covering the adhesive area
What are the side effects of NRT patch in first hour?
mild itching, burning, tingling
What are the general side effects of nrt patch?
vivid dreams or sleep disturbances, HA, local skin irritation - skin can appear red for 24 h, if skin stays red for > 4 days or swells or if rash appears, seek medical attention
What is the pregnancy category of the patch?
D
What are additional patient education points?
water will not harm the patch if it is applied correctly (pt may bathe, swim, shower, exercise), do not cut the patch (nicotine would evaporate), do not wear patch in hot tub, if patch falls off apply a new patch
What is the dose of NRT nasal spray?
1 dose = 1 mg nicotine (0.5mg spray in each nostril)
What is the starting dose of NRT nasal spray?
1-2 doses / h. Increase prn to max of 5 doses per h or 40 mg/d. For best results use at least 8 doses daily x 6-8 wks
How does one discontinue NRT nasal spray?
Gradually taper over 4 to 6 wks
What are the directions for use of NRT nasal spray?
prime pump, blow nose, tilt head back slightly and insert tip of bopttle into nostril as far as comfortable, spray in each nostril, do not sniff or inhale while spraying, wait 2-3 mins before blowing nose, avoid skin eye or mouth contact
What are the side effects of NRT nasal spray?
hot peppery feeling in back of throat or nose, sneezing, coughing, water eyes, runny nose. side effects lessen with repeated use
What is the pregnancy category of NRT nasal spray?
D
Where is NRT inhaler nicotine absorbed?
buccal mucosa
What is the delivery of nicotine via a NRT inhaler if 80 puffs are within 20 mins?
2 mg
What is the dosing schedule for NRT inhaler?
6 cartidges/d with increase prn. Max 16 cart/d. Min use of 3 wks and max of 12 wks. Gradual dose reduction over 6--12 wk if needed
What are the directions for use for NRT inhaler?
inhale deeply into back of throat or puff in short breaths, nicotine cart is depleted after 20 min of active puffing, cart does not have to be used all at once, open cart retains potency for 24 h, reusable mouth piece should be cleaned with mild soap, do not eat or drink for 15 min before or while using inhaler
What is the pregnancy category for the inhaler?
d
What are the side effects of the NRT inhaler?
mild irritation of the mouth and throat, unpleasant taste or cough when first using, rhinitis, dyspepsia, hiccups, HA
What is the moa of Zyban?
Dopamine and norepinephrine reuptake inhibitor
What are the clinical effects of Zyban?
decreases cravings for cigs, decreases symptoms of nicotine withdrawal
What are the contraindications for zyban?
hx of seizures (lowers seizure threshold), anorexia or bulimia nervosa, pts on Wellbutrin or MAOIs, pts undergoing abrupt discontinuation of ETOH or sedatives
What is the pregnancy category for zyban?
C
What is the dosing for zyban?
150mg qam x 3 d, then 150mb bid x 7-12 wk (therapy should begin one wk prior to quitting)
What are the side effects of zyban?
insomnia (avoid bedtime dosing), dry mouth, ha, appetite suppression, wt loss; also less common symp are tremor and skin rash
Is tapering necessary for zyban?
no
Can zyban be used with NRT?
yes
If zyban therapy is not effective by week 7, what should the pt do?
stop therapy and re-evaluate to possibly start at a later date
Can pt use zyban longer than 12 wks?
yes if effective and needed
What is the moa of Chantix?
binds to nicotinic receptors in the brain with high affinity resulting in agonist activity while also acting as a antagonist by preventing the binding of nicotine therefore blocking the pleasure sensation received from smoking
What is the dosing for chantix?
Days 1-3 0.5mg/d, Days 4-7 0.5mg BID, Day 8 and beyond 1mg BID. Treatment is started one week prior to quitting smoking
What is the duration of therapy in chantix?
12 wks, can do additional 12 wks
How should a patient take chantix?
after a meal with a full glass of water
What are the contraindications for chantix?
serious hypersensitivity or skin rxn
What are the precautions and warnings for chantix?
renal impairment, psych disorders
What is the black box warning on chantix?
neurospych events such as depression, suicidal ideations, attempts, and completed suicide have been reported
What is the pregnancy category for Chantix?
C
Can chantix be used with a NRT?
No