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100 Cards in this Set
- Front
- Back
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What is the most effective modality to treat smocking cessation
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counseling and medication when used together rather than when used alone
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Since there is a strong correlation between counseling intensity and quitting describe the counseling sessions
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they should be > or = 10 minutes in length and there should be > or = 4 sessions
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What is the first line treatment for smoking cessation
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nicotine replacement products
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Name the 5 formualtions of nicotine that can be used
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nicotine gum
inhaler lozenge nasal spray patch |
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Name the 2 non nicotine agents that can be used
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bupropion
varenicline |
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Can the nicotine products be used in combination
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yes
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What should be cautioned if using nicotine products in combination and why
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caution if there are cardiovascular conditions because the side effects are additive
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Besides using combination nicotine products what other smoking cessation products can be used in combination
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can use bupropion with nicotine
-do not use varenicline with nicotine |
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Does nicotine conmbination or bupropion SR + nicotine have greater evidence of benefit
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combination nicotine
-bupropion SR + nicotine has less evidence of benefit |
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Why should varenicline not be used with nicotine products
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due to increased risk of SE
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What effect does smoking have on the P450 system and why is this important
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smoking causes induction of the P450 system
-this is important because when smokers quit they may experience SE and have surpatherapeutic drug levels of caffeine, theophylline, fluvoxamine, olanzapine and clozapine |
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Give the adverse outcomes that can occur if smoking while pregnant
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adverse outcomes for the child:
spontaneous abortion low birth weight sudden infant death |
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What are the treatment recommendations based on in pregnant women
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the number of cigarettes they smoke in a day
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What is the recommendation for stopping cigarettes if a pregnant woman smokes less than 5 cigs a day
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behavioral suppport
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What is the recommendation from ACOG for pregnant women that smoke more than 5 cigs a day, what about other sources recommendation and what is the pregnancy category of these options
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ACOG recommends buproprion which is preg category C
-other sources recommend nicotine replacement, all nicotine products are preg category D except the gum which is category C |
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Explain the 5 As model for treating tobacco use
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-Ask about tobacco use
get status of use for every pt at each visit -Advise to quit -Assess is the pt willing to quit? how recent did you quit? urges? -Assist if willing to quit offer meds and/or counseling, relapse prevention -Arrange have follow up w/ pt |
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Brand name of nicotine gum
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Nicorette
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Brand name of nicotine inhaler
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Nicotrol inhaler
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Brand name of nicotine nasal spray
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Nicotorl NS
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Brand name of nicotine patch
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NicoDerm CQ
Habitrol |
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Brand name of nicotine lozenge
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Commit
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Name the nicotine replacement products that are OTC and RX
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OTC:
gum, patch (also Rx), lozenge RX: inhaler, spray, patch |
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What is the dosing of the nicotine gum based on
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the amount of cigarettes the person smokes per day...if <25 or >25
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Give the dosing recommendation for the nicotine gum
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< 25cig/day use 2 mg gum
> 25cig/day use 4mg gum |
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How long should the pt use the nicotine gum
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up to 12 weeks
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Give the dosing regimen for the nicotine gum over the 12 wk peroid
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1 gum Q1-2h x 6wks
then 1 gum Q2-4h x 3wks then 1 gum Q4-8h x 3 wks |
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What is the max pieces of gum for one day
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24 pieces
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Name common SE of the nicotine gum
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dyspepsia
mouth soreness hiccups jaw ache |
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How long can the nicotine inhaler be used
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up to 6 months
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How many sprays equal one dose of the nicotine nasal spray
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1 dose = 2 sprays
1 spray in each nostril |
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How long can the nicotine nasal spray be used
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3 to 6 months
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Which form of nicotine replacement has the highest adherence rate
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nicotine patch
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Name the strengths of the nicotine patch
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7mg/hr
14mg/hr 21mg/hr |
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What is dosing of the nicotine patch based on
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the number of cigarettes smoked/day
<10 or >10 cigs/day |
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Give the dosing recommendation for the nicotine patch
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>10 cig/day begin with the 21mg/d patch
<10 cig/day begin with the 14mg/d patch |
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Give the dosing regimen for the nicotine patch based on the amount of cigs/day
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>10 cigs/day
21mg/24hr x 6wks 14mg x 2 wks 7mg x 2 wks <10cigs/day 14mg x 6 wks 7mg x 2wks |
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How long should 1 nicotine patch be worn
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for 24 hours
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Which nicotine replacement product has a max and minimum amount that should be used in a day
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logenze
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What is the dosing based on for the nicotine lozenges
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when the pt has the first cigarette of the day
>30min upon waking up or < 30min upon waking up |
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Give the dosing recommendations of the lozenges based on the time of waking up
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1st cig > 30 min of waking up use the 2 mg lozenges
1 cig <30 min of waking upuse the 4mg lozenges |
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What is the max and minimum amount of lozenges that should be used in a day
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max: 20/day
min: 9/day |
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Give the dosing regimen of the lozenges
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1 lozenge Q1-2 x 6wks
1 lozenge Q2-4 x 3 wks 1 lozenge Q 4-8 x 3 wks |
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Why may a pt need to wear the patch for a shorter period of time in the day
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to avoid insomnia
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If trying to avoid insomnia with nicotine patch how long should it be worn
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16hrs
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Is the nicotine lozenge effective in pregnant pts
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NO
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When should the use of nicotine replacement products be cautioned
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-recent MI (w/in 2wks)
-serious arrhythmias -serious or worsening angina |
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according to the FDA what age do you have to be to purchase nicotine procuts
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18
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Which nicotine product has been shown to delay or reduce weight gain
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nicotine gum
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Which nicotine product also stands as a coping mechanism and why
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the nicotine inhaler bc it has a hand to mouth action
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In which pts should the nicotine nasal spray be avoided
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in pts with reactive airway disease
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Which nicotine product has the fastest delivery system
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nicotine nasal spray
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Which nicotine product has the highest dependence potential
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nicotine nasal spray
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Which nicotine product is useful for rapid relief of nicotine withdrawal
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nasal spray
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What is the brand name of bupropion when used for smoking cessation
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Zyban
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Give the MOA of bupropion SR in smoking cessation
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blocks neural re uptake of dopamine and or NE and blocks nicotinic acetylcholinergic recptors
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Can bupropion be used with nicotine replacement therapy
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yes
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When should bupropion be initiated for smoking cessation
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start 1-2 weeks before quitting
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Give the dosing regimen of bupropion for smoking cessation
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150mg Qam for 3 days
then 150mg BID |
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Give BBW of Zyban
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not approved for children
not approved for bipolar increased risk of suicidal thinking and behavior in children,teenagers and young adults |
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Give SE of bupropion
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dry mouth
insomnia HA N/V constipation seizures (dose related) changes in blood pressure(likely increase) weight loss |
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Give contraindications to the use of bupropion (Zyban)
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history of seizures
eating disorder use of MAOI w/in the previous 14d |
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Can bupropion be used in CVD risk
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yes
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What is the pregnancy category of bupropion, is it used?
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preg category C
it is used in pregnancy |
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What is the max dose of Zyban and why
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450mg/day
due to increased seizure risk over this dose...the drug decreases the seizure threshold |
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Why is a Medguide required for the use of Zyban
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because it is an antidepressant
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Give the brand name of varenicline
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Chantix
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Generic of Chantix
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varenicline
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Give the MOA of varenicline (Chantix)
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a partial neuronal alpha4 beta 2 nicotinic receptor agonist
AND stimulates dopamine receptors which reduces the cravings and withdrawal symptoms |
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By what mechanism does Chantix reduce cravings and signs of withdrawal
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by stimulating the dopamine receptors
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Can chantix be used with NRT
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use is not recommended with NRT
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When should the pt begin to use Chantix
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start 1 wk before the quit date
(means pt is using chantix and cigs at the same time) |
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Give the dosing regimen of chantix
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Days 1-3: 0.5mg/day
Days 4-7: 0.5mg BID Day 8 = quit date and beyond: 1mg BID |
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When should the second pill of chantix be taken and why
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at dinner to avoid insomnia
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Give the BBW for chantix
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neuropsychiatric events including depression, suicidal ideation, attemps
stop taking if become hostile, agitated, depressed |
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Give SE of chantix
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nausea**
abnormal dreas constipation flatulence vomiting serious skin rxns** |
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Which drug used for smoking cessation must be adjusted for renal impairment and how
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Chantix
decrease dose if CrCl <30ml/min |
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What is the pregnancy category of Chantix
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category C
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Give the all the pharmacological options for smoking cessation
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-nicotine replacement therapy
(gum, patch, nasal spray, inhaler, lozenge) -bupropion (Zyban) -Varencicline (Chantix) |
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How should the pt be instructed to use the nicotine gum
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1. pt should chew gum SLOWLY until they a flavored taste emerges
2. then park the gum b/t the cheek and gum to facilitate nicotine absorption through oral mucosa 3. slowly chew and park gum for 30 minutes until taste is gone |
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What type of beverages interfere with the absorption of nicotine gum
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acidic
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Give examples of beverages that can interfere with nicotine gum
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coffee
juice soft drinks |
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How long should beverages besides water be avoided while using the nicotine gum
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for 15 minutes before or during chew
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Why is it that some patients do not receive optimal effect when using the nicotine gum
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bc they do not chew enough gum, should chew every 1 to 2 hours in the beginning
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How should a pt use a cartridge with the nicotine inhaler
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continuous puffing for 20 minutes
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How long is a nicotine inhaler cartridge good
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for one day
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When is the peak effect of the nicotine inhaler achieved
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w/in 15 minutes
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When does the delivery of the nicotine from the inhaler decline
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below 40 F so in cold weather keep in pocket or warm area
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what type of beverages should be avoided with nicotine inhaler
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acidic beverages
-only use water 15min before and during chewing |
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How should the pt use the lozenge
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it should be allowed to dissolve in the mouth and not chewed or swallowed
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What type of beverages should be avoided with nicotine gum, inhaler and lozenges
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acidic beverages
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How should the head of the nicotine nasal spray be tilted when used
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slightly back
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What are 2 options for patients experiencing insomnia while taking the nicotine patch
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-remove the 24hr patch before bed
-use the 16 hour patch |
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When should a new nicotine patch be applied
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as soon as the pt wakes up
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What is the most common SE of the patch and how is this treated
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about 50% of pts will experience a local skin rxn
treatment: -rotate the site of the patch -use hydrocortisone 1% or triamcinolone cream 0.5% |
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how long does it take for bupropion (zyban) to start working
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about 1 wk
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By how many hours should doses of bupropion be separated
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by at least 8 hours
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Due to increase N/V while taking chantix, give counseling points for the pts
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take with food and a full glass of water (8oz)
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How long do most people take chantix
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up to 12 weeks but another 12 weeks is possible if needed
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Give symptoms of nicotine withdrawal
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urge to smoke
depression trouble sleeping irritability frustration anger feeling anxious difficulty concentrating restlessness decreased heart rate increased appetite weight gain |
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What types of allergic rxns can be seen with chantix
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angioedema
serious skin rxns |
