OTC Dr. Dunican
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| vapors in cig contains what | nitrogen, carbon monoxide, hyrogen cyanide and benzene
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| what does nicotine do to the body | increase BP increase HR increase force of contraction, vasocontricts vessels, arousal, enhanced tast performance, increase metabolic rate, appetite suppression
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| where is nicotine metoblized | CYP2A6
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| what is the elmination rate | 1/2 to 2 hrs in chronic smoker so people will have to keep smoking to maintain therapeutic level
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| what is the therapeutic leave | 20-40ng/ml so withdraw over night
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| the pharmacokinetic drug interaction | induction of CYP1A2
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| if someone quit smoking what would happen to drugs that are metabolized by CYP1A2 | increase in concentrations olanzapin, caffeine, theophylline
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| what are some pharmacodynamic affects of nicotine | OCs, beta blocker, benzodiazepines
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| THE PHARMACOLOG OF NICTOINE DOES WHAT | REENFORCEDT HE PHARMACOLOGY OF NICOTINE
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| cigarette is an efficient deliver system | because smoker can control the amount of nictoine by how deeply they inhale and how often, choosing the number of cig, time smoke is held in lungs (depth, frequency)
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| what are some of the withdrawal sy | head ache, weight gain, changes sleep pattern, fatigue, insomia, dizz, decrease the heart rate, loss of concentration, hostility, increase skin timeperature, craving, anxiety, impatient
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| what is the typically nicotine withdrawal symtoms to subside | 2 to 4 weeks subside not mean disapear either
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| how many people what to quit smoking but are having trouble | 7 of of ten
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| statistics on quit | assistance from clinician increase odds of quit, brief seesion help but intense session help even more, only 4.7 % of current smokers were able to quit and maintain abstinence for 3-12 months, 40 % everyday, current smoker stopped smoking for at least 1 d
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| the 5 a are for couseling on helping to quit | (blank)
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| the 5 r's are to | motivate when patients are not ready to quit
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| what are some treatment oppitions to quit smoking | NRT nicotine replace therapy, RX NRT, bupropian ZYBAN, CHANTIX varenicline works on nicotine receptors, {used to use:clonidine, nortriptyline}
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| what are some non-pharmacologic theray | managing the withdraw symptoms Cravings (avoid additional stress druign first few weeks, wait out the urge becuase only last for a few minutes, distraction, excercise)
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| what are the recommendations for dizziness | use extra caution, change positions slowly
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| what are the recommendations for chest tightness | use relaxation techniques, deep breathing use NRT if it helps
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| what are the recommendation for cough dry throat nasal drip | drink plenty of fluid
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| what are the recomm for constipation | drink plenty of fluids eat fruits, veggies, whole grain cereals
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| for hunger/weight gain recommendation | drink water or low calorie liquieds, be prepared with low calorie snacks treat carrot sticks like cig.
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| recommendaitons for isomnia | avoid caffeine after 6 pm, relaxation techniques
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| recommendations for irritability | take walks, try hot baths, relaxation techniques
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| what is the first line of therapy | (chantix is NOT) burpropin
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| what is the nicotine inhaler brand name and is it OTC or RX | RX nicotrol
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| what are our OTC options of NRT | patches gum and lozenge (couseling)
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| when should you not use NRT | when still smoking, don't recommend using combination, sever CVD, recent MI, serious arrhythmias, if have sever HP or uncontroled (CAN use if have controled HP), pregnancy/nurising, adolescents, asthma, depression refer to doc. ( can use under doc)
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| how should you use the gum | chew slowly unitl tastes pepery or feel tingle in mouth (15 chews) Chew and park when taste gone, chew and park again
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| when using nicotine gum what | (blank)
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| what are some side effects | unpleasant taste, mouth irritation, jaw muscle, soreness/fatigue, hpyersalivation, hiccups, dyspepesia, and fatulence
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| if you chew to rapidly what will this lead to | lightheadedness, nause ,vomiting, irritation,of throat and mout, hiccups, indigestion
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| what is the special with nicotine lozenges (commit) | the dosing is depend on how soon they get their cravings
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| with the lozenges how do you use it | suck then park, max 20 lozenges/day, avoid eating and driking 15 mins before or after, not chewed or swallowed, use on dosing shedual, may cause heart burn
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| what are the three brands of patches | nicoderm CQ, prostep, nicotrol
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| how do you use the nicotine patches | use the step down approach for nicotine CQ ...
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| how should you discard the patch | you should fold up to adhear onself and discard back into foil patch
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| what are some side effects from patches | if getting light headness it might be over dose so decrease, if irritating change sites, use cortisone cream, if dreams take off before bedtime
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| what is the brand name for OTC nicotine gum | Nicorette
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| what is the brand name for nicotine nasal spray, is it otc or rx | it is rx NICOTROL NS
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| what is the brand name for the patches | Nicoder CQ and Prostep they come in OTC and generic
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| what is the brand name for nicotine lozenges | Commit which are OTC
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| nicorette gum is called ? what strengths? what flavors? what is the max/day | nicotine polacrilex gum/ 2 and 4 mg/ mint, orange, fresh mint, cinnamon, fruit, flavor burst/ 24 pieces per day for up to 12 weeks then refer out/ if over 25 cig use 4 if under 24 use 2mg gum
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| dosing for nictoine gum on weeks 1-6 | 1 piece q 1-2h (typically 9 pieces per day) max is 24 pieces per day for up to 12 weeks
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| to avoid sub therapeutic dosing what should you recommend for nicotine gum | recommend fixed schedule and taper over 1-3 months rather than using PRN
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| how should nicotine gum be administured | avoid eating and drinking anything but water for 15 mins before and during use. acidic beverage may interfere with buccal absorption of nicotine by reducing salivary pH
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| if a patient is using commit and has a craving within 30 minutes of waking what dose of lozenge should you use | 4mg lozenge
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| what is nicotine patches dosing for someone who smoke getting than 10 weeks | 21mg/24hr starting patch for patients who smoke >10 cigarettes/day and use weeks 1-6 then 14mg/24hr weeks 7-8 and 7mg/24hr weeks 9-10
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| why chose one NRT over another | dental problems, tanning not like lines from patch, not hold something in buccul cavitity, allergic to adhesive, patient choice
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| reasons for choseing one NRT over another | patient choice, lifestyole habits, coexisting medical conditions, contraindications to use, higher levels of smoking=higher doses, longer duration of treatment
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| reasons for choseing one NRT over another | previous attempts: SE numberous failed attempts may warrant use of combo (NRT+PO RX med)
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| reasons for choseing one NRT over another | smoke continuous throughtout day=patch or if smoke intermittently= gum/lozenge (=PRN)
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| reasons for choseing one NRT over another | Dental issures/ TMJ= no gum, social acceptance of gum might not be good for job, dermatologic conditions,acne can't use over other medications, weight gain will be prevented with weight gain)
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| what is better about patch for a longer term smoker | the patch provides more of a steady stream
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| when the park and chew method is used how long shousl the patient chew the guym before parking | about 15 chews or until taste pepper taste and tingle
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| if someone smokes 15 cigarettes per day and smokes his first cigarette within 10 miutes of waking up each morning | nicorette guym 2 mg q 1 to 2 h and commit lozenge 4mg q1-2h (14 mg is not appropiate should have started with 21mg)
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| how is commit lozenger dosed | based of when you get first craving
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| what is the role of the pharmacist: | how to use the products correctly, help them chose the right product for them, encourage them with support, monitoring ask about problems, following up, counsel on non-pharmacological options, motivate to quite, send to smoking cessation clinic ran by Rph
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| need to know | know strengths, doses, brand generic names, nonpharmacological treatment, cyp1a3, genereal helath consequience, specifics of cardiovascular and pulmonary effects, effects of second hand smoke, benifts of quitting figure 50-1, withdrawal symptoms and how
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| also need to know | to manage (nonpharmacologic, NRT: brand generic names, strengths, available, dosing including max SE, when to chose one over another
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| nice to know and wher to go | nice to know stats, specific components of cigarette smoke, need to know nictine, carbon monoxide, carcinogens, and tar, rx options, 5R's
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| where to go for more information | CDC website, OTC book, manufacturers websites, review articles, website for products are awesome
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