Help
Options
Didn't know it?
click below
click below
Knew it?
click below
click below
Don't Know
Remaining cards (0)
Know
retry
shuffle
restart
0:00
Embed Code - If you would like this activity on your web page, copy the script below and paste it into your web page.
Normal Size Small Size show me how
Normal Size Small Size show me how
Naplex
Smoking - Clinical pearl
| Question | Answer |
|---|---|
| Estrogen-containing OC is contraindicated in which population | Age ≥ 35 years and Cigarette smoking |
| What happens if pt on warfarin quits smoking | Supratherapeutic: raising serum concentrations |
| Vaccinations in Smokers | • Annual influenza vaccine is recommended for all persons • Pneumococcal vaccine in smokers age 19-49 years |
| Medication Options for smoking cessation | • Combination NRT • Varenicline • Bupropion SR |
| Regimen of Combination NRT | • Long-acting patch + • Short-acting gum, lozenge, or nasal spray |
| Varenicline vs other 2 treatment options | Most effective monotherapy |
| Varenicline + NRT | More effective but increase adverse effects |
| Bupropion SR vs other 2 treatment options | • Least effective • Can combine with NRT |
| Treatment option to delays weight gain | • Nicotine gum (4 mg >> 2 mg for delaying weight gain) • Lozenge (4 mg >> 2 mg for delaying weight gain) • Bupropion SR (Reduces appetite) |
| Smoking cessation for depression pt | Bupropion SR |
| pt w Dentures | Avoid Nicotine gum |
| Asthma/ COPD | Avoid Nicotine nasal spray |
| Skin conditions | Avoid Nicotine patch |
| Seizures | Avoid: Bupropion (Contraindicated), varenicline (Use caution) |
| Rx Nicotine Replacement Therapy | Nicotine nasal spray |
| OTC Nicotine Replacement Therapy | • Nicotine patch (Nicoderm CQ) • Nicotine gum (Nicorette) • Nicotine lozenge (Nicorette Mini) |
| Nicotine Long-acting | Nicotine patch (NicoDerm CQ) |
| Nicotine Short-acting | • Nicotine gum (Nicorette) • Nicotine lozenge (Nicorette Mini) • Nicotine nasal spray (Nicotrol NS) |
| Avoid Nicotine in | immediate post-MI period, life-threatening arrhythmias, angina, and pregnancy |
| Nicotine Side Effects | • Insomnia, nervousness, headache, dizziness, dyspepsia |
| Nicotine Patch Side Effects | • Vivid dreams, skin irritation • Highest adherence rate; remove before an MRI |
| Nicotine Gum/lozenge Side Effects | • Hiccups, nausea, mouth irritation • Acidic beverages/foods reduce buccal absorption; do not eat/drink 15 minutes before or during use |
| Nicotine Nasal spray Side Effects | Nasal irritation, watery eyes, sneezing, transient changes in taste/smell |
| Individuals < 21 year of age | The FDA prohibits sale of nicotine products; identification required for purchase |
| Nicotine patch dose for > 10 cigarettes / day: (21 - 14 - 7 6 - 2 - 2) | • 21 mg × 6 weeks • 14 mg × 2 weeks • 7 mg × 2 weeks |
| Nicotine patch dose for =< 10 cigarettes / day: (14 - 7 6 - 2) | • 14 mg × 6 weeks • 7 mg × 2 weeks |
| Nicotine Gum/Lozenge Dosing (12 wks) | • > 30 mins: 2 mg • =< 30 mins: 4 mg • Q1-2H × 6 weeks • Q2-4H × 3 weeks • Q4-8H × 3 weeks |
| Bupropion Formulations for smoke cessation | • 12-hr ER / SR (also for depression) • Other form (IR: depression, 24-hr ER: depression / seasonal affective disorder) |
| Bupropion SR dosing for cessation | • Start 1-2 weeks before quit date • Start 150 mg QAM for 3 days, • Then 150 mg BID • Max: 300 mg/day • Use up to 6 months |
| Bupropion SR Contraindications | • Seizure disorder • Anorexia/bulimia • Use with MAO inhibitors, linezolid or IV methylene blue |
| Minimize insomia caused by Bupropion SR | • 1st dose on waking • 2nd dose 8 hours after 1st dose |
| Bupropion SR for smoke cessation: Does not need to be tapered | TRUE |
| Bupropion SR Side Effects | • Dry mouth • Insomnia • Tremors • Weight loss |
| Varenicline Side Effects | • Nausea • Abnormal dreams • Insomnia (take 2nd dose earlier than bedtime) • Headache |
| When to start Varenicline | Start ≥ 1 week before quit date |
| Varenicline dosing (28-day therapy pack) | • 0.5 mg tabs (11): - Days 1-3: 0.5 mg daily - Days 4-7: 0.5 mg BID • 1 mg tabs (42): - Day 8 (and beyond): 1 mg BID • For 12 weeks; additional 12 weeks if needed |
| How to Chew Nicotine Gum | • Chew slowly until tingle or peppery flavor • Park btw the cheek & gum line When tingle/flavor goes away, chew until it returns • Park again Repeat until most of the tingle/flavor is gone Do not eat/drink for 15 min before or while chewing |
| How to administer Nicotine Lozenge | • Place in mouth, allow it to dissolve slowly • Move from one side of the mouth to the other • Do not chew or swallow May cause a warm or tingling sensation • Do not eat or drink for 15 minutes before or during use |
| How to administer Nicotine Nasal Spray | • Tilt head back slightly and spray once in each nostril (Breathe through the mouth!) • Do not sniff, swallow or inhale through the nose • May cause nose and throat irritation |
| Behavioral therapy | • Adolescents • Pregnant patients • Patients with light tobacco use (eg, <10 cigarettes daily) |
| Bupropion MoA | Inhibits reuptake of dopamine and norepinephrine |
| Varenicline MoA | Stimulates neuronal nicotinic receptors |
Created by:
dao.vo11017