E-Cigarettes and Nicotine Replacement Therapy

Study Notes

Electronic cigarettes work by delivering nicotine vapor into the lungs as a person inhales, providing a hand-to-mouth ritual similar to smoking.
Each cartridge is inserted into the inhalator and air is drawn into the mouth through the mouthpiece.
Recommended usage is 6-12 cartridges per day.

Examples include Bupropion and Varenicline, which are the only two nicotine-free pharmaceuticals approved for smoking cessation.
They act as competitive antagonists of nicotine for its receptors.
Generally well tolerated by smokers, except for pregnant or breastfeeding women.
Help with the craving for nicotine and withdrawal symptoms by working in the brain to reduce physical effects of nicotine.

Examples include benzodiazepines, which are not commonly used in smoking cessation.

Concomitant use of NRT, Bupropion, or Varenicline and smoking is well tolerated.
Number of cigarettes smoked is likely to be less than at baseline, resulting in reduced health hazards.

Pharmacists play a proactive role in promoting health and encouraging positive behavioral changes.
Provide patients with information on the risks associated with smoking.
Encourage abstinence by directly advising the patient on how to quit and highlighting benefits of stopping smoking.

Decreased carbon monoxide levels
Restoration of olfactory and gustatory senses
Increased self-respect, sense of accomplishment
Improved lung function (up to 30%) within 2-3 months
Reduction in the risk of coronary heart disease (50%) after 1 year
Progressive decline in the risk of lung cancer as the number of years of abstinence increases

Ask patients if they smoke
Advise patients who smoke to quit
Assess the patient's willingness to quit
Assist the patient in efforts to quit through counseling and/or pharmacologic therapy
Arrange follow-up within a short time frame

Overview: NRT is a smoking-cessation aid used to ameliorate nicotine withdrawal symptoms by providing a non-tobacco, controlled-release amount of nicotine.
Increases the chance of quitting smoking by about 50-70%.
Nicotine dose from NRT is lower and administered more gradually than with smoking, reducing addictive potential.

Nicotine Gum
- Available in 2mg or 4mg pieces
- Heavy smokers use the 4mg pieces
- Daily dose should not exceed 15 pieces
- Side-effects: Mouth ulcer, nausea, hiccups, insomnia, jaw pain, and dental problems
Nicotine Lozenges
- Available in 2mg or 4mg strengths
- Daily dose should not exceed 20 lozenges
- Side-effects: Sore throat, insomnia, nausea, and hiccups
Transdermal Nicotine Patches
- Available in different strengths per patch
- Attach to a cleaned part of the body such as arm, wrist, or chest
- May be worn for 16-24 hours/day
- Side-effects: Insomnia, vivid dreams, and skin irritation
Nicotine Inhaler
- Side-effects: Not specified