Nicotine Replacement Therapy (NRT) Quiz

Nicotine Replacement Therapy (NRT)

• Combination therapy is more effective than monotherapy, doubling successful quit rates.
• NRT forms: gums, lozenges and mini lozenges, inhalator, transdermal patch, quickmist mouth spray, and nasal spray (not available in Australia).
• All NRT forms have equal efficacy, differing in the rate of nicotine delivery.

Instructions for Use

• Patch: apply in the morning or bedtime, remove before bedtime if applied in the morning or remove in the morning if applied at bedtime (16 hours), and replace next day (24 hours).
• Gums: chew 1 piece slowly until flavor becomes strong, park between the cheek and gum, and chew again when flavor fades.
• Lozenges: place between the cheek and gum, suck slowly until taste is strong, stop sucking until taste fades, and continue to suck again when taste fades.
• Inhalator: insert cartridge into mouthpiece, take a shallow puff every 2 seconds or take 4 deep puffs every minute, and continue for up to 20 minutes.
• Mouth Spray: point the spray nozzle towards the open mouth, press the top of the dispenser to release one spray into the mouth, and avoid the lips.

Smoking Cessation

• Smoking is a major cause of preventable morbidity and mortality in the developed world.
• Benefits of quitting smoking: reduced risk of diseases, improved health, and increased life expectancy.

Pharmacokinetics of Nicotine

• Nicotine is a colourless, odourless naturally occurring alkaloid with a short half-life of 40-120 minutes.
• Nicotine plasma concentration range: 10-80 ng/ml, with 20-35 ng/ml for regular smokers.
• Metabolized by CYP2A6 mainly, CYP2B6, CYP2E1, and CYP1A2.
• Cotinine is nicotine's major non-addictive metabolite.

Pathophysiology of Dependence

• Nicotine absorption into the pulmonary venous circulation reaches the brain in less than 10-20 seconds.
• Activation of dopaminergic receptors releases rewarding neurotransmitters, leading to desensitization and upregulation of receptors with chronic exposure.
• Tolerance: decreased responsiveness to nicotine, requiring increasing doses to obtain the same effects.
• Dependence: withdrawal symptoms upon reduction or abstinence, with a strong tendency to relapse post-quitting.

Role of Pharmacist

• Applying the 5As of quitting: Ask, Advise, Assess, Assist, and Arrange.
• Applying the 5Rs of quitting: Relevance, Risks, Rewards, Roadblocks, and Repetition.
• Applying the AAH: Ask, Advise, and Help.

Test your knowledge about Nicotine Replacement Therapy, including combination therapy, NRT forms, and instructions for use.