Smoking Cessation Medications Overview

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Questions and Answers

What is the primary goal of nicotine replacement therapy (NRT)?

  • To replace tobacco with another addictive substance
  • To relieve cravings and reduce withdrawal symptoms (correct)
  • To increase addiction to nicotine
  • To completely eliminate cravings for nicotine

What is a typical characteristic of patients attempting to quit smoking?

  • They usually need to try multiple times before succeeding (correct)
  • They have no difficulty recognizing their addiction
  • They require minimal support to quit
  • They often succeed on their first attempt

Which of the following forms of nicotine replacement therapy is NOT available over-the-counter?

  • Oral prescription tablets (correct)
  • Nicotine gum
  • Transdermal patch
  • Nasal spray

Which group of patients should use nicotine replacement therapy with caution?

<p>Individuals with serious arrhythmias (B)</p> Signup and view all the answers

What is a common side effect of nicotine gum?

<p>Hypersalivation (C)</p> Signup and view all the answers

How does nicotine replacement therapy affect smokers with cardiovascular disease?

<p>It can increase heart rate and blood pressure (A)</p> Signup and view all the answers

Which of the following statements about nicotine lozenges is true?

<p>They require more frequent dosing than patches (D)</p> Signup and view all the answers

What might restrict the use of nicotine replacement therapy in certain patients?

<p>History of cardiovascular problems or serious arrhythmias (A)</p> Signup and view all the answers

What is a major disadvantage of using nicotine gum for smoking cessation?

<p>It requires frequent dosing which can affect adherence. (B)</p> Signup and view all the answers

Which of the following is an adverse effect of using the transdermal nicotine patch?

<p>Local skin reactions (B)</p> Signup and view all the answers

What is a key advantage of the nasal spray for smoking cessation?

<p>It provides immediate management of withdrawal symptoms. (B)</p> Signup and view all the answers

What is the mechanism of action of varenicline in smoking cessation?

<p>It partially agonizes nicotinic receptors without strong stimulation. (D)</p> Signup and view all the answers

Why is varenicline not recommended for use in patients with a history of seizures?

<p>It may significantly increase seizure threshold. (D)</p> Signup and view all the answers

What safety consideration is associated with bupropion in smoking cessation therapy?

<p>Avoid in patients with a current seizure disorder. (A)</p> Signup and view all the answers

What major side effect may increase in patients using varenicline alongside alcohol?

<p>Decreased alcohol tolerance (D)</p> Signup and view all the answers

What factor limits the combination use of the nicotine patch with bupropion?

<p>The patch cannot be titrated down effectively (A)</p> Signup and view all the answers

What specific neuropsychiatric effect should patients taking varenicline be monitored for?

<p>Hostility and mood changes (C)</p> Signup and view all the answers

What is a concern regarding the use of the nicotine nasal spray?

<p>Frequent dosing may be undesirable (B)</p> Signup and view all the answers

Which of the following is a potential risk when combining nicotine replacement therapy with varenicline?

<p>Higher risk of toxicity from nicotine (D)</p> Signup and view all the answers

What is a key characteristic of bupropion as a smoking cessation aid?

<p>It has a different mechanism of action than traditional cessation therapies. (C)</p> Signup and view all the answers

Why should nicotine patches generally be removed at night?

<p>To prevent interference with sleep due to nicotine absorption. (C)</p> Signup and view all the answers

What potential complication is linked to the use of varenicline during pregnancy?

<p>Uncertain efficacy for smoking cessation (C)</p> Signup and view all the answers

Flashcards

Smoking Cessation

Stopping the habit of smoking

Nicotine Replacement Therapy (NRT)

Medication aids in quitting smoking by substituting nicotine

NRT Precautions

Care must be taken for certain medical conditions due to heart rate and blood pressure increase and issues with the gastrointestinal tract.

NRT Formulations

Various forms of NRT are available, including gum, patches, nasal spray, and lozenges

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Gum (NRT)

Over-the-counter NRT; used frequently to ease nicotine cravings

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Lozenge (NRT)

Over-the-counter medication, a form of NRT that eases nicotine cravings.

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Smoking Cessation Success

Using medication in cessation aids in success

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Nicotine Receptors

Specific proteins in the body that nicotine binds to.

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Varenicline

A partial nicotinic receptor agonist used to help people quit smoking. It reduces nicotine cravings and withdrawal symptoms.

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Varenicline and Alcohol

Varenicline can increase the effects of alcohol. It might make you more sensitive to alcohol, leading to stronger effects and increased risks of negative consequences.

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Varenicline and CNS Depression

Varenicline can cause CNS depression. This can impair mental alertness and affect tasks requiring focus, like driving or operating machinery.

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Varenicline and Suicidal Thoughts

Varenicline might increase the risk of suicidal thoughts and behavior, especially in people with a history of mental health issues.

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Varenicline and Seizures

Varenicline can increase the risk of seizures in people with a history of seizures or without.

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Varenicline and Cardiovascular Risks

Research suggests that varenicline might increase the risk of cardiovascular events, potentially due to its effects on nicotinic receptors.

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Bupropion SR (Zyban)

A medicine that helps people quit smoking. It works by affecting the brain chemicals that cause cravings.

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Bupropion and Contraindications

Bupropion should not be used by individuals with seizure disorders, eating disorders, or who are abruptly discontinuing alcohol or certain medications.

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Bupropion and Mental Health Risks

Bupropion might cause adverse effects like suicidal thoughts, mood changes, and depression. Careful monitoring is important.

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Bupropion and Pregnancy

Bupropion can cross the placenta, but its effects on fetal development are not fully understood. The balance of risks and benefits must be considered.

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Bupropion and Lactation

Bupropion and its active metabolites are found in breast milk. This might pose risks for infants, so careful monitoring is needed.

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Nicotine Patch

A transdermal patch that delivers nicotine to the body gradually. It's a common method for smoking cessation.

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Nicotine Patch Advantages

The patch offers once-daily dosing, can be combined with other agents, and provides consistent nicotine levels throughout the day.

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Nicotine Patch Disadvantages

The patch cannot be adjusted for sudden cravings, and it's not recommended for people with skin conditions.

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Study Notes

Smoking Cessation Medications

  • Tobacco use is a leading cause of preventable disease and death in the US.
  • Cigarette smoking is a major modifiable health risk.
  • Ask patients about nicotine use at every healthcare visit.
  • Educate patients about the benefits of not smoking or quitting.
  • The average smoker tries to quit about 5 times before success.
  • Pharmacotherapy for smoking cessation increases success rate by 50%.

Nicotine Replacement Therapy (NRT)

  • NRT helps relieve nicotine cravings and withdrawal symptoms.
  • Different NRT types are equally effective overall.
  • NRT binds to nicotine receptors.
  • Available as gum, patch, nasal spray, and lozenge.

NRT Precautions

  • Cardiovascular disease: Nicotine increases heart rate/blood pressure. NRT is generally safe but use caution. Discontinue if irregular heartbeat or palpitations occur. Avoid immediate post-MI, serious arrhythmias, or severe/worsening angina.
  • GI disease: Use with caution in patients with esophagitis or active ulcers. Healing can be delayed.
  • Renal/Hepatic impairment: Decreased nicotine clearance in moderate/severe impairment; consider dose reduction.

NRT Formulations

  • Gum: OTC; adverse effects include hypersalivation, hiccups, dyspepsia, mouth/jaw soreness. Advantages: oral substitute, may delay/reduce weight gain, easy titration, combinable with other agents. Disadvantages: frequent dosing, may be problematic for dental/jaw issues, not desirable for some patients socially.
  • Lozenge: OTC; adverse effects include nausea, hiccups, cough, insomnia. Advantages: oral substitute, may delay/reduce weight gain, easy titration, combinable with other agents. Disadvantages: frequent dosing can compromise adherence, stomach upset/nausea/loose stools.
  • Patch: OTC; adverse effects include local skin reactions (erythema, pruritus, burning), headaches, sleep disturbances (if used at night). Advantages: once-daily dosing, combinable with other agents, consistent nicotine levels. Disadvantages: cannot acutely manage withdrawal as monotherapy, not for dermatologic conditions. Works well with bupropion.
  • Nasal Spray: Prescription; adverse effects include nasal/throat irritation, rhinitis, tearing, sneezing, cough, headache. Advantages: rapid withdrawal management, combinable with other agents. Disadvantages: frequent dosing, not desirable for some, nasal irritation, not for chronic nasal disorders or severe reactive airway disease.

Varenicline (Chantix)

  • Generic name for varenicline. (Chantix has a discontinued drug status, and is replaced with the generic name varenicline)
  • Partial neuronal nicotinic receptor agonist.
  • Prevents nicotine stimulation of the dopaminergic system.
  • Binds to 5-HT3 receptors (significance unclear).
  • Reduced craving/withdrawal, but stimulation to dopamine activity is less than nicotine's stimulation.
  • May enhance alcohol's adverse effects (reduced alcohol tolerance, increased neuropsychiatric risk).
  • May enhance nicotine's adverse effects.
  • May cause CNS depression (caution with tasks requiring alertness).
  • Post-marketing reports of traffic accidents, near-misses, and other injuries in patients taking varenicline.
  • Increased potential for suicide/depression and decreased seizure threshold.
  • Caution in patients with renal impairment.
  • 2011 meta-analysis suggested possible increased risk of cardiovascular events (MI).
  • Not fully established efficacy for pregnancy.
  • Infants exposed via breast milk may experience seizures/excessive vomiting.

Bupropion SR (Zyban)

  • Licensed for tobacco dependence.
  • Primarily has dopaminergic/noradrenergic mechanism.
  • Independent of antidepressant effect.
  • Sustained-release tablets.
  • Contraindicated in a history of seizures, anorexia/bulimia, or abrupt cessation of certain drugs (ethanol, benzodiazepines, barbiturates, antiepileptics).
  • Not to be used with MAOIs (concurrently or within 14 days of discontinuation).
  • Adverse effects include suicidal thoughts, mood changes, hallucinations, panic, and depression (Black Box Warning for children, adolescents, and young adults).
  • Monitor closely for suicidal thoughts.
  • Other possible adverse effects: restlessness, insomnia, anxiety, anorexia, cognitive impairment.
  • Effective in combination with a nicotine patch (slow patch titration).
  • Combination treatment shows higher abstinence rates at 6 years.
  • Do not smoke when combining this treatment.
  • Bupropion and metabolites cross placenta.
  • Inconsistent data on cardiovascular malformations in pregnancy
  • Further research needed for pregnant patients.
  • Bupropion and metabolites are present in breast milk.
  • Infants may experience seizures/sleep disturbances. Monitor for changes in sleep/feeding/behavior/growth, and neurodevelopment.

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