Podcast
Questions and Answers
What is the primary goal of nicotine replacement therapy (NRT)?
What is the primary goal of nicotine replacement therapy (NRT)?
What is a typical characteristic of patients attempting to quit smoking?
What is a typical characteristic of patients attempting to quit smoking?
Which of the following forms of nicotine replacement therapy is NOT available over-the-counter?
Which of the following forms of nicotine replacement therapy is NOT available over-the-counter?
Which group of patients should use nicotine replacement therapy with caution?
Which group of patients should use nicotine replacement therapy with caution?
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What is a common side effect of nicotine gum?
What is a common side effect of nicotine gum?
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How does nicotine replacement therapy affect smokers with cardiovascular disease?
How does nicotine replacement therapy affect smokers with cardiovascular disease?
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Which of the following statements about nicotine lozenges is true?
Which of the following statements about nicotine lozenges is true?
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What might restrict the use of nicotine replacement therapy in certain patients?
What might restrict the use of nicotine replacement therapy in certain patients?
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What is a major disadvantage of using nicotine gum for smoking cessation?
What is a major disadvantage of using nicotine gum for smoking cessation?
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Which of the following is an adverse effect of using the transdermal nicotine patch?
Which of the following is an adverse effect of using the transdermal nicotine patch?
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What is a key advantage of the nasal spray for smoking cessation?
What is a key advantage of the nasal spray for smoking cessation?
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What is the mechanism of action of varenicline in smoking cessation?
What is the mechanism of action of varenicline in smoking cessation?
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Why is varenicline not recommended for use in patients with a history of seizures?
Why is varenicline not recommended for use in patients with a history of seizures?
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What safety consideration is associated with bupropion in smoking cessation therapy?
What safety consideration is associated with bupropion in smoking cessation therapy?
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What major side effect may increase in patients using varenicline alongside alcohol?
What major side effect may increase in patients using varenicline alongside alcohol?
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What factor limits the combination use of the nicotine patch with bupropion?
What factor limits the combination use of the nicotine patch with bupropion?
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What specific neuropsychiatric effect should patients taking varenicline be monitored for?
What specific neuropsychiatric effect should patients taking varenicline be monitored for?
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What is a concern regarding the use of the nicotine nasal spray?
What is a concern regarding the use of the nicotine nasal spray?
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Which of the following is a potential risk when combining nicotine replacement therapy with varenicline?
Which of the following is a potential risk when combining nicotine replacement therapy with varenicline?
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What is a key characteristic of bupropion as a smoking cessation aid?
What is a key characteristic of bupropion as a smoking cessation aid?
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Why should nicotine patches generally be removed at night?
Why should nicotine patches generally be removed at night?
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What potential complication is linked to the use of varenicline during pregnancy?
What potential complication is linked to the use of varenicline during pregnancy?
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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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Description
This quiz covers key concepts regarding smoking cessation medications and Nicotine Replacement Therapy (NRT). Participants will learn about the effectiveness of pharmacotherapy, precautions, and the importance of educating patients. Test your knowledge on quitting smoking and related therapies!
