Chantix dosing
decrease dose for renal impairment
do not use if patients <8 years old
not approved for combination therapy with nicotine replacement products
Chantix indication for use
temporary aid for patients that want to give up tobacco use
chantix mechanism of action
prevents nicotine from binding to neuronal nicotinic acetylcholine receptors
chantix side effects
nausea (most common, dose limiting), abdominal pain, constipation, headache, and insomnia
chantix dosing
titrate dose up over period of days, decrease dose if nauseous
chantix
no significant drug interactions or contraindications
monitor for side effects
chantix therapeutic considerations
cannot be used with nicotine replacement therapy
Bupropion SR indications
temporary aid for patient that wants to give up tobacco use
Bupropion SR mechanism of action
affects levels of different brain neurotransmitters, dopamine and norepinephrine
Bupropion SR side effects
insomnia, dry mouth
Bupropion SR dosing
do not crush or chew
patient should begin therapy one week prior to quitting to assure therapeutic plasma drug levels
taper at start of therapy, no need to taper when discontinuing therapy
adjust dose in liver and renal disease
Bupropion SR drug interactions
alcohol or sedatives should NOT be used with this since all may decrease seizure threshold
theophylline, oral corticosteroids
Bupropion SR monitoring
discontinue therapy if patient is not progressing toward abstinence by the seventh week of therapy
medication side effects
Bupropion therapeutic considerations
may benefit patient with depression
can be used with nicotine replacement therapy
start one week prior to nicotine replacement therapy
patient MUST quit smoking once nicotine replacement therapy starts
Bupropion SR contraindications
history of seizures
anorexia or bulimia nervosa
MAO inhibitor
don't use concurrently or within 14 days of treatment with MAOI
alcohol or sedatives
should not be used since all may decrease seizure threshold
Tobacco cessation medications
bupropion SR (Zyban) -- tablet
Varenicline (chantix) -- tablet
Medications used to treat tobacco addictions (nicotine replacement therapy)
OTC:
Nicorette - gum Commit- lozenge
Nicoderm CQ, Nicotrol- patches
Prescription:
Nicotrol NS- nasal spray
Nicotrol- inhaler
nicotine replacement therapy indication
temporary nicotine replacement for the patient who wants to give up tobacco use
nicotine replacement therapy mechanism of action
serve as alternative source of nicotine in nicotine dependent individuals in order to provide relief from withdrawal symptons
nicotine replacement therapy GUM side effects
lightheadedness, irritation of throat/mouth, dyspepsia
nicotine replacement therapy PATCH side effects
vivid dreams, skin irritation (can occur in response to either nicotine or adhesive), tachycardia
nicotine replacement therapy SPRAY side effects
hot peppery feeling in the back of throat and nose, sneezing, cough, watery eyes and nose, dependence
Gum and patch nicotine replacement dosing
based on number of cigarettes smoked per day
gum nicotine replacement therapy dosing
should be chewed slowly until first sign of taste or tingle, then parked until taste or tingle fades, repeat until chewing gum no longer produces tingling sensation (approximately 30 minutes)
patch nicotine replacement therapy dosing
should be applied to upper body, hairless, dry, and clean area
different area each day
do not cut
inhaler nicotine replacement therapy dosing
should be used by puffing short breaths then holding puff in the mouth
nicotine therapy replacement drug interactions: GUM
may stick to dental work/dentures
cauting in patients with difficulty chewing or with severe cavities
nicotine replacement therapy contraindications
~smoking while using any of these products is contraindicated
~patients with underlying cardiovascular disease (recent myocardial infarction, arrhythmias, severe or worsening angina)
~patients with severe dermatological conditions
~patients with chronic n
nicotine replacement therapy monitoring
medication side effects
concurrent use of tobacco
nicotine replacement therapy therapeutic considerations
~gum, lozenge, and spray can be titrated to manage withdrawal symptoms, but don't provide consistent nicotine levels
~the patch provides consistent levels
~the patch may be removed at night if patient suffers from vivid dreams while using nicotine patch
~
health risks associated with tobacco use
~cardiovascular disease, COPD, cancer, delayed healing/recovery following surgery, dental issues, etc.
~smoking while using oral contraceptives increases risk of thromboembolism
tobacco clinical practice guidelines
the five A's: Ask, Advise, Assess, Assist, Arrange