Counseling and medication are more effective when used together than either modality used alone.  There is a strong correlation between couseling intensity and quitting success (couseling sessions should be > 10 minutes in length and number of sessions should be ≥ 4)

There are 7 first - line (5 nicotine and 2 non-nicotine) drugs that increase long - term smoking abstinence. What are they?

Nicotine gum

Inhaler

Lozenge

Nasal Spray

Patch

Bupropion SR

Varenicline

A note:

Smoking causes and induction of some isoforms of the p450 system. Therefore, smokers who quit can experience side effects from supratherapeutic drug levels of caffeine, theophylline, fluvoxamine, olanzapine, and clozapin. High levels of clozapine have increased risk for agranulocytosis. Ensure that smokers get required vaccines, including pneumococcal and an anual influenza vaccine

Ask About Tobacco Use

Advise To Quit

Assess

Assist

Arrange

NicoDerm CQ; Habitrol

All agents are Preg Category D except the lozenge which has no pregnancy category designation

What must patients show prior to nicotine replacement purchases?

Patients must show identification for proof of age prior to purchase of nicotine products. The FDA prohibits sale of nicotine products to individuals younger than 18 years of age (REMS)

The inhaler hand to mouth use mimics smoking action, providing a coping mechanism

Blocks neural re-uptake of dopamine and/or norepinephrine and blocks nicotinic acetylcholinergic receptors

150 mg QAM for 3 days, then 150 mg BID

Start 1-2 weeks before quit date

Not approved for use in children, not approved for bipolar, increase risk of suicidal thinking and behaviour in young adults with depression or other psychiatric disorders

What side does this medication not have that is common with other antidepressant medications?

partial neuronal alpha4-beta2 nicotinic receptor agonist

Also stimulates dopamine activity to a small degree, resulting in reduced cravings and other withdrawal symptoms

How fare out from quit date should Varenicline be started?

One week before quit date

Serious neuropsychiatric events including depression, suicidal ideation, suicide attempt and completed suicide have been reported in patients taking Chantix. Stop taking this medication if patients become hostile, agitated, depressed, or have changes in behaviour or thinking that are not typical for the patient

Gum should be chewed slowly until a "peppery" or "flavored" taste emerges, then "parked" between cheek and gum to facilitate nicotine absorption through the oral mucosa. Gum should be slowly and intermittently chewed and parked for about 30 minutes or until the taste dissipates

Acidic beverages (coffee, juices, soft drinks) interfere with the buccal absorption of nicotine, so eating and drinking anything except water should be avoided for 15 minutes before or during chewing

No. Patients often do not use enough gym to obtain clinical effects. Instruct to use at least 1 piece q1-2 hours

Frequent, continuous puffing for 20 minutes is advised with each catridge

Once a cartridge is opened, it is only good for one day

generally maintained for 3 months and then gradually tapered during the following 3 months

Seperate inhaler from food by at least 15 minutes

Should be allowed to dissolve in the mouth rather than chewing or swallowing it

Generally, patients should use 1 lozenge every 1-2 hours during the first 6 weeks of treatment, using a minimum of 9 lozenges/day, then decrease over time

At the start of each day, place the patch on a relatively hairless location, typicaly between the neck and waist, rotating the site to reduce local skin irritation

Patches should be applied as soon as the patient wakes on the quit day. With patients who experience sleep disruption, have the patient remove the 24 - hour patch prior to bedtime, or use the 16 hour patch

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Local Skin Reactio:

Skin reactions usually are mild and self-limiting, but occasionally worsen over the course of therapy.

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It takes about 1 week for the medication to start working. For your best chance to quiting, you should not stop smoking until you have been taking for 1 week. Set a date to stop smoking during the second week of starting ths medicaiton

Do not take if have a seizure disorder, are taking Wellbutrin (IR, SR, or XL), or have taken an MAO - I within the last 14 days or had an eating disoder

8 hours apart

Start taing the medication 1 week (7 days) before the quit date.

This allows the medication to build up in the body. May continue to smoke during this time. Try to stop smoking on the quit date. If it doesn't happen, try again. Some people need to take the medication for a few weeks to work best

Most people will take this medicine for up to 12 weeks. If quite smoking by 12 weeks, another 12 weeks of therapy may be helpful to stay cigarette-free