Term
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Definition
| dose dependant activate/inhibit nicotinic receptors in PNS & CNS. low-activate, high-block |
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Term
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Definition
Rapid metabolism
Inhaled:90-98% from lungs enters blood.
Cigar & smokless tobacco absorb primarily in mouth.
Crosses membranes(placenta & breast milk) |
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Term
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Definition
CV:NE from sympathetic & epi from adrenals constrict bl vessels, increase HR, increase force of ventricular contraction= increase BP & increase cardiac work
GI:Parasympathetic activation(increase gastric acid, tone & motility of smoothe muscle)
CNS: stimulant-stimulate respiration, arousal on EEG, tremors, convulsions, increase alertness, facilitates memory, increase cognition, decrease aggression, suppress appetite, DA activates pleasure center |
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Term
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Definition
Tolerance d/t desensitize nicotine receptors.
Tolerance delops to nausea & dizziness |
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Term
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Definition
| DA stimulation promotes cont use. Withdrawl can cause abstinence syndrome-impaired concentration, hostile, insomnia, wt gain, cravings, nervous, restless, irritable, impatient, GI disturbances, HA, Inc skin temp, Dec HR & BP, depression,drowsiness, insomnia |
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Term
| Chief single avoidable cause of death in society |
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Definition
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Term
| Statistics on prevalence of smoking |
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Definition
| Slightly higher in males, varies by state, southeatern/midwest more likely, American Indians & Alaskan Natives, whites 22% blacks 20%, lower education & socioeconomic status |
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Term
| Complications of smoking/second hand exposure |
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Definition
| Negative effect in many disease states. Chief avoidable cause of death. Risk proportional to # smoked/day, # yrs, amt inhaled |
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Term
| Health consequences of exposure to cigarette smoke |
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Definition
| cancer, CV disease, pulmonary disease, reproductive effects, cataracts, periodontitis, peptic ulcer disease, poor surgical outcomes |
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Term
| Medications that interact with cigarette smoking |
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Definition
| Benzos, BB, caffeine, Thorazine, Clozaril, flecainide, Luvox, Haldol, Heparin, insulin, Mexitil, Zyprexa, opiods, Inderal, oral contraceptives, tacrine, Theophyline |
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Term
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Definition
Quit smoking
Maintain cessation (few are sucessful 1st time, cyclic process) |
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Term
NPT
addressing withdrawl symptoms |
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Definition
Physiologic withdrawl begins within 24h, peaks in 24-48h, dissapates 2-4wks
Psychologic aspects months-years |
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Term
| Components of successful cessation |
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Definition
| offer treatment at every visit. Record tobacco use. NRT + counseling + skills training |
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Term
Tx categories
Pts who use & are willing to quit |
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Definition
| 5 A's (Ask, Advise, Assess, Assist, Arrange) |
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Term
Tx categories
Pts who use but unwilling to quit |
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Definition
| 5 R's (Relevance, Risks, Rewards, Roadblocks, Repetition) |
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Term
Tx categories
pts who have recntly quit tobacco |
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Definition
| relapse-prevention treatment |
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Term
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Definition
Couseling:invidual, group, proactive phone
Behavioral: specific action
Cognitive:retrain thinking patterns |
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Term
| Pharmacologic therapy for smoking cessation |
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Definition
NRT: gum, patches, nasal spray, inhaler, lozenge
Bupropion, Chantix |
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Term
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Definition
40mg=fatal
N/V/D,salivation,cold, sweat, disturbed hearing & vision, confusion, faint, weak irrg rapid pulse, resp paralysis |
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Term
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Definition
| Stimulate nicotine receptors causing DA release. Provide non-tobacco source of nicotine to avoid w/d, helps break behavioral patterns |
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Term
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Definition
| Major difference is site and rate of absorption. Extensive 1st pass metabolism. Onset less rapid than smoking |
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Term
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Definition
Based on # cigarettes smoke in a day (4mg >25cigs, 2mg <25)
1 piece q1-2h, increase dose interval q6wks |
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Term
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Definition
| 'Chew' slow, when taste-stop &'park' gum buccual 1-2min. Repeat, placing in different area for total 30min/tast is gone |
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Term
Nicotine gum
Contraindication/caution |
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Definition
| pregnancy/breast feeding, CV disease, <18 y/o, esophagitis, peptic ulcer disease, DM |
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Term
Nicotine gum
adverse effects |
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Definition
| hiccups, nausea, upset stomach, heartburn, sore throat(may be incorrect use), adhesion to dental work, mouth sores, bad taste |
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Term
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Definition
Stop & call provider if mouth, jaw, teeth probs. irregular HR/palpitations, nicotine poisoning s/s.
Use scheduled rather than PRN initial
Max 24pieces/day
Avoid eat & drink 15 min before & during gum |
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Term
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Definition
| Based on # cigarettes in a day (>10/day or <10). Step down over 6-10 wks. 16 & 24h patches, use 16h if sleep interruption. Smaller patch if CV, weigh <100lbs, or smoke <1/2pack/day |
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Term
Nicotine Patch
contraindications/cautions |
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Definition
| pregnancy/breast feeding, CV, disease, antidepressants, <18 y/o, allergy to adhesive tapes, dermatologic probs |
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Term
Nicotine Patch
side effects |
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Definition
Skin reaction(red, burning, pruritis)
vivid/abnormal dreams (change to 16h patch)
insomnia, HA |
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Term
Nicotine Patch
pt teaching |
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Definition
Remove & call provider:skin redness does not go away in 4 days, skin welling/rash, irreg HR/palpitation, nicotine poisoning s/s.
Apply new dry, clean, hairless spot.
wash hands after. Remove/replace same time q day. |
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Term
Nicotine Nasal spray
dosing |
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Definition
Rx only. 1-2 sprays each nostril qhour
Max 40/day. Good for pt who want to rapid manage withdrawl s/s |
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Term
Nicotine Nasal spray
Contraindications/cautions |
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Definition
| pregnancy/breast feeding, CV, nasal polyps, nasal allergies, rhinitis/sinusitis, asthma/airway disease |
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Term
Nicotine Nasal spray
side effects |
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Definition
| nasal irritation, rhinorrhea, throat irritation, watery eyes, sneezing, cough, HA, rhinitis |
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Term
Nicotine Nasal spray
pt teaching |
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Definition
| Do not sniff,swallow,inhale during administration |
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Term
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Definition
| Provides hand-mouth ritual. Max 16 cart/day. 20min/cart,frequent continuous puffing. Taper down |
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Term
Nicotine Inhaler
contraindication/caution |
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Definition
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Term
Nicotine Inhaler
side effects |
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Definition
| mouth/throat irritation, bronchitis, tooth disorder, same as other NRT |
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Term
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Definition
| Dosing based on when smoke 1st cigarette of day <30min of wakening.20-30min. Increase dose interval q6wks. |
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Term
Nicotine Lozenge
contraindication/caution |
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Definition
|
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Term
| Nicotine Lozenge side effects |
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Definition
| mouth irritation, dyspepsia, nausea, hiccups(worse if 2 at a time, or one right after another) and same as other NRT |
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Term
Nicotine Lozenge
pt teaching |
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Definition
| Do not bite/chew swallow. Dont eat or drink 15min before & after. Suck and rotate until dissolved. |
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Term
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Definition
| Unknown, inhibit uptake of NE, serotonin, and DA. Structurally similar to amphetamine (causes CNS stimulant & appetite suppress) |
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Term
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Definition
daily x3 days, then BID x7-12wks
Seperate doses by 8hrs, do not take second dose after 6pm. Dose adjust hepatic impair. |
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Term
Zyban
contraindication/caution |
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Definition
| SEIZURE hx, head injury, anorexia, cocaine use, alcohol withdrawl, MAOI use in last 14 days, liver/kidney dysfunction, elderly, recent MI/HTN |
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Term
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Definition
| seizures, hallucinations, paranoia, psychosis, insomnia, agitation, dry mouth, HA, palpitation |
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Term
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Definition
| Takes 7 days to reach steady state. set quit date 7-14 days after start. |
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Term
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Definition
| CYP 450 2B6 & 2D6, 1/2 life 21hr parent, 20-37 metabolites |
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Term
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Definition
| MAOIs, ethanol, BB, steroids, SSRIs, nicotine, TCAs, 2D6, 2B6 |
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Term
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Definition
| Partial agonist alpha-4, beta-2, ACh,& nicotinic receptors. Promotes release of DA |
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Term
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Definition
| nausea (decreases over time), dry mouth, constipation, gas, altered taste, vomit, psychologic changes:eratic bx, suicidal thoughts/behaviors. sleep disturbances, HA, abnormal dreams, seizure, DM, dizzy, disturbed vision, CV events |
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Term
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Definition
| 1/2 life 17hrs, renal impair delays excretion |
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Term
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Definition
first week titration, then BID 1mg.
12-24 wks total |
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Term
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Definition
| Wouldn't use in hx depression/suicide ideation or attempts. Caution in CV pts. Cannot use in truck driver, bus driver, airplane pilot, air traffic controller d/t unpredictable side effects. |
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Term
Nicotine Gum
advantage/disadvantage |
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Definition
Advantage:OTC,satisfy oral cravings, delay wt gain, titrate therapy
Disadvantage:not socially acceptable, difficult w/dentures,proper technique needed |
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Term
Nicotine lozenge
advantage/disadvantage |
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Definition
advantage:OTC, satisfy oral craving, easy titration
Disadvantage: GI side effects |
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Term
Nicotine Patch
advantage/disadvantage |
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Definition
advantage:OTC, consistent level, easy use and conceal,once day,avoid bad taste and GI side effects
Disadvantage: Cannot titrate,allergic reactions, 16h may lead to early cravings, 24h may cause sleep disturbances |
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Term
Nicotine nasal spray
advantage/disadvantage |
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Definition
Advantage:titrate, mimic hand-mouth
Disadvantage: Rx,nausea/throat irritation, dependence,5min before driving/operating machinery, avoid in chronic nasal disorders/airway disease |
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Term
Nicotine Inhaler
advantage/disadvantage |
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Definition
Advantage:titrate, maintain smoking ritual
Disadvantage:Rx,irritation throat/mouth, cartridge storage, avoid in bronchospastic, maintain smoking ritual |
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Term
Zyban
advantage/disadvantage |
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Definition
Advantage:generic,easy use, few compliance probs, can be used w/NRT,benefits pt w/depression
Disadvantage:Rx,seizure risk, insomnia |
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Term
Chantix
advantage/disadvantage |
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Definition
Advantage:prevent relapse by affecting reward center, no nicotine, no observed drug interactions
Disadvantages: Rx-brand name,No titration, minimal post-market data, nausea |
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Term
|
Definition
| Nortriptyline, clonidine, NicVax (vaccine stimulates production of ATB bind to nicotine in body unable to experience pleasure. Avoid vapor cigarettes. |
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