Smoking cessation

HG is a 17-year-old female who is interested in tobacco cessation. She asks about starting on nicotine gum. What advice should the pharmacist offer? A Encourage her to start behavioral counseling first. B Encourage her to start behavioral counseling and the nicotine gum at the same time (to improve success rate). C Encourage her to start behavioral counseling, nicotine gum and bupropion at the same time (to improve success rate). D Encourage her to start behavioral counseling, nicotine gum and varenicline at the same time (to improve success rate). E She is a good candidate for the nicotine inhaler.

A FDA prohibits sale of nicotine products to individuals younger than 18 years of age (REMS). Adolescents, pregnant women and light smokers should use behavioral counseling before pharmacologic treatment is considered.

Which of the following agents would be useful for a patient who needs to treat both depression and a smoking addiction? A Forfivo XL B Bactroban C Chantix D Sarafem E Viibryd

A Forfivo XL is bupropion.

What are the most common side effects of bupropion therapy? A Insomnia and dry mouth B Rash and itching C Sedation and lethargy D Weight gain and increased blood glucose E Anxiety and depression

A Insomnia and dry mouth are two of the most common side effects with bupropion.

In addition to the nicotine patch, BH is interested in the nicotine gum after hearing about its potential impact on weight. Which of the following counseling statements concerning the nicotine gum are correct for BH? A Chew each piece slowly until a "flavored" taste emerges, then remove the gum and use another piece in 30 minutes. B For best results, use one piece of gum every 4-6 hours in the first 6 weeks. C BH should chew one piece of the 4 mg gum every 1-2 hours. D BH will need to use the gum for approximately 6 months. E BH should use a maximum of 9 pieces of gum per day.

C Patients who smoke the 1st cigarette of the day within 30 minutes of awakening OR patient who smoke at least 25 cigarettes per day should use the 4 mg gum. This is also the dose of gum and lozenge that has been shown to delay weight gain. A minimum of 9 pieces per day is recommended in the 1st 6 weeks (chewing one piece every 1-2 hours). When the tingling/flavored taste appears, the gum should be parked between the cheek and the gums.

Which of the following statements is true regarding varenicline use for tobacco cessation? A Varenicline should be started the day after the patient's quit date. B Varenicline is contraindicated in pregnancy. C Varenicline should be taken with food and a full glass of water. D Varenicline is not associated with any gastrointestinal side effects. E Varenicline has a boxed warning for seizure risk.

C Varenicline should be taken with food and a full glass of water. It is not contraindicated in pregnancy but should be used with caution.

Choose the correct counseling statement for the Nicotrol inhaler: A The hand to mouth action when using the inhaler increases cravings for real cigarettes. B This is the preferred tobacco cessation treatment if you have asthma. C This medication may cause mouth and throat irritation. D To quit effectively, take one puff of the inhaler every 20 minutes. E This medication can cause nasal irritation.

C When using the inhaler, the patient should puff contiuously for a total of 20 minutes. The hand to mouth coordination is actually a good coping mechanism for patients since it mimics the action of smoking a cigarette. The inhaler can worsen bronchospastic diseases, such as asthma and COPD, and can cause mouth and throat irritation. The nicotine nasal spray can cause nasal irritation.

A patient asks the pharmacist for advice on using the Nicorette mini-lozenge. The patient states that she does not feel much benefit after using one. The pharmacist asks how the patient uses the lozenge, and the patient replies she chews it and swallows it. Which of the following counseling statements for the lozenge is correct? (Select ALL that apply). A The lozenges should be used in combination with Chantix. B A prescription will be required if the patient wishes to use this beyond 2 weeks. C Use 1 lozenge every 1-2 hours during the first 6 weeks of treatment. D Do not eat or drink anything for 15 minutes before or during lozenge use. E Dissolve the lozenge in the mouth; do not chew.

CDE The lozenge should be allowed to dissolve in the mouth rather than chewing or swallowing it. Acidic beverages (e.g., 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 use of the nicotine lozenge.

What is the mechanism of action of varenicline? A It is a nicotinic receptor antagoist B It blocks dopamine and norepinephrine uptake C It inhibits reuptake of serotonin D It is a partial nicotinic receptor agonist E It is a dopamine and serotonin receptor agonist

D Varenicline is a partial neuronal alpha-4 beta-2 nicotinic receptor agonist.

Select the tobacco cessation options that is/are preferred for BH? (Select ALL that apply.) A Chantix B Zyban C Zyban plus nicotine patch D Nicotine patch E Nicotine patch plus nicotine lozenge

DE Zyban (bupropion) and Chantix (varenicline) are not good options for BH due to her history of seizures (with another form of buproprion). Chantix also has a warning for seizures and both drugs can cause psychiatric side effects in patients with a prior history of mental illness.

JE has been successful quitting smoking with bupropion. He has not smoked a cigarette in the past 6 months and is very committed to staying tobacco-free. His provider would like to discontinue his bupropion therapy. What should the pharmacist recommend to safely discontinue JE's bupropion therapy? A Decrease bupropion dose to 150 mg daily for 4 weeks, then 75 mg daily for 4 weeks, then stop. B Decrease bupropion dose to 150 mg daily for 2 weeks, then 75 mg daily for 2 weeks, then stop. C Decrease bupropion dose to 150 mg daily for 2 weeks, then stop. D Decrease bupropion dose to 150 mg daily for 1 week, then stop. E Bupropion does not need to be tapered.

E Bupropion does not need to be tapered upon discontinuation.

Which of the following immunizations can be recommended for BH? A Annual influenza vaccine; Pneumovax 23 once after age 65 B Annual influenza vaccine; Pneumovax 23 now and again after age 65 C Annual influenza vaccine; Prevnar 13 now; Pneumovax 23 after age 65 D Prevnar 13 now; Pneumovax 23 in 12 months and then again after age 65 E Prevnar 13 now; Pneumovax 23 after age 65

b Smoking is a criteria for Pneumovax 23 vaccination between ages 19-64 years. Patients should receive a second dose after age 65 as long as it has been at least five years since the last dose. Refer to the Immunizations chapter for additional information.

LB is a female patient who is starting bupropion for tobacco cessation. Which of the following statements concerning bupropion are correct? (Select ALL that apply.) A Bupropion should be started at least 1 week before her desired quit date. B Her dose should be titrated to 450 mg daily. C Doses should be taken at least 8 hours apart. D It is safe to use in patients taking Forfivo. E Do not use if she has either anorexia or bulemia.

ACE

What is the advantage of using the nicotine patch and nicotine gum together? (Select ALL that apply.) A There is a higher chance of success with combination therapy. B Patients may experience less tachycardia. C Patients may experience less nighttime insomnia. D The gum may be useful to control breakthrough cravings. E There is no advantage to using both together.

AD Combination therapy will work better than just one form of nicotine replacement alone.

BS, who has smoked an average of 12 cigarettes per day for the last year, is interested in tobacco cessation using the patch. What dose should the pharmacist recommend? A Use 21 mg/24 hr patch for 6 weeks, then the 14 mg/24 hr patch for 4 weeks, then 7 mg/24 hr patch for 4 weeks B Use 21 mg/24 hr patch for 6 weeks, then the 14 mg/24 hr patch for 2 weeks, then 7 mg/24 hr patch for 2 weeks C Use 14 mg/24 hr patch for 6 weeks, then 7 mg/24 hr patch for 4 weeks D Use 14 mg/24 hr patch for 6 weeks, then 7 mg/24 hr patch for 2 weeks E Use 7 mg/24 hr patch for 6 weeks

B

Which of the following drug levels would increase in a patient who stops smoking? A Gemfibrozil B Theophylline C Clonazepam D Ziprasidone E Aripiprazole

B