NAPLEX - Tobacco Cessation

Dry Mouth, Insomnia

(Tobacco Cessation) BUPROPION SR (Zyban) Major side effects include (2) + Agitation + HA + NVC + Sweating + Anxiety + Tachycardia/tremors + Dizziness + Blurred vision

Dopamine, Norepinephrine

(Tobacco Cessation) BUPROPION SR (Zyban) MoA is to block reuptake of (2) to reduce cravings and withdrawal symptoms

1 week, 300

(Tobacco Cessation) BUPROPION SR (Zyban) Must be started at least _____ BEFORE quit date 150mg QAM x 3 days, then 150mg BID up to *6 months* Max dose is _____mg/day

9

(Tobacco Cessation) NICOTINE GUM/LOZENGE For efficacy, patients must take a MINIMUM of ______ pieces/day for the *first 6 weeks* of Tx

Partial Nicotinic Agonist

(Tobacco Cessation) VARENICLINE (Chantix) MoA is a _______ to cause low-level stimulation of the receptor while blocking ability of nicotine to bind - Relieves withdrawal symptoms - Inhibits dopamine surges

30

(Tobacco Cessation) VARENICLINE (Chantix) Must be renally dose adjusted for CrCl <____ mL/min 0.5mg QD titrated to MAX 0.5 mg BID

1 week

(Tobacco Cessation) VARENICLINE (Chantix) Must be started ____ BEFORE quit date (Days 1-3): 0.5mg QD (Days 4-7): 0.5mg BID (Day 8 - QUIT and beyond): 1 mg BID

Estrogen Oral Contraceptives

(Tobacco Cessation) Women aged *35 and older* who smoke should NOT take _________ due to increased risk of CV events

8 hours

(Tobacco Cessation) BUPROPION SR (Zyban) In order to reduce insomnia, patients should take the 1st dose upon awakening and the 2nd ______ later

Counseling, Medication

(Tobacco Cessation) A COMBINATION approach of (2) is more effective than either method alone - Behavioral + Social Support

Suicidality

(Tobacco Cessation) BUPROPION SR (Zyban) Has BBW for increased ____ in childrens-young adults taking antidepressants

Neuropsychiatric Events, Hypertension

(Tobacco Cessation) BUPROPION SR (Zyban) Has major warnings for (2) + Activation of mania/hypomania + Closed angel glaucoma + Hypersensitivity

7 weeks

(Tobacco Cessation) BUPROPION SR (Zyban) If the patient does not show significant progress after _____, consider D/C

Seizure Disorder, Anorexia/Bulimia, MAO Inhibitors within 14 days, Linezolid, Methylene Blue (IV), Abrupt D/C (Alcohol, BZD, Barbs, Antiepileptics)

(Tobacco Cessation) BUPROPION SR (Zyban) Is contraindicated in (6)

2, 4, 12 week

(Tobacco Cessation) NICOTINE GUM/LOZENGE Initial dosing for the gum/lozenge is based on *time to 1st cigarette* 1st cigarette >30 minutes after waking = ____mg 1st cigarette <= 30 minutes after waking = ____ mg Tx duration is generally a _______ schedule

24, 20

(Tobacco Cessation) NICOTINE GUM/LOZENGE Maximum amount of: Gum = ______ pieces/day Lozenge = ______ pieces/day

6-16, 12 weeks, 6 months

(Tobacco Cessation) NICOTINE INHALER - Rx only Dosing is ______ cartridges daily for up to _____, then decrease frequency over the next 6-12 weeks Can use up to ______ total

Mouth/Throat Irritation, Cough, Rhinitis

(Tobacco Cessation) NICOTINE INHALER - Rx only Side effects of the nicotine INHALER include (3) + HA + Dizziness + Nervousness + Insomnia + Dyspepsia

Nasal Irritation, Watery Eyes, Sneezing, Taste/Smell Changes

(Tobacco Cessation) NICOTINE NASAL SPRAY - Rx only Side effects of the nicotine NASAL SPRAY include (4) + HA + Dizzness + Nervousness + Insomnia + Dyspepsia

8, 5, 40, 3 months

(Tobacco Cessation) NICOTINE NASAL SPRAY - Rx only Is dosed at 1-2 doses (1 dose = 2 sprays) per hour, increased as needed for symptom relief MINIMUM ____ doses/day MAXIMUM _____ doses/hr OR _____ doses/day Can be used up to ______ in total

14, 7, None

(Tobacco Cessation) NICOTINE PATCH <= cigarettes dosing Weeks 1-6 = ______mg Weeks 7-8 = ______mg Weeks 9-10 = ______mg

21, 14, 7

(Tobacco Cessation) NICOTINE PATCH >10 cigarettes dosing Weeks 1-6 = ______mg Weeks 7-8 = ______mg Weeks 9-10 = ______ mg

Vivid Dreams, Skin Irritation

(Tobacco Cessation) NICOTINE PATCH Notable side effects of the nicotine PATCH include (2) + HA + Dizziness + Nervousness + Insomnia + Dyspepsia

21, 14, 10 week, 6/2/2

(Tobacco Cessation) NICOTINE PATCH (NicoDerm) Initial dosing is based on *# cigarettes/day* >10 cigarettes/day = _____ mg patch <= 10 cigarettes/day = ____ mg patch Overall Tx duration is a _______ schedule in blocks of ___/___/___ weeks

Post-MI, Arrhythmias, Angina, Pregnancy

(Tobacco Cessation) NICOTINE REPLACEMENT TX All nicotine replacements have warnings to be avoided in (4) Inhaler/nasal spray: + Asthma + COPD + Chronic respiratory conditions

Patch

(Tobacco Cessation) NICOTINE REPLACEMENT TX Of all the formulations, the _____ has the highest adherence rate - Combination of this PLUS a short-acting NRT is most effective

Bupropion SR, Varenicline

(Tobacco Cessation) NON-NICOTINE TX (2) drugs used for smoking cessation that are NOT nicotine replacement therapies

PPSV23, Influenza

(Tobacco Cessation) Smokers aged *19-64* should receive (2) vaccinations

Caffeine, Theophylline, Fluvoxamine, Olanzapine, Clozapine, Warfarin (R)

(Tobacco Cessation) Smokers who quit can experience INCREASED levels of (6) drugs

15 minutes

(Tobacco Cessation) TX CONSIDERATIONS Acidic beverages interfere with the buccal absorption of nicotine and should be spaced at least _______ after eating/drinking before using nicotine lozenge

20 minutes

(Tobacco Cessation) TX CONSIDERATIONS Each nicotine inhaler cartridge provides about _____ of continuous puffing - Is only good for ONE day after opening

Gum, Lozenge, Bupropion SR

(Tobacco Cessation) TX CONSIDERATIONS For concerns about weight gain, use (3) agents

Bupropion SR

(Tobacco Cessation) TX CONSIDERATIONS For concomitant depression, use (1)

Varenicline, Bupropion SR, Nicotine Inhaler, Nicotine Spray

(Tobacco Cessation) TX CONSIDERATIONS For patients with cost concerns, AVOID (4)

Gum

(Tobacco Cessation) TX CONSIDERATIONS For patients with dentures, AVOID (1)

Nicotine Inhaler, Nicotine Spray

(Tobacco Cessation) TX CONSIDERATIONS For patients with respiratory conditions, AVOID (2)

Patch

(Tobacco Cessation) TX CONSIDERATIONS For patients with skin conditions, AVOID (1)

Ask, Advise, Assess, Assist, Arrange

(Tobacco Cessation) The (5) A's for treating tobacco use and dependence

1A2

(Tobacco Cessation) The non-nicotine chemicals in tobacco smoke induce CYP enzymes, especially ________ - Smokers who quit can obtain supraTx levels of drugs

5, 2

(Tobacco Cessation) There are (#) nicotine replacement therapies and (#) non-nicotine therapies that are effective first-line medications for tobacco dependence - Combining *2* is most effective - Medications should be encouraged for all patients

Patch, Gum, Lozenge, Inhaler, Nasal Spray

(Tobacco Cessation) There are (5) nicotine formulations that are used for nicotine replacement therapy in smoking cessation

Pregnancy, Adolescents, Smokeless Tobacco Users, Smokers <10 Cigarettes/Day

(Tobacco Cessation) Treatment guidelines promote the use of BEHAVIORAL COUNSELING over drugs in (4) populations

12 weeks

(Tobacco Cessation) VARENICLINE (Chantix) Can be used for _____ ideally, but also extended for an additional same duration to maintain success if needed

4 weeks

(Tobacco Cessation) VARENICLINE (Chantix) For patients unable to abruptly quit on Day 8, the goal should be to decrease smoking by 50% in the first _____, then another 50% in the next time span, and completely stop by week 12

Neuropsychiatric Events, Seizures

(Tobacco Cessation) VARENICLINE (Chantix) Has major warnings for (2) + Increases alcohol effects/risk of blackout + Somnambulism + Accidentally injury + CVD risk + Angioedema/rash

Nausea (30%), Insomnia, Abnormal Dreams, Headache

(Tobacco Cessation) VARENICLINE (Chantix) Major side effects include (4) + Constipation + Flatulence + Vomiting