Tobacco Cessation

Matt Adams is starting tobacco cessation and is going to use the 4 mg gum. How much should he use initially?

A) At least 1 piece of gum every 1-2 hours during the start of therapy (for the first 6 weeks) Patients often do not use enough gum to obtain optimal clinical effects. Instruct the patient to use at least 1 piece of gum every 1-2 hours during the start of therapy (for the first 6 weeks), then 1 piece of gum every 2-4 hours for 3 weeks, then 1 piece of gum every 4-8 hours for the last three weeks.

What are the most common side effects of varenicline therapy?

D) Nausea and abnormal dreams Nausea, insomnia and abnormal dreams are a few common side effects of varenicline.

A new warning has been added to the labeling of varenicline in 2015. This new warning describes the potential interaction between varenicline and:

B) Alcohol Increased effects of alcohol have been reported in patients taking varenicline. Instruct patients to reduce the amount of alcohol they consume until they know how varenicline affects them.

Which of the following drug levels would increase in a patient who stops smoking?

B) Zyprexa generic for OLANZapine Smoking induces the metabolism of caffeine, theophylline, olanzapine and clozapine, and some other agents. If a patient suddenly stopped smoking but continued to take either of these, the concentration would increase as the induction effect wore off.

Which of the following agents would be useful for a patient who needs to treat both depression and a smoking addiction?

*Buproban (bupropion)* Look up brand names: Viibryd Sarafem Chantix Bactroban

Which of the following tobacco cessation therapies works by reducing nicotine cravings and other withdrawal symptoms by blocking dopamine and norepinephrine reuptake?

A) Bupropion Bupropion blocks neural reuptake of dopamine and norepinephrine resulting in reduced cravings and other withdrawal symptoms.

John Thompson smokes so often that he smells like an ash-tray. His family has been begging him to quit and Mr. Thompson finally seems ready to apply himself seriously to this effort. He has agreed to use the gum as he thinks he must have something in his mouth to replace the cigarette. Which of the following counseling statements concerning the nicotine gum are correct?

A) Chew slowly until a "flavored" taste emerges, then "park" the gum between the cheek and gum. 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 fifteen minutes before or during chewing. Varenicline should not be used in combination with NRT.

Beth Hogan wishes to quit smoking. She has tried using gum in the past. She has never participated in any type of support program. Choose the correct statement/s. (Select ALL that apply.)

A) Counseling and medication are more effective when used together. B) There is a strong correlation between counseling intensity and quitting success. D) Many patients fail with nicotine gum or lozenges because they do not use an adequate amount daily. E) There is a national quitline that can provide support for Mrs. Hogan. NOTE: Medication and counseling are more effective when used together; this applies to all medications. Psychological support, such as individual or group counseling, provides a better chance of success.

Heather Gray 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. FDA *prohibits* sale of nicotine products to individuals younger than 18 years of age (REMS).

Tim Perez's doctor has advised him to use the nicotine patch with the gum. Why did the doctor offer this advice to use a combination of nicotine products? (Select ALL that apply.)

A) Higher chance of success E) The gum may be useful to control breakthrough cravings NOTE: Using the combination of the nicotine patch with either the gum, nasal spray or the lozenge will work better than just one form of nicotine replacement alone.

What are the most common side effects of bupropion therapy?

A) Insomnia and dry mouth Insomnia and dry mouth are 2 of the most common side effects with bupropion.

Which of the following products is/are available over-the-counter? (Select ALL that apply.)

A) Nicotine gum B) Nicotine lozenge C) Nicotine patch Nicotine gum, lozenge, and patch are all available OTC. Spray and inhalers are Rx only.

Cecilia is pregnant and wants to quit smoking. Which of the following agents is NOT pregnancy category C?

A) Nicotrol Inhaler The OTC nicotine replacement products are Pregnancy Category C.

Laura Brown will use bupropion for tobacco cessation. Which of the following statements concerning bupropion are correct? (Select ALL that apply.)

A) Patients should stop smoking on their quit date at least 1 week after starting bupropion. C) Do not use if she has a seizure disorder. E) Do not use if she has either anorexia or bulemia. Do not chew, cut, or crush tablets (medication may be released too rapidly).

Benjamin Lewis is a 50 year-old male who has stopped smoking since starting the nicotine patch two weeks ago but now complains of insomnia. What advice should the pharmacist offer?

B) Advise him to wear the patch during waking hours (for 16 hours, instead of 24 hours). NOTE: The patches should NOT be cut and CAN be worn for 16 hours in patients who have problems with insomnia.

Chantix requires dose adjustment for which of the following conditions?

B) Chantix requires dose adjustment for which of the following conditions? Chantix requires dose reduction in patients with significant renal impairment (CrCl < 30 mL/min).

Frank Walker is prescribed Chantix for tobacco cessation. What is the generic name of Chantix?

B) Varenicline

Mike Baker smokes 1.5 packs of cigarettes per day, with the first cigarette within 10 minutes of waking up in the morning. What strength of gum should he use at the initiation of nicotine replacement therapy?

C) 4 mg gum pieces If the first cigarette smoked is less than or equal to 30 minutes after waking up, use the 4 mg gum

Choose the correct counseling statement for the Nicotrol inhaler:

C) Frequent, continuous puffing for 20 minutes is advised with each cartridge. Once a cartridge is opened, it is only good for 1 day. After using the inhaler for a total of 20 minutes, remove the used cartridge and throw it away out of reach of children and pets. The mouthpiece is reusable. Clean the mouthpiece with soap and water regularly. Delivery of nicotine from the inhaler declines significantly below 40 degrees F. In cold weather, the inhaler and cartridge should be kept in an inside pocket or other warm area.

Which of the following products simulates a "hand-to-mouth" movement and can be useful for patients who wish to repeat a hand-to-mouth habit?

C) Nicotine inhaler

Amy Lee is going to use the nicotine patch to help her quit smoking. Choose the correct counseling statement.

C) Rotate patch application sites to reduce skin 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?

C) Use 1 lozenge every 1-2 hours during the first 6 weeks of treatment. D) Do not eat or drink anything other than water for 15 minutes before or during lozenge use. E) Dissolve the lozenge in the mouth; do not chew. 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. Patients often do not use enough nicotine replacement medications to obtain a good response. Use 1 lozenge every 1-2 hours during the first 6 weeks of treatment, with a minimum of 9 lozenges daily, then decrease over time.

Which of the following statements is true regarding varenicline use for tobacco cessation? Chantix = varenicline

C) Varenicline should be taken with food and a full glass of water. Varenicline should be taken with food and a full glass of water. This medication is pregnancy category C.

Chantix has a boxed warning for this serious, possible adverse effect:

D) Serious psychiatric events Serious neuropsychiatric events including depression, suicidal ideation, suicide attempt and completed suicide have been reported in patients taking Chantix. Instructions should include directions to stop taking the medication if they become hostile, agitated, depressed, or have changes in behavior or thinking that are not typical. Next

Bert Stewart, who smokes an average of 8 cigarettes per day for the last year, is interested in tobacco cessation. Mr. Stewart is interested in using the patch. What dose should the pharmacist recommend?

D) Use 14 mg/24 hr patch for 6 weeks, then 7 mg/24 hr patch for 2 weeks

Jeremiah Evans has been successful in quitting smoking. Mr. Evans 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 Mr. Evans's bupropion therapy?

E) Bupropion does not need to be tapered.

Which of the following tobacco cessation nicotine products comes as a transdermal patch?

E) NicoDerm CQ