Flashcards in Smoking Cessation Deck (14)
Paxton's epidemiology #funfact regarding smoking.
Who have greater risk for dependence and greater difficulty quitting smoking?
What NT does nicotine work on most?
What are the S/S of nicotine withdrawal?
- irritability, frustration, anger
- dysphoric or depressed mood
- difficulty concentrating
- increased appetite or weight gain
- decreased HR
Describe the overall treatment for smoking cessation?
1 . Nicotine meds to deliver nicotine SLOWLY (risk of abuse low)
2. Counseling and combination cessation therapies
What is the general recommendation regarding nicotine replacement?
- controls withdrawl sxs throughout the day
2. Short-acting form (gum, lozenge)
- control "breakthrough" cravings
Be thoughtful about NRT in pt w/vascular disease (Vasoconstrictor)
What is the SSRI used for smoking cessation?
Haha which one of you dingles put that this is an SSRI? Downey Jr would be mad at you
- start tab 7-14d prior to anticipated quit date
What is Varenicline MOA?
Partial agonist that binds selectively to a4b2 nicotinic Ach receptor with GREATER affinity than nicotine
- blocks nicotine from binding
- stimulates receptor but lesser degree --> still have DA release to reinforce smoking to relieve craving/withdrawal sxs
How would you describe to the patient how to use Varenicline?
Start 1 week before quit date
Plus behavior support/counseling
Longer lead-in time (starting more than 1wk prior) has shown more improved 24wk cessation rates
Varenicline Clinical Pearls
1. use for pt who have never attempted cessation AND those who have
2. pt needs MOTIVATION to quit
3. can use for up to 24wk
4. Not allowed by pilots, truckers, bus drivers, air traffic controllers**
5. C.I. in preg/breastfeeding
6. No taper required
Varenicline drug Interactions
- minimally metabolized = minimal med interactions
** w/ETOH = increased intox, aggressive behavior, amnesia
- dd Nausea (becomes less severe w/continued use)
- insomnia, abn dreams
What was the original BBW on Varenicline? (now removed)
Neuropsychiatric sxs and exacerbations of pre-existing psych illness (e.g. agitation, hostility, depressed mood, suicidal ideation)
Stop varenicline if serious mood or behavioral changes
Smoking cessations and pregnancy considerations?
Counseling is preferred tx
Nicotine = Cat D
- NRT during pregnancy probably safer for fetus than smoking
Bupropion, varenicline = Cat C