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Nicotine Addiction

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Nicotine Addiction. Pharmacy Practice II Winter 2005. Tobacco Use Interview. When did you start? Why? How much, how often? What do you like? What don’t you like? Health risks? Quitting experience? What would it take to quit?. Pharmacist’s Role. Ask Advise Assess Assist Arrange. - PowerPoint PPT Presentation
  • Nicotine AddictionPharmacy Practice IIWinter 2005

  • Tobacco Use InterviewWhen did you start?Why?How much, how often?What do you like?What dont you like?Health risks?Quitting experience?What would it take to quit?

  • Pharmacists RoleAskAdviseAssessAssistArrange

  • Stages of ChangePrecontemplationContemplationPreparationActionMaintenance

  • PrecontemplationUnaware, unwilling, too discouragedWont change in the next six monthsListen, empathy, identify barriersFocus on benefits of changeInterview questions

  • ContemplationOpen to information, thinking about quitting in next 6 monthsProvide information, emotional supportEncouragementResourcesInformation about optionsWhat it will take, who is available

  • PreparationGetting ready o try new behavior within 30 daysGoal setting, praise readiness, enlist support of othersGoalsResourcesOptionsWho can help

  • ActionTaking steps, needing willpowerHabituating behaviorsStimulus control, reinforce + behaviors, continuing emotional supportAction plansOther supportProduct informationPositive effects

  • MaintenanceEngaged for at least six monthsContinue emotional supportRelapse preventionReinforce benefitsRelapse encouragement, persistence

  • Treatment optionsBehavior modificationNicotine lozengesNicotine gumNicotine patchesNicotine inhalerNicotine nasal sprayBupropion SR

  • Treatment optionsNicotine polacrilex lozenges2 mg (1st cig > 30 min after waking)4 mg (1st cig < 30 min after waking)Allow to slowly dissolve (20-30 min)Do not chew, eat, or drink< 20 lozenges/dCI: pregnancy, CVD, PUDSE: hiccups, sore mouth, sore throat, nausea12 weeks

  • Treatment optionsNicotine polacrilex gum2 mg (24 cigs/d)Bite and parkAvoid eating, drinking while chewingAcid decreases releaseSE: hiccups, nausea, sore throat, sore mouthCI: pregnancy, CVD, esophagitis, PUD12 weeks

  • Treatment OptionsTransdermal nicotine7, 14, 21 mg, 24-hour5, 10, 15 mg, 16-hourUsage guidelines p.1166SE: local skin reaction, insomniaCI: pregnancy, CVD, derm. problems8 weeksMust not use tobacco

  • Rx Nicotine replacementNicotine InhalerSE: local irritation of mouth & throatUp to 6 monthsNicotine Nasal SpraySE: nasal irritationUp to 6 months

  • Bupropion SRWellbutrin, ZybanAntidepressant, dopamine reuptake inhibitorStart 1 week before quitting150 mg q am x 3 d, then increase to bid (may take second dose mid afternoon)CI: History of seizure, eating disordersSE: insomnia, dry mouthCan use with nicotine replacement

  • Whats new? Rimonabant (Acomplia)Cannabanoid Receptor AntagonistWeight loss, tobacco cessationPhase III clinical trials

  • Other considerationsCostsIrritabilityWeight gainProper disposal of productsAbstinence rates14-30% vs 8-20% placebo

  • ReferencesSee Blackboard linksTreating Tobacco Use and Dependence, www.cme.wisc.edu/online/ctri/index.htm University of Wisconsin Medical School and center for Tobacco Research and Intervention

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