Patch
Delivers consistent nicotine levels over ___ hours
16 and 24
True or false: nicotine gum can be titrated to manage withdrawal symptoms
True
True or false: lozenges may cause weight gain
False
Nasal spray is not recommended for patients with ________?
•Chronic nasal disorders
•Severe reactive airway disease
True or false: one advantage of the oral inhaler is that it mimics the hand-to-mouth ritual of smoking
True
True or false: the patch cannot be used in combination with other agents
False; it can be combined with other agents
What is one disadvantage of nicotine gum?
•Frequent dosing à barrier to adherence
•May cause issues with dental work
•Proper chewing technique necessary for effectiveness and minimize adverse effects
What side effects are associated with use of lozenges?
GI side effects (nausea, hiccups, heartburn) if using more than 1 lozenge at a time or continuously after another
What is the starting dose for nasal spray?
Spray 1-2 doses/hour
What is the starting dose of oral inhaler?
Start six cartridges per day
Name one disadvantage of the patch
•Cannot be titrated to acutely manage withdrawal symptoms
•Not recommended for patients with dermatologic conditions (e.g. psoriasis, eczema, atopic dermatitis)
How many pieces of gum should a patient chew daily to improve chances of quitting?
9 pieces
What food/beverages may reduce effectiveness of the lozenge?
Coffee, juices, wine, soft drinks (due to high acidity)
The nasal spray may require a tapering down of the dose over ______ weeks before discontinuation
4-6
True or false: cartridges may be less effective in cold environments
True; use inhaler at room temperature (>60°F)
If left on overnight, the patch can cause ________
Insomnia or abnormal dreaming
Fill in the blank for the starting doses:
People who smoke <30 min after waking: ____ mg
People who smoke >30min after waking: ____ mg
4, 2
Fill in the blank for the starting doses:
People who smoke <30 min after waking: ____ mg
People who smoke >30min after waking: ____ mg
4, 2
Use at least ____ doses daily for first 6-8 weeks
8
What is the recommended duration of therapy for oral inhaler?
3 months
Name 3 counseling points to give to a patient who is starting on a nicotine patch
•Can bathe, swim, shower, exercise with patch
•Do not cut patches
•Remove patch before MRI procedures
•After removal, skin may appear red for 24 hours (if longer than 4 days, refer to HCP)
•Local skin reactions (redness, burning, itching) may occur due to adhesive
•Patch can be left on overnight but may cause insomnia or abnormal dreaming (remove patch 60 min before bedtime to minimize effects)
How would you counsel a patient to properly chew nicotine gum?
Chew until a distinguishable taste change, park the gum between the gums and cheek until tingling sensation subsides
How would you counsel a patient to properly use a lozenge?
Place the lozenge between the gums and cheek; rotate to new site in mouth periodically to avoid mucosal irritation
What side effects are associated with the nasal spray (usually in the first week of using it)?
Hot peppery feeling, sneezing, cough, watery eyes, runny nose
How would you counsel a patient to use an oral inhaler?
Use the inhaler longer and more often at first to help control cravings (best results are achieved with frequent continuous puffing over 20 minutes)