Nicotine replacement
T/F: It is safe to smoke while using nicotine patches
true
This medication can cause vivid dreams
Chantix
T/F: Patients taking benzodiazepines for insomnia have better sleep quality and improvement in sleep architecture
False: benzodiazepines cause long term changes in sleep architecture (increase stage 2 NREM, decrease stage 3 and 4 and REM sleep)
please avoid benzos for insomnia :)
This medication can also lead to weight loss (not a GLP-1)
Topiramate
This medication requires daily visits to an opioid treatment program center for administration
Methadone
Smoking how many cigarettes daily is the threshold for selecting a 21 mg nicotine patch?
10+
Consider asking patients brand of cigarettes they use: more expensive brands have longer burn times (more smoke exposure) than cheaper brands
longer burn time: Marlboro, Newport
shorter burn times: Sonoma, Paramount, Lucky Strike, etc
What neurotransmitters does Zyban/Wellbutrin increase?
Norepinephrine and dopamine
What antidepressant that is often prescribed for insomnia has recommendations of Level B evidence from AFP that it should not be used to treat insomnia due to risk of side effects?
Trazodone
Statistically significant increased risk of falls on trazodone when compared to patients on zolpidem IR, zolpidem ER, benzodiazepines and placebo
https://www.aafp.org/pubs/afp/issues/2023/0200/fpin-ci-trazodone-insomnia.html
Disulfiram
What forms of MAT can be used in pregnancy?
Methadone or buprenorphine
Naltrexone should be avoided as it requires an opioid free period 7-10 days prior to initiation which increases risk for relapse and the withdrawal period can cause increased stress on the fetus
This is a resource that may help patients to get access to free NRT therapies
Smoking cessation hotline (1-800 QUIT NOW)
T/F: a patient with psychiatric conditions should not use Chantix
False: Can use Chantix if there is a history of psychiatric conditions.
Anthenelli, et al (2016): study did not show a significant increase in neuropsychiatric adverse events attributable to varenicline or bupropion relative to nicotine patch or placebo.
First line medication class of sleeping agents in pregnancy
Antihistamines
This medicine is contraindicated if CrCl <30 mL/min
Acamprosate
This form of MAT has a risk of QT prolongation
Methadone
Apply hydrocortisone or flonase first or use tegaderm under the patch
When should you start Chantix?
Ideally 2 weeks before quit date
What Z hypnotic medication is best for sleep latency and sleep maintenance?
Eszopiclone
Has a longer half life which allows it to improve sleep maintenance
What medication helps to reduce the number of heavy drinking days?
Gabapentin
This medication has a main side effect of nausea but can also cause hepatic injury
naltrexone (vivitrol)
Name another form of NRT besides gum, lozenges or patches
Nicotine nasal spray
Can be expensive and burns the first few times it is used
People from what ethnic background/race are more susceptible to menthol-induced nicotine addictions due to a genetic variant?
African American
MRGPRX4 gene variants cause defects in ACh receptors, thus when nicotine binds, you don't develop an addiction. Adding menthol to the cigarette alters ACh receptors and keeps them open (which helps drive nicotine addictions)
What sleeping medicine is the best option for helping blind patients sleep?
Melatonin (10 mg)
What two medications require liver enzyme monitoring during treatment?
disulfiram and naltrexone
How long before and after taking suboxone should you avoid eating, drinking or brushing teeth?
15-30 minutes
Certain substances can alter the absorption of suboxone (citrus foods, carbonated drinks, mouthwash or minty toothpaste can dry out mucous membranes)