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Nicotine Replacement Therapy: Administration and Overview. Barbara Hart, MPA and Claudia Lechuga , MS Bronx BREATHES T: (718)430-2601 E: [email protected] / [email protected] www.bronxbreathes.org June 15, 2009. Smoker Assessment. History of usage Previous quit attempts

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Nicotine replacement therapy administration and overview

Nicotine Replacement Therapy: Administration and Overview

Barbara Hart, MPA and Claudia Lechuga, MS

Bronx BREATHES

T: (718)430-2601

E: [email protected] / [email protected]

www.bronxbreathes.org

June 15, 2009


Smoker assessment
Smoker Assessment

  • History of usage

  • Previous quit attempts

    • Withdrawal/abstinence symptoms

  • Motivational level for quit attempt

  • Current social environment

    • Stressors

    • Triggers

    • Biological/medical assessment

    • Family and friend support/sabotage


Previous quit attempts
Previous Quit Attempts

  • Dates

  • Age

  • Method used to quit

    • Medications or counseling used (if any)

  • Duration of that method

  • Problems and successes experienced

  • Reason for relapse

  • Withdrawal/Abstinence Symptoms


Current quit attempt
Current Quit Attempt

  • Motivational Level

    • Confidence

  • Main reason for considering/wanting to stop

  • Concerns about quitting

    • Weight gain concerns


Use of nrt
Use of NRT

Reasons for using NRT

Reasons for NOT using NRT

Medical conditions requiring caution/physician input

i.e. recent MI, pregnancy, current arrythmia

Age

Under 18s require physician/parental input

Specific issues

Allergy to patches

Personal aversion to medication

Questionable efficacy

i.e. those smoking less than 10pd

  • Doubles the success rate

  • Treats nicotine withdrawal

    • Helps patient feel more comfortable

  • Safe

    • Patient receiving same drug (nicotine) in a less addictive form over a relatively short period


Tobacco cessation medications
Tobacco Cessation Medications

Nicotine Replacement

Non-nicotine medication

Bupropion ^

(Zyban/Wellburtrin)

Varenicline ^

(Chantix)

  • Patch *

  • Gum *

  • Lozenge *

  • Oral Inhaler ^

  • Nasal Spray ^

* Available OTC ^ prescription only




Use and efficacy of combination therapy
Use and Efficacy of combination therapy

  • Multiple patch therapy (42 vs 21mg)

    • 20% increased abstinence

    • No significant increased sleep disturbances

    • (Dale 1995; Jorenby 1995)

  • Patch + Gum

    • Kornitzer 1995; Puska 1995

      • Early better rates

        • 7% increase at 6 months

      • Not sustained at 1 year

      • No increase in adverse events

    • 2008 OHS Guidelines Meta-analysis

      • Path + Gum/Spray OR = 1.9

        • Compared to patch alone (OR=1)

    • Fiore 2008

      • Abstinence rates

        • Nicotine Patch = 23.4%

        • Nicotine Gum = 19.0%

        • Long term Patch + Gum = 36.5%


Important points about nrt
Important Points about NRT

  • Nicotine is the addictive part of tobacco smoke but NOT the most dangerous part

  • People do NOT generally become addicted to medication

  • People DON’T use enough medication or stop TOO EARLY

    • Medications are SAFE and EFFECTIVE

    • Plan on minimum of 2 months of medication

  • Combinations

    • Work better than single medications

      • Use Long acting + Short acting


Nrt kits available
NRT Kits Available

Moderate Smokers

Heavy Smokers

  • Smoke 10-20 per day

  • Includes:

    • Novartis Step 1

      • 28 count 21 mg patches

  • Smoke 20+ per day

  • Includes:

    • Nicorelief Gum

      • 110 pieces of 4mg gum

    • Novartis Step 1

      • 28 count of 21mg patches


Nrt enrollment forms
NRT Enrollment Forms

  • Necessary for each course distributed

  • Full information required

  • Fax or email back to Bronx BREATHES





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