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Nicotine Addiction

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.

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Nicotine Addiction

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  1. Nicotine Addiction Pharmacy Practice II Winter 2005

  2. 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?

  3. Pharmacist’s Role • Ask • Advise • Assess • Assist • Arrange

  4. Stages of Change • Precontemplation • Contemplation • Preparation • Action • Maintenance

  5. Precontemplation • Unaware, unwilling, too discouraged • Won’t change in the next six months • Listen, empathy, identify barriers • Focus on benefits of change • Interview questions

  6. Contemplation • Open to information, thinking about quitting in next 6 months • Provide information, emotional support • Encouragement • Resources • Information about options • What it will take, who is available

  7. Preparation • Getting ready o try new behavior within 30 days • Goal setting, praise readiness, enlist support of others • Goals • Resources • Options • Who can help

  8. Action • Taking steps, needing willpower • Habituating behaviors • Stimulus control, reinforce + behaviors, continuing emotional support • Action plans • Other support • Product information • Positive effects

  9. Maintenance • Engaged for at least six months • Continue emotional support • Relapse prevention • Reinforce benefits • Relapse – encouragement, persistence

  10. Treatment options • Behavior modification • Nicotine lozenges • Nicotine gum • Nicotine patches • Nicotine inhaler • Nicotine nasal spray • Bupropion SR

  11. Treatment optionsNicotine polacrilex lozenges • 2 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/d • CI: pregnancy, CVD, PUD • SE: hiccups, sore mouth, sore throat, nausea • 12 weeks

  12. Treatment optionsNicotine polacrilex gum • 2 mg (<24 cigs/d), 4 mg (>24 cigs/d) • Bite and park • Avoid eating, drinking while chewing • Acid decreases release • SE: hiccups, nausea, sore throat, sore mouth • CI: pregnancy, CVD, esophagitis, PUD • 12 weeks

  13. Treatment OptionsTransdermal nicotine • 7, 14, 21 mg, 24-hour • 5, 10, 15 mg, 16-hour • Usage guidelines p.1166 • SE: local skin reaction, insomnia • CI: pregnancy, CVD, derm. problems • 8 weeks • Must not use tobacco

  14. Rx Nicotine replacement • Nicotine Inhaler • SE: local irritation of mouth & throat • Up to 6 months • Nicotine Nasal Spray • SE: nasal irritation • Up to 6 months

  15. Bupropion SR • Wellbutrin, Zyban • Antidepressant, dopamine reuptake inhibitor • Start 1 week before quitting • 150 mg q am x 3 d, then increase to bid (may take second dose mid afternoon) • CI: History of seizure, eating disorders • SE: insomnia, dry mouth • Can use with nicotine replacement

  16. What’s new? • Rimonabant (Acomplia) • Cannabanoid Receptor Antagonist • Weight loss, tobacco cessation • Phase III clinical trials

  17. Other considerations • Costs • Irritability • Weight gain • Proper disposal of products • Abstinence rates • 14-30% vs 8-20% placebo

  18. References • See Blackboard links • Treating 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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