Nicotine Addiction

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Nicotine Addiction

• Pharmacy Practice II
• Winter 2005

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Tobacco Use Interview

• When 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?

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Pharmacists Role

• Ask
• Advise
• Assess
• Assist
• Arrange

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Stages of Change

• Precontemplation
• Contemplation
• Preparation
• Action
• Maintenance

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Precontemplation

• Unaware, unwilling, too discouraged
• Wont change in the next six months
• Listen, empathy, identify barriers
• Focus on benefits of change
• Interview questions

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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

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Preparation

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

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Action

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

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Maintenance

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

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Treatment options

• Behavior modification
• Nicotine lozenges
• Nicotine gum
• Nicotine patches
• Nicotine inhaler
• Nicotine nasal spray
• Bupropion SR

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Treatment optionsNicotine polacrilex lozenges

• 2 mg (1st cig gt 30 min after waking)
• 4 mg (1st cig lt 30 min after waking)
• Allow to slowly dissolve (20-30 min)
• Do not chew, eat, or drink
• lt 20 lozenges/d
• CI pregnancy, CVD, PUD
• SE hiccups, sore mouth, sore throat, nausea
• 12 weeks

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Treatment optionsNicotine polacrilex gum

• 2 mg (lt24 cigs/d), 4 mg (gt24 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

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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

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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

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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

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Whats new?

• Rimonabant (Acomplia)
• Cannabanoid Receptor Antagonist
• Weight loss, tobacco cessation
• Phase III clinical trials

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Other considerations

• Costs
• Irritability
• Weight gain
• Proper disposal of products
• Abstinence rates
• 14-30 vs 8-20 placebo

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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