NC STEP/Mission Hospitals

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NC STEP/Mission Hospitals School Cessation and
Treatment Guide
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Cessation Guide
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Treatment Guide
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Recommended ST Treatment Approach

• 1) Behavioral treatment
• Oral examination
• /- oral replacement products
• 2) Bupropion
• 150 mg po qd x 3 days then bid
• Quit 1 week later
• Continue for 3-6 months
• 3) Tailored nicotine patch therapy
• /- gum/lozenge for self-titration

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Smokeless Tobacco Pharmacology

• Potential available nicotine is twice that
  obtained from smoking a cigarette (per unit
  dose)
• chewing tobacco 4.5 mg
• moist snuff 3.6 mg
• 4 mg nicotine gum 1.9 mg
• cigarette 1.8 mg

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Nicotine Gum for ST Use

• Should not be used as monotherapy
• 4 mg
• Frequent use initially (10-15/day)

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Nicotine Lozenge for ST Use

• Nicotine Polacrilex
• 2 mg
• 4 mg
• 1-2 lozenges every 1-2 hours
• Minimum of 9/day
• Taper over 12 weeks

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Pharmacologic TreatmentNicotine Patch
Percentage Replacement
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NRT for ST Users
Peak serum
nicotine
Cans or pouches
Patch dose
concentrations
per week
(ng/mL)
0-10
Low
1
14 mg/d
11-20
Intermediate
2-3
21or 22 mg/d
gt 20
High
gt 3
42 or 44 mg/d
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Bupropion SR for ST UseDosing

• 150 mg daily for 3-4 days
• then
• 150 mg twice a day for 3-4 days
• THEN
• STOP Tobacco

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