nicotine replacement therapy: administration and overview
DESCRIPTION
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 - PowerPoint PPT PresentationTRANSCRIPT
Nicotine Replacement Therapy: Administration and Overview
Barbara Hart, MPA and Claudia Lechuga, MSBronx BREATHEST: (718)430-2601
E: [email protected] / [email protected]
June 15, 2009
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
• 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
• Motivational Level– Confidence
• Main reason for considering/wanting to stop• Concerns about quitting
– Weight gain concerns
Use of NRT
Reasons for using NRT• 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
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
Tobacco Cessation Medications
Nicotine Replacement• Patch *• Gum *• Lozenge *• Oral Inhaler ^• Nasal Spray ^
Non-nicotine medication• Bupropion ^
– (Zyban/Wellburtrin)
• Varenicline ^– (Chantix)
* Available OTC ^ prescription only
Nicotine Delivery Comparison
Nicotine Delivery DeviceNicotine in Product
Approx Amount of Nicotine Delivered to
UserComments
Marlboro Red 13 mg 1-3 mgMarlboro Light 13 mg 1-3 mgCigars 10-40 mg Highly Variable
Moist Snuff 3-12 mgVaries depending on pH and other characteristics
Nicotine Gum 2 mg piece Up to 0.8 mgNicotine Gum 4 mg piece Up to 1.5 mgNicotrol Patch (Pharmacia) 15 mg / 16 hoursNicoderm CQ Step 3 (Glaxo Smith Kline) 7 mg / 24 hoursNicoderm CQ Step 2(Glaxo Smith Kline) 14 mg / 24 hoursNicoderm CQ Step 1(Glaxo Smith Kline) 21 mg / 24 hours
Tobacco Products
Nicotine Replacement Products
Only delivers nicotine to the consumer
Also delivers a wide range of carcinogens and other
toxins
Medication Overview
Product Use Advantages Disadvantages Precautions Side Effects CostNicotine Patch
Apply each day to clean, dry, hairless skin. Start 21 mg patch if .10 cig per day; can taper to 14 mg in 4-6 weeks, then 7 mg in 2 weeks if no cravings
Place and forget; over the counter; can decrease morning cravings if worn at night
Passive - no actions to take when craving occurs
Not recommended to use while smoking; caution within 6 weeks of heart attack
Skin reaction (50% of patients; usually mild and can use hydrocortisone cream); Rotate sites; vivid dreams or sleep disturbances possible at night
$45/2 week supply (generics available and effective)
Nicotine Gum
Chew every 1-2 hours as needed; chew and park; 2 and 4 mg strength (4mg if around 1 ppd)
Use as needed; can self-dose; Over the counter
Difficult to chew Avoid food and acidic drinks 15 minutes before and while using (decreases absorption)
Jaw pain; nausea if swallowing saliva
$35-50/2 week supply
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
• 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
Moderate Smokers• Smoke 10-20 per day• Includes:
– Novartis Step 1• 28 count 21 mg patches
Heavy Smokers• Smoke 20+ per day• Includes:
– Nicorelief Gum• 110 pieces of 4mg gum
– Novartis Step 1• 28 count of 21mg patches
NRT Enrollment Forms
Necessary for each course distributed
Full information required
Fax or email back to Bronx BREATHES
NRT Enrollment Forms (cont’d 1)
NRT Enrollment Forms (cont’d 1)
NRT Enrollment Forms (cont’d 1)