1
Q
psychoactive drug
A
substance that when ingested, alters mental processes such as cognition or affect
2
Q
addiction
A
bio-psycho-social phenomenon, multi-faceted process of drug dependency
3
Q
physical dependency
A
physiological state of cellular adaptation that occurs when the body becomes as accustomed to a drug that it can only function normally when the drug is present
4
Q
psychological dependency
A
believing they can’t manage without the substance - may escalate to feelings of loss or desperation if the drug is unattainable
5
Q
withdrawal
A
negative bodily reaction = physical disturbances or illness that occurs dueing the process of ceasing to take a drug
6
Q
4 c’s of addiction
A
craving, compulsion, loss of control, use despite consequences
7
Q
addiction means
A
- change in level of functioning
- interfereing with life, work, family
- psychological consequences
- increase use despite interference in life
8
Q
american society of addiction medicine (asam) characterizes addiction w/ ABCDE
A
- inability to abstain
- impairment in behavioural control
- craving
- diminished recognition of sig problems with behaviours
- dysfunctional emotional response
9
Q
substance dependence
A
Chronic requirement for substance Cognitive and physical symptoms Evidence of tolerance Evidence of withdrawal syndrome
10
Q
intoxication
A
the state in which the body is poisoned by alcohol or another substance and the person’s physical and mental control is significantly reduced
11
Q
withdrawal state
A
- sx occur when stop drugs
- may have signs of physiological dependence
- one indicator os SUD
- onset & course r/t the drug
- withdrawal features opposite of intoxication sx
12
Q
nursing goal of withdrawal
A
- safe withdrawal
- pt be drug free
- protect pt dignity
- prepare pt for ongoing treatment & recovery
13
Q
cross tolerance
A
tolerance for a substance one has not taken before as a result of using another substance similar to it
14
Q
cross dependence
A
dependence on a drug can be relieved by other similar drugs
15
Q
synergistic effect
A
interaction of two or more medicines that results in a greater effect than when the medicines are taken alone
16
Q
paradoxical effect
A
the opposite of the intended drug response
17
Q
rebound affect
A
form of withdrawal; paradoxical effects that occur when a drug has been eliminated from the body
18
Q
delirium tremens
A
a disorder involving sudden and severe mental changes or seizures caused by abruptly stopping the use of alcohol (Very serious)
19
Q
post acute withdrawal syndrome
A
cluster sx occuring for 1-2 weeks
20
Q
teratogenic effect
A
Effect of a drug administered to the mother that results in abnormalities in the fetus.
21
Q
REM rebound
A
the tendency for REM sleep to increase following REM sleep deprivation (created by repeated awakenings during REM sleep)
22
Q
half life of drug
A
the time it takes for the amount of a drug’s active substance in your body to reduce by half
23
Q
drug agonists
A
activates receptor site by being able to mimic or enhance the actions of a neurotransmitter (morphine)
24
Q
antagonists
A
able to fit into the receptor site, without activating it (naloxone)
25
partial agonists
able to only weakly activate receptor sites, while preventing other drug molecules the opportunity to bind at that receptor site (suboxone)
26
neurotransmitters
chemicals found in hte brain that are used to relay, amplify, and modulate signals b/w a neuron & another cell
27
common neurotransmitters
dopamine, endocannabioids, endorphins, GABA, glutamate, norepinephrine, serotonin
28
tolerance
body's adaption to presence of drug, resulting in loss of sensitivity to it; requires increased amounts to produce the same outcome as originally experienced
29
pharmacokinetics
deals with how psychoactive drug administered, absorbed, distributed, metabolized, elimiated
30
whats the fast route of admin
inhalation
31
bio theories mean
pre-existing or induced chemical, physiological, or structural abnormality is the cause of substance abuse
32
disease model
the belief that people abuse alcohol because of some biologically caused condition
- firmly places substance use disorders as an illness
33
popularity of disease model
- simple solution to complex problem
- provides foundation for popular model of recovery: AA
34
Epigenetics
the study of environmental influences on gene expression that occur without a DNA change
35
Neurobiology of Addiction
-have a connection the the Ventral Tegmental area dopanergic responses and the Nucleus accumbens ?
-for reward response to food, water and sex usually but drugs lead to pleasurable responses as well
36
Behaviour/psychological model
This model focuses on the reinforcement and reward systems in the brain. Substance use is viewed as an adaptive strategy to seek balance and to respond to life stressors
37
Stress-Diathesis Model
Internal genetic predisposition and environmental factors play a role in risk for person to become addicted to a substance
38
Neurobiological model
Substances disrupt various parts of the mesolimbic dopamine system in the brain
39
ventral tegmental area
a group of dopamine-containing neurons located in the midbrain whose axons project to the forebrain, especially the nucleus accumbens and cortex
A.K.A the reward center
40
components of the VTA
Mesolimbic, hippocampus, amygdala
41
what is harm reduction
- practical strategies aimed at reducing negative consequences associated with drug use
- safer use, managed use, abstinence
- meets ppl "where they're at"
- non-judgemental & non-coercive
- strong commitment to public health & human rights
42
SAVE ME protocol
stimulate (911)
airway
ventilate
evaluate
medication
evaluate
43
examples of harm reduction
needle exchange, supervised injection site, methadone maintenance & treatment, suboxone, heroin assisted treatment, controlled drinking
44
general effects of cns depressants if large amounts are consumed
euphoria
relaxation
sedation
drowsiness
stupor
unconsciousness
coma
45
depressants produce a
reduction of arousal & activity in CNS; slowing metabolism & functioning of central & peripheral nervous system
46
depressants are used therapeutically as
anaesthetics, sleeping aids, anti-anxiety agents, sedatives
47
examples of depressants
barbiturates
non-barbiturate sedative hypnotics
benzodiazepines
antihistamines
solvants/inhalants
alcohol
48
all CNS depressants share same ....
mechanism GABA inhibitors
49
large doses of barbiturates lead to
impaired judgement
loss of coordination
delayed reaction time
slurred speech
decreased respiration
impaired short-term memory
50
do barbiturates disrupt REM sleep
TRUE
51
is physical or psychological dependence common in barbiturates
BOTH
52
benzos enhance
actions of GABA causing excessive, inhibitory influence on neurons
53
Barbiturates have greatest effect on
RAS & Medulla
54
Barbiturates have a ________ of causing overdose
High risk
55
Level of intoxication in barbiturates
Mild- Sedation, Moderate-Coma, Severe-Deep coma with absent gag reflex (shock or resp arrest)
56
barbiturates work on which neurotransmitter
GABA
57
medical uses for barbiturates
treating seizure disorder, neonatal withdrawal, insomnia, preoperative anxiety, and induction of coma for increased intracranial pressure. They are also useful for inducing anesthesia.
58
side effects of benzo
drowsiness.
light-headedness.
confusion.
unsteadiness (especially in older people, who may fall and experience injuries)
dizziness.
slurred speech.
muscle weakness.
memory problems.
59
Therapeutic Window/Index
measure of drug safety; relationship between beneficial and adverse effects (lithium has a small therapeutic window)
60
CIWA
Nausea, tremors, anxiety, agitation, sweats, headache, tactile visual or auditory hallucinations
EXAM
(0-7 for each)
61
Alcohol is considered ___ because it affects each and every organ
dirty
62
With the use of alchohol ________ the substance turns alchohol to ACETALDEYDE (this substance causes organ issues
Dehydrogenase
63
Alchohol _______ REM cycles
Decreases
64
MAOIs
antidepressants, happy pills (Cause lots of reactions)
65
How much alchohol is metabolized per hour?
15 cc's
66
ALCOHOL USE DISORDER
(Function, tried to quit, binging, daily use)
Require use of alcohol to function
Make attempts to limit heavy alcohol use to a specific time with periods of abstinence
Engages in continuous binges lasting for days, weeks, or months interspaced with periods of abstinence
Engages in daily use of alcohol in excess of what is prudent for health or social norms.
67
Alchohol dehydrogenase are located in the ________
stomach
68
Acetaldehyde is then turned into
Aldehyde dehydrogenase
69
Signs and symptoms of Alchohol Withdrawal
Tremors, increased bp, insomnia, nausea, vomitting, psychomotor aggitation, seizure (tonic clonic)-DT concern & diaphoresis
70
Dt's are most common in the first _______ hours
48-96
71
Wernicke's syndrome
condition characterized by loss of memory and disorientation, associated with chronic alcohol intake and a diet deficient in thiamine. (reversible)
Thiamine deficiency
72
alcohol withdrawal syndrome occurs how long after cessation of alcohol?
6-24 hours
73
Phenobarbital (Luminal)
Antiseizure med. Precautions/interactions: contraindicated in history of substance use disorder. Side effects: drowsiness, hypotension, respiratory depression.
74
Side effects of benzodiazepines
Sedation, tolerance, dependence, respiratory depression
75
Benzodiazepines
Gold standard for treating withdrawal symptoms of alchohol dependency
76
Flumenazil
Benzodiazepine antagonist
77
rohypnol
"roofies"
memory blackouts & often loss of consciousness
inhibit movement & speech once ingested
78
inhalants
- depressant & minor hallucinogenic effects
- volatile gases, substances that exist in gases form at body temp
79
volatile substance abuse (VSA)
sniffing solvents contained in plastic model glues and nail polish removers
80
initial effect of inhalants
euphoria, light-headedness, excitation
other side effects: nausea, increased salivation, sneezing, coughing, loss of coordination, depressed reflexes, sensitivity
81
antihistamines therapeutic use
combat allergy sx
anti-nauseants
sleeping aid
anti-spasmodic
treat persons with excessive stomach acid
82
antihistamines can be used as
mood-altering agents or to enhance the effects of other CNS depressants (abuse potential remains moderate)
83
clinical triggers for alcohol
medical, mental, psychosocial
84
biotransformation begins in the ... by ...
stomach by alcohol dehydrogenase
85
alcohol dehydrogenase creates
acetaldehyde
86
acetaldehyde is broken down by ... to produce
aldehyde dehydrogenase = CO2, water & fatty acids
87
physical complications of chronic AUD
hangover, liver, circulation, CNS, digestive system, sleep cycle, peripheral nervous system, emotions, respiratory, sexuality
88
medical complications for AUD
- cerebellar damage
- vitamin deficiency
- decrease brain size
- alcohol induced dementia
- wernicke's syndrome
- korsakoff's syndrome
89
sleep and AUD
- decreases REM
- decreases restful sleep
- decrease melatonin production
- insomnia
- REM rebound-dreaming
90
2 main complications of AUD
respiratory depression, aspiration pneumonia
91
alcohol withdrawal sx
- sweating
- tachycardia
- hand tremor
- insomnia
- nausea & vomiting
- hallucinations
- psychomotor agitation
- seizures
92
PAWSS
- useful screening tool for predicting pts risk of developing severe complications from alcohol withdrawal
(10 item)
- can be used before pt stops using alcohol & on admission to detox/hospital
93
CIWA
measures severity of alcohol withdrawal
- vomiting
- tremor
- sweating
- anxiety
- agitation
- hallucinations
- orientation or clouding
- hypertension
- tachycardia
- hyperthermia
- nausea
- anxiety
- headache
94
What are some dangers of barbiturate drugs
Suicide risk. Very lethal in OD. Suppresses breathing
95
What are benzodiazepines?
anti-anxiety medications used to treat depression, anxiety, and schizophrenia
96
What do Benzodiazepines act on
Acts on the GABBA neurotransmitter
97
What are some current medical uses of benzodiazepine drugs?
Used in short term bases. Mixed with haldol to calm someone that is agitated.
98
Benzos have a narrow therapeutic window
false
99
Common side effects of benzos
Decrease in anxiety, speech slurring, decrease in blood pressure, dizziness, insomnia, decrease in REM sleep
100
What are some neurocognitive impairment risks and symptoms of benzodiazepine drugs?
Older pts are higher risk: signs and symptoms of dementia but not really dementia, falls risk, dizziness. Nothing longer than 2 wks for adults, very addictive, can cause tolerance right away.
101
What are some dangers of mixing CNS depressants with alcohol?
ODing mostly
102
phenobarbital
- seizure disorders
- alcohol withdrawal syndrome
- benzo withdrawal
- CNS depressant
- decrease neurotransmission in CNS
- metabolized by liver
- long half life = 2-6 days
103
thiamine
assess in clients with alcohol related disorders
- anorexia
- irritable mood
- tachycardia
- muscle weakness
- memory loss
- wernicke's syndrome
104
benzos
- gold standard in treatment for alcohol withdrawal & delirium tremens
- all benzo effective in reducing alcohol withdrawal sx
- effective in preventing seizures & DT
- increased risk sedation, memory deficits, respiratory depression
105
how must benzo be used to end up getting off them
taper method
106
disulfiram (antabuse)
- alcohol deterrent agent
- inhibits aldehyde dehydrogenase that breaks down alcohol
- build up of acetaldehyde = noxious reaction
- occurs 5-10 mins of mixing alcohol
107
disulfiram side effects
- facial flushing
- vasodilation
- throbbing headache
- sweating
- dry mouth
- palpitation
- chest pain
- dyspnea
- hypertension
- tachycardia
108
Naltrexone
opioid antagonist-*is recommended for patients who have a goal of a reduction of alcohol consumption or abstinence.
109
acamprosate (campral)
- alcohol dependence treatment
- decreases excitatory glutamate neurotransmission & increases GABA
- side effects: diarrhea, nausea, anxiety & depression
- not hepatically metabolized
110
clonidine (adrenergic agonists)
- suppress persistant noradrenergic sx like anxiety, hypertension, tachycardia not resolved with benzo or anticonvulsant
111
what does clonidine not prevent
seizures or delirium tremens
112
clonidine may cause what?
hypotension = BP must be measured and monitored regularly
113
adults with moderate to severe alcohol use disorder 1st line treatment
naltrexone or acamprosate should be offered
114
acamprosate is recommended for pts who
goal is abstinence
115
pharmacology of narcotics
- alters pain perception
- mimics action of endogenous opioid peptides (endorphins)
- anticonvulsant effect
- effect BP, smooth muscle, cardiac rate, breathing
- brain-reward mechanism (dopamine)
- GABA activation
116
many factors that increase vulnerability to addiction...
family history, trauma, early exposure, exposure to high risk environment, psychiatric disorders
117
assessment of OUD
- nursing assessment
- psychiatric nursing treatment plans
- history & psychiatric nursing diagnosis
- substance use
- compulsive behaviours
- history of withdrawal attempts
- treatment history
- abstinence
118
assessment tools for OUD
- clinical opioid withdrawal scale (COWS)
- subjective opioid withdrawal scale (SOWS)
119
COWS
assess degree of withdrawal from opioids in order to determine readiness to be started on buprenorphine/naloxone
120
SOWS
self-administered tool used to determine degree of opioid withdrawal for potential inductions of suboxone outside of a medical setting (individuals home)
121
spectrum of treatments exist for OUD
- withdrawal management alone
- opioid agonists (suboxone, methadone)
- 24 hr slow-release oral morphine
- inject hydromorphone
- psychosocial treatment interventions
- residential treatment
- harm reduction
122
short-acting opioids withdrawal time
- 12 to 16 hr since last dose
(heroin, morphine)
123
intermediate-acting opioids withdrawal time
- 17 to 24 hrs since last dose
(slow-release oral morphine)
124
long-acting opioids withdrawal time
- 24 to 48 hrs or more since last dose (methadone)
125
clonidine for OUD
- decreases sympathetic outflow in response to narcotic withdrawal
- tachycardia
- hypertension
- sweating
- pilo-erection
- doesn't decrease drug cravings
- decreases physiological sx
- taper
- rebound syndrome
- CAUSES HYPOTENSION
126
methadone indications
- metabolized by liver
- once daily dose
- half life is 25 hrs
- single dose lasts for 24 hrs
- blocks opioid receptors
- decreases euphoria from opioid use
- doesn't block effect or cravings from other drugs (coke)
127
whats the initial dose of methadone
30mg/day
128
methadone safety
- drug interactions, age, history of respiratory disease, other prescribed sedatives contribute to increased harm with methadone
- tolerance is rapidly lost if doses are missed, or treatment is discontinued (3 days)
- doses need to be adjusted or pt can suffer over sedation or respiratory depression
129
naltrexone (revia)
- reduces cravings
- semi synthetic opioid antagonist
- blocks opioid receptor sites
- maintenance drug
- opioid free 7-10 days before first dose
- suicidial thoughts
- caution with psych history
- motivation important
130
buprenorphine
- partial agonist
- long duration of action
- indicated for opioid addiction
- abuse potential
- sedation
- drowsiness
- resp depression concern
131
buprenorphine/naloxone
- 4:1 ratio
- SL route
- naloxone component is induced only to prevent diversion & injection use
132
why is naloxone included in the tablet?
- only to prevent diversion and injection (has poor oral & SL bioavailability = not absorbed when tablet is taken as directed
- if buprenorphine/naloxone is injected = naloxone component become active and results in rapid onset of withdrawal
133
facts about suboxone
- increased functional state
- increased attendance at appointments
- decrease drug use
- increased work attendance
- increase adherence to programs
- decreased disease transmission
- safer in OD
- less euphoric, hypotension, resp depression, low sedation, decrease drug cravings
134
opioids and benzos both
decrease respiratory drive & should not be co-precribed
135
co-occurring substance use may include
various combos of legal, prescription, over the counter, and legal substances
136
co-occurring substance use is associated with
younger age, lower educational attainment, lower socioeconomic status, childhood abuse, and males
137
whats the most common diagnosis in those with multiple substance use disorders
alcohol use disorder
138
concurrent use of sedatives is associated with
increased risk of respiratory depression, overdose, and death
139
screening for co-occurring substance use disorders
- ASSIST (clinician-performed screening tool to identify high risk substance use in adult pts)
- TAPS (tobacco, alcohol, prescription medication, and other substance use tool)
- AUDIT-C1 (alcohol screener used to identify hazardous drinking or an active alcohol use disorder)
140
principles for treating co-occurring substance use disorders
- treatment concurrently
- severity of each substance should guide treatment
- should be triaged according to which carriers highest risk of mortality (prioritize OUD over weed disorder)
- safety should be prioritized!!!!
141
examples of common presentations of co-occurring substances
- benzo & opioids
- cocaine & alcohol
- opioids & alcohol
- tobacco & other substances
142
benzo use is associated with
higher risk of hep C, seroconversion, higher risk of HIV, increased risk of death
143
what happens when alcohol and cocaine are combined?
- cocaethylene formed
144
what happens with cocaethylene
- same pharmacologic action of cocaine & causes similar but more intense effects = increased heart rate, more euphoria, drug liking, and longer half life
145
current smoking is associated with
increased alcohol consumption
146
hallucinogens primarily effect
serotonin
147
what neurotransmitter does cannabis work on
endocannabinoids (anandamide)
148
LSD-like hallucinogens
- indolealkylamines (similar to serotonin)
- colourless, tasteless, odourless
- semi synthetic
- most powerful of all known hallucinogens
149
initial effects of LSD hallucinogens are felt in & last for
less than an hour & last 8-12 hrs
150
physical sx of LSD
- increased heart rate & blood pressure
- elevated body temperature
- reduced appetite
- nausea & vomiting
- abdominal discomfort
- rapid reflexes
- motor incoordination
- pupil dilation
151
what is hallucinogen persisting perception disorder
flashbacks from the hallucination trip
152
short term effects of psilocybin
- increased BP, HR, temp
- nausea & vomiting
- cramping
- hallucinations
- distortions of time, space, body image
- heightened sensory awareness
153
psilocybin is one of several hallucinogens being
option to treat anxiety, cluster headaches, depression, addiction
154
what is the only natural hallucinogen
mescaline (peyote)
155
high doses of mescaline can cause
- headache
- hypotension
- cardiac depression
- slowing resp rate even tho has secondary stimulant properties
156
what is mda
serotonin-releasing chemical related to mescaline & amphetamines
157
what are the serious effects of mda
sizures, resp insufficiency due to spasms of chest muscles
- require immediate treatment as MDA-associated deaths or near-death is common
158
MDMA is derived from
oil of sassafras & oil of nutmeg to suppress appetite
159
MDMA effects
releases of serotonin, decreases activity in the amygdala, increases activity in prefrontal cortex
160
chronic use of MDMA
- teeth grinding
- dehydration
- anxiety
- insomnia
- fever
- uncontrolled seizures
- high BP
- depression caused by sudden drop in serotonin levels
161
phencyclidine
PCP
- produces hallucinogenic by blocking a specific neurochemical receptor site = pain perception, learning, memory, and emotion
- high doses = seizures, coma, resp depression
162
ketamine
low doses produce delusions and mental confusion that progress into hallucinations and degrees of dissociation bordering on schizo-like state
163
cannabis
- low doses = altered perception
- high dose = hallucinations
- THC binds to THC receptors
164
main psychoactive agent for cannabis
tetrahydrocannabinol
165
key risk factors for developing cannabis disorder
- younger age
- male sex
- deprived socioeconomic status
- early onset of cannabis use
- other substance use concerns
- family history of substance use disorder
- mental health disorders
166
immediate physiological effects of MJ
tachycardia
- other effects:
(hypertension, bronchial relaxation, dry mouth, conjunctival injection, hunger)
167
neurological & immune sx of MJ
- reduction is size of hippocampus, brain volume
- MJ triggered flashback
- memory issues
- suppresses REM & immune system
(faster onset of sx in HIV pts)
168
cancer, reproduction, circulation effects MJ
- risk cancer mouth, tongue, throat, lungs (smoking)
- higher risk of testicular cancer
- reduced sperm count, low testosterone
- cardiac arrythmias
- MI risk
169
cannabis hyperemesis syndrome
severe cyclic nausea and vomiting
- relief of sx with hot showers
170
half life of infrequent use of MJ
1.3 days
171
half life of frequent use of MJ
5-13 days due to absorption of THC in fat
172
screening tool for cannabis disorder
CUDIT-R questionnaire (self-screening tool)
173
amotivational syndrome
psychiatric disorder characterized by a variety of changes in personality, emotions and cognitive functions such as lack of activity, inward-turning, avolition, apathy, incoherence, blunted affect, inability to concentrate and memory disturbance.
174
harm reduction for cannabis
- delay starting cannabis
- limit daily use
- avoid smoking
- limit the use of higher-potency products
- don't drive after consuming
- some groups shouldn't use (prego, heart disease, hx psychosis)
175
stimulants produce
general increase in activity of cerebral cortex creating mood elevation, increased vigilance
176
some stimulants are used as
appetite suppressants, decongestants, treat ADHD & produce changes through dopamine
177
higher doses of stimulants produce
irritability, violent behaviour, spasms, convulsions
178
all stimulants primarily act on
dopamine system & norepinephrine
179
half life of cocaine
0.5-2.0 hrs
180
half life ofmeth
10 hours = more efficient due to less frequent dosing requirements (ppl report transitioning from cocaine to meth)
181
free basing
similar to crack, made with ether & ammonia rather than baking soda to convert cocaine into base
182
cocaine and meth during urine drug testing
- cocaine metabolized quickly = detectable for 3-5 days (this is highly specific = almost no false +)
- meth = urine 3-5 days
183
cocaine withdrawal
- sx starting 90 mins after last dose
- sx last for 7-10days
184
withdrawal sx of cocaine
fatigue, depression, lethargy, irritability, cramps, dehydration
185
ritalin works in ... to improve ...
RAS to improve concentration & focus
186
atomoexetine
CNS stimulant for ADHD
187
medical uses of amphetamines
- improves action of smooth muscles
- anorexic side effects
- weight loss
- treatment resistant depression
- narcolepsy
- ADHD
- HIV disease
188
withdrawal sx of amphetamines
fatigue, disrupted REM, irritability, strong hunger, abdominal & muscle cramps, apathy, violent behvaiours, depression
189
nicotine in the brain
stimulants the release of dopamine in nucleus accumbens
190
nicotine effects
- increased HR BP
- depresses spinal reflex
- reduces msucle tone
- decreases skin temp
- increases acid in stomach
- reduces urine formation
- loss of appetite
- increases adrenaline
191
medical complications of nicotine
- cancers
- stroke
- emphysema
- bronchitis
- heart disease
- ulcers
- wrinkles
192
second hand smoke
composed of mainstream smoke that has been exhalaed and side stream smoke emitted from the tip of cig
193
third hand smoke
tobacco smoke pollutants found in second hand smoke that have settled on surfaces of indoor space (clothes, walls)
194
5 a's for tobacco
- ask about use
- advise every user to quit
- assess readiness to quit
- assist pharmatherapy, counselling, help resources
- arrange follow up or referral
195
nicotine withdrawal sx
Having urges or cravings to smoke. ...
Feeling irritated, grouchy, or upset. ...
Feeling jumpy and restless. ...
Having a hard time concentrating. ...
Having trouble sleeping. ...
Feeling hungrier or gaining weight. ...
Feeling anxious, sad, or depressed.
196
what are some common NRT
patch, gum, inhaler, nasal spray, lozenge
197
nictone gum
- absorb slowly from buccal
- 24mg/day
- give hourly - 2 hours
198
side effects of NRT
- skin reactions from patches
- sleep disturbances = stimulant
- heart palpitations
- nausea & vomiting
- GI complaints
- mouth & throat pain
- mouth ulcers
199
zyban
- blocks dopamine re-uptake
- decreases nicotine
- half life 14 hrs
- contradindications (hx seizures, eating disorders, MAOI drug use)
200
champix
- blocks nicotine receptors
- decreases physiological cravings for nicotine
201
side effects champix
- nausea
- insomnia
- constipation
- GI problems
- abnormal dreams
addictions
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