Pharm for Cessation

Question 1

What can be done for smoking cessation that isn’t a drug?

Answer 1

Nicotine patch/gum:

1. harm reduction
2. replace full agonist (inhaled tobacco smoke) with nicotine (full agonist)
3. Can prevent withdrawal
4. SE’s: if you smoked too many cigarettes at once there is a similar activating effect with the patch/gum
5. Maybe E-cigarette use (used like a patch)

Question 2

Drug for smoking cessation?

Answer 2

Bupropion antidepressant for smoking cessation (block neuronal uptake/recycling of NE and DA) to help improve alertness, attention, concentration, motivation!!

Question 3

SE’s of buproprion?

Answer 3

1. worried about psychiatric worsening, agitation, depression, anxiety suicidality especially age s in pharm

Question 4

What can be used to deal with nicotine/inhaled smoke that isn’t bupropion?

Answer 4

Varenicline!! (partial nicotine receptor agonist that replaces the full agonist that is NICOTINE); allows you to avoid most withdrawal and still some activity of the nicotine receptor

Question 5

SE’s of varenicline?

Answer 5

1. Insomnia, vomiting, constipation, headache, ABNORMAL DREAMS
2. Agitation, depression, psychosis, suicidal behavior
3. Cardiovascular events might NOT be reduced!!

Question 6

Combo treatment for cessation?

Answer 6

1. Maybe add support sessions to improve med management outcomes
2. Best combo is varenicline and higher nicotine replacement therapy