ILE 5 Smoking Cessation Unit, pre-class assignment
First Line Smoking Cessation Products – Update this chart from your P1 to organize information and prepare for class
Required reading: Dipiro chapter 86- section on Nicotine only.
Review reading: Required reading from P1 year – Handbook of Nonprescription Drugs, Chapter 47
Objectives for pre-class reading:
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Compare and contrast onset, frequency of administration, and duration of action of medications used for smoking cessation based on
dosage form and structure. (5, 6)
Identify at least three common adverse drug effects of chronic medication classes used for smoking cessation (3h)
Identify the usual duration of therapy to adequately treat nicotine dependence. (2)
Compare and contrast quit dates in relation to onset of various therapies used for smoking cessation. (3)
Identify precautions or contraindications to medications used for smoking cessation (3)
Identify at least two specific monitoring parameters of each chronic medication class used for smoking cessation. (4b, 4c)
The highlighted sections should match the chart you created in ILE 2 Fall of P1 year
Smoking Cessation Products
Patch
Gum
1st cigarette ≤30 minutes
after waking: 4 mg
1st cigarette >30 minutes
after waking: 2 mg
Lozenge
1st cigarette ≤30
minutes after waking: 4
mg
1st cigarette >30
minutes after waking: 2
mg
Cherry, Mint
Bupropion
X
Varenicline
X
X
X
Doses available
21mg
14mg
7mg
Flavors available
None
Original, Cinnamon,
Fruit, Mint
Instructions on when to start
Same day as quit date
Same day as quit date
Same day as quite date
How to choose starting dose
Based on how many cigarettes
smoked per day
Dosing schedule
>10 cigarettes per day
21 mg/day F4-6W; 14mg/day F2W;
7mg/day F2W
Based on when you have
your first cigarette after
waking
Weeks 1–6:
1 piece q 1–2 hours
Weeks 7–9:
1 piece q 2–4 hours
Weeks 10–12:
1 piece q 4–8 hours
Based on when you
have your first
cigarette after waking
Weeks 1–6:
1 piece q 1–2 hours
Weeks 7–9:
1 piece q 2–4 hours
Weeks 10–12:
1 piece q 4–8 hours
Recommended duration of therapy
8-10 weeks
Up to 12 weeks
Up to 12 weeks
12 weeks
Patient counseling
Rotate patch application site
daily; do not apply a new patch to
the same skin site for at least one
week
May wear patch for 16 hours if
patient experiences sleep
disturbances (remove at bedtime)
Fold up and place in the trash
Maximum, 24 pieces/day
Chew each piece slowly
Park between cheek and
gum when peppery or
tingling sensation
appears (~15–30 chews)
Resume chewing when
tingle fades
Repeat chew/park steps
until most of the nicotine
is gone (tingle does not
return; generally 30 min)
Maximum, 20
lozenges/day
Allow to dissolve
slowly (20–30
minutes)
Nicotine release may
cause a warm, tingling
sensation
Do not chew or
swallow •Occasionally
rotate to different
areas of the mouth
Avoid alcohol use,
antidepressants, and
other antipsychotics
One week prior to
scheduled quick date
X
One week before quit
date
X
150 mg once daily for 3
days and then twice
daily for 7-12 weeks
Administered at least 8
hours apart
0.5 mg daily for 3
days, increased to 0.5
mg twice daily for 3
days, and then
increased to 1 mg
twice daily for a
standard 12-week
treatment.
12-24 weeks
Should be taken after
eating with a full glass
of water.
May experience vivid
or strange dreams
Use caution driving,
drinking alcohol, and
operating heavy
machinery
Common adverse effects
Local skin reactions, Sleep
disturbances (abnormal/vivid
dreams, insomnia); associated with
nocturnal nicotine absorption
Contraindications/Warnings/
Precautions
Recent (≤ 2 weeks) myocardial
infarction, Serious underlying
arrhythmias, Serious or worsening
angina pectoris,
Pregnancy and breastfeeding,
Adolescents (<18 years)
Monitoring parameters for efficacy
and timing
Decreased cravings for nicotine and
ultimately no smoking
Monitoring parameters for safety
and timing
MRI – can cause burning due to
containing metal products
Skin irritation
Park in different areas of
the mouth
No food or beverages 15
minutes before or
during use
•Mouth and throat
irritation •Hiccups
•GI complaints
(dyspepsia, nausea)
Recent (≤ 2 weeks)
myocardial infarction
•Serious underlying
arrhythmias •Serious or
worsening angina
pectoris
•Temporomandibular
joint disease
•Pregnancy3 and
breastfeeding
•Adolescents (<18 years)
Decreased cravings of
nicotine and ultimately no
smoking
Adverse effects more
commonly experienced
when chewing the
lozenge or using incorrect
gum chewing technique
(due to rapid nicotine
release):
–
Lightheadedness/dizzines
s
– Nausea/vomiting
– Hiccups
– Mouth and throat
irritation
No food or beverages
15 min- utes before or
during use
Mouth and throat
irritation •Jaw muscle
soreness •Hiccups
•GI complaints
(dyspepsia, nausea)
•May stick to dental
work
•Recent (≤ 2 weeks)
myocardial infarction
•Serious underlying
arrhythmias •Serious or
worsening angina
pectoris
•Pregnancy3 and
breastfeeding
•Adolescents (<18
years)
Insomnia, dry mouth,
nausea, restlessness,
tremors
nausea, vomiting, and
insomnia
Current or past seizure
disorders, a history of
monoamine oxidase
inhibitor use over the
last 14 days, and a
history of anorexia
nervosa or bulimia.
Patients with
cardiovascular
symptoms, heart attack
Decreased cravings of
nicotine and ultimately
no smoking
Adverse effects more
commonly experienced
when chewing the
lozenge or using
incorrect gum chewing
technique (due to rapid
nicotine release):
–
Lightheadedness/dizzin
ess
– Nausea/vomiting
– Hiccups
– Mouth and throat
irritation
Decreased cravings of
nicotine and ultimately
no smoking
Adverse effects and
hypersensitivity
Decreased cravings of
nicotine and ultimately
no smoking
Adverse effects and
hypersensitivity
If there are changes
in mood or
homicidal/suicidal
ideation STOP
medication therapy