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Nicotine Addiction. Pharmacy Practice II Winter 2005. Tobacco Use Interview. When did you start? Why? How much, how often? What do you like? What don’t you like? Health risks? Quitting experience? What would it take to quit?. Pharmacist’s Role. Ask Advise Assess Assist Arrange. - PowerPoint PPT Presentation
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Nicotine AddictionNicotine Addiction
Pharmacy Practice IIPharmacy Practice II
Winter 2005Winter 2005
Tobacco Use InterviewTobacco Use Interview
When did you start?When did you start? Why?Why? How much, how often?How much, how often? What do you like?What do you like? What don’t you like?What don’t you like? Health risks?Health risks? Quitting experience?Quitting experience? What would it take to What would it take to
quit?quit?
Stages of ChangeStages of Change
PrecontemplationPrecontemplation ContemplationContemplation PreparationPreparation ActionAction MaintenanceMaintenance
PrecontemplationPrecontemplation
Unaware, unwilling, too discouragedUnaware, unwilling, too discouraged Won’t change in the next six monthsWon’t change in the next six months Listen, empathy, identify barriersListen, empathy, identify barriers Focus on benefits of changeFocus on benefits of change Interview questionsInterview questions
ContemplationContemplation
Open to information, thinking about Open to information, thinking about quitting in next 6 monthsquitting in next 6 months
Provide information, emotional supportProvide information, emotional support EncouragementEncouragement ResourcesResources Information about optionsInformation about options What it will take, who is availableWhat it will take, who is available
PreparationPreparation
Getting ready o try new behavior Getting ready o try new behavior within 30 dayswithin 30 days
Goal setting, praise readiness, enlist Goal setting, praise readiness, enlist support of otherssupport of others
GoalsGoals ResourcesResources OptionsOptions Who can helpWho can help
ActionAction Taking steps, needing willpowerTaking steps, needing willpower Habituating behaviorsHabituating behaviors Stimulus control, reinforce + Stimulus control, reinforce +
behaviors, continuing emotional behaviors, continuing emotional supportsupport
Action plansAction plans Other supportOther support Product informationProduct information Positive effectsPositive effects
MaintenanceMaintenance
Engaged for at least six monthsEngaged for at least six months Continue emotional supportContinue emotional support Relapse preventionRelapse prevention Reinforce benefitsReinforce benefits Relapse – encouragement, Relapse – encouragement,
persistencepersistence
Treatment optionsTreatment options
Behavior Behavior modificationmodification
Nicotine lozengesNicotine lozenges Nicotine gumNicotine gum Nicotine patchesNicotine patches Nicotine inhalerNicotine inhaler Nicotine nasal sprayNicotine nasal spray Bupropion SRBupropion SR
Treatment optionsTreatment optionsNicotine polacrilex lozengesNicotine polacrilex lozenges
2 mg (12 mg (1stst cig > 30 min after waking) cig > 30 min after waking) 4 mg (14 mg (1stst cig < 30 min after waking) cig < 30 min after waking) Allow to slowly dissolve (20-30 min)Allow to slowly dissolve (20-30 min) Do not chew, eat, or drinkDo not chew, eat, or drink < 20 lozenges/d< 20 lozenges/d CI: pregnancy, CVD, PUDCI: pregnancy, CVD, PUD SE: hiccups, sore mouth, sore throat, nauseaSE: hiccups, sore mouth, sore throat, nausea 12 weeks12 weeks
Treatment optionsTreatment optionsNicotine polacrilex gumNicotine polacrilex gum
2 mg (<24 cigs/d), 4 mg (>24 cigs/d)2 mg (<24 cigs/d), 4 mg (>24 cigs/d) Bite and parkBite and park Avoid eating, drinking while chewingAvoid eating, drinking while chewing Acid decreases releaseAcid decreases release SE: hiccups, nausea, sore throat, sore SE: hiccups, nausea, sore throat, sore
mouthmouth CI: pregnancy, CVD, esophagitis, PUDCI: pregnancy, CVD, esophagitis, PUD 12 weeks12 weeks
Treatment OptionsTreatment OptionsTransdermal nicotineTransdermal nicotine
7, 14, 21 mg, 24-hour7, 14, 21 mg, 24-hour 5, 10, 15 mg, 16-hour5, 10, 15 mg, 16-hour Usage guidelines p.1166Usage guidelines p.1166 SE: local skin reaction, insomniaSE: local skin reaction, insomnia CI: pregnancy, CVD, derm. problemsCI: pregnancy, CVD, derm. problems 8 weeks8 weeks Must not use tobaccoMust not use tobacco
Rx Nicotine replacementRx Nicotine replacement
Nicotine InhalerNicotine Inhaler SE: local irritation of mouth & throatSE: local irritation of mouth & throat Up to 6 monthsUp to 6 months
Nicotine Nasal SprayNicotine Nasal Spray SE: nasal irritationSE: nasal irritation Up to 6 monthsUp to 6 months
Bupropion SRBupropion SR
Wellbutrin, ZybanWellbutrin, Zyban Antidepressant, dopamine reuptake inhibitorAntidepressant, dopamine reuptake inhibitor Start 1 week before quittingStart 1 week before quitting 150 mg q am x 3 d, then increase to bid 150 mg q am x 3 d, then increase to bid
(may take second dose mid afternoon)(may take second dose mid afternoon) CI: History of seizure, eating disordersCI: History of seizure, eating disorders SE: insomnia, dry mouthSE: insomnia, dry mouth Can use with nicotine replacementCan use with nicotine replacement
What’s new? What’s new?
Rimonabant (Acomplia)Rimonabant (Acomplia) Cannabanoid Receptor AntagonistCannabanoid Receptor Antagonist Weight loss, tobacco cessationWeight loss, tobacco cessation Phase III clinical trialsPhase III clinical trials
Other considerationsOther considerations
CostsCosts IrritabilityIrritability Weight gainWeight gain Proper disposal of productsProper disposal of products Abstinence ratesAbstinence rates
14-30% vs 8-20% placebo14-30% vs 8-20% placebo
ReferencesReferences
See Blackboard linksSee Blackboard links Treating Tobacco Use and Treating Tobacco Use and
Dependence, Dependence, www.cme.wisc.edu/online/ctri/index.www.cme.wisc.edu/online/ctri/index.htm University of Wisconsin Medical htm University of Wisconsin Medical School and center for Tobacco School and center for Tobacco Research and InterventionResearch and Intervention