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SMOKING CESSATION/CHAPTER 30 notesI.Nicotine Delivery1.Reaches bloodstream to the brain within 10-15 seconds after pufII.Nicotinic Receptors:1.Nicotine has both stimulant and depressant efects in the CNS2.Increases EF dopamine levels in the region3.Releases ACH, Norepi, dopamine, serotonin, vaspressin, beta endorphins, growth hormone and adrenocorticotropic hormone (ACTH)III.Goals of Treatment1.Identifying who is ready to quit2.Complete discontinuation of tobacco3.Cold Turkey or nicotine replacement therapya.Bupropion (Zyban) – goal is to be tobacco free at the end of 7-12 weeks of therapyb.Varenicline (Chantix) – 12 weeks of therapyIV.Nicotine Replacement therapy1.Gum, Lozenge, transdermal patch, inhaler, nasal spray2.Doesn’t achieve the same peak levels as smoking, but raises levels enough to suppress WD symptoms3.Polacrilex gum to PREG C4.Transdermal nicotine is PREG DV.Antidepressants1.Bupropion (Zyban) – started 1-2 weeks before quit smoking date2.Contraindicated: seizure disorder, bulimia, anorexia nervosa, within 14 days of MAOIs3.Current use of Zyban and Wellbutrin is contraindicated because Bupropion is the active ingredient in Wellbutrin4.Can increase risk of suicide ideation and suicidality in children, adolescents and young adultsVI.Nicotinic Receptor Partial Agonists1.Varenicline (Chantix) – started 1 week before quit date2.Nausea is the most common ADR, plus insomnia and HA3.PREG C 4.NOT prescribed to children <18yrs old5.Use caution in older patients with decreased renal function
VII.Combination Therapy1.Long term (>14weeks) nicotine patch plus other nicotine replacement therapy (NRT), either gum or spray2.Nicotine patch plus the nicotine inhaler3.Nicotine patch plus Buproprion SR (sustained release)VIII.Nonpharmacologic Treatment1.Smoking cessation interventions – individual or group counseling2.Hypnosis, Acupuncture, Massage3.Relaxation and exerciseNicotine poisoning:a.Children and pets – ingesting even a small amount may be toxic to childrenb.Symptoms include: N/V, increased salivation, HA, sweating, seizures and respiratory failurec.Severe toxicity treatments include: IV fluids, airway support & mechanical ventilation with atropine for bradycardia or muscarinic signsDrugs Affecting the Integumentary System – Chapter 23I.Anti-infectives (p.648)a.Bacterial infections are the most common of all ages
b.Meds commonly used: Topical agents and oral antibioticsc.Most common pathogens: Staphylococcus aureus and Streptococcus pyogenesd.RARE – Gram negative bacilli by may occur in the immunocompromised or DM pts. Usually require IV ABXe.Impetigo – usually treated topically unless moderate or severe case1.Treated with Mupirocin (Bactroban)2.New Med now out – Retapamulin (Altabax)3.How to treat depends on # of lesion and location (face,eyelid,mouth)f.Moderate/Severe Impetigo, boil/abscess, perianal streptococcal infection and cellulites all require prompt treatment with systemic antibioticsa.Boils (Furuncles) – infections of hair follicles by S. aureus