Tobacco cessation fall 2011 Instructor (1)_ For use in lecture (3)

Nicotine nasal spray summary disadvantages need for

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NICOTINE NASAL SPRAY: SUMMARY DISADVANTAGES Need for frequent dosing  can compromise  compliance. Nasal/throat irritation may be  bothersome. Higher dependence  potential. Patients with chronic nasal  disorders or severe reactive  airway disease should not  use the spray. ADVANTAGES Patients can easily  titrate therapy to  rapidly manage  withdrawal symptoms.
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NICOTINE INHALER Nicotrol Inhaler (Pfizer) Nicotine inhalation system  consists of: Mouthpiece Cartridge with porous plug  containing 10 mg nicotine and  1 mg menthol Delivers 4 mg nicotine  vapor, absorbed across  buccal mucosa
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NICOTINE INHALER: DOSING Start with at least 6 cartridges/day during the first  3-6 weeks of treatment Increase prn to  maximum  of 16 cartridges/day In general, use 1 cartridge every 1-2 hours Recommended duration of therapy is 3 months Gradually reduce daily dosage over the following  6–12 weeks
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Air in Aluminum laminate sealing material Porous plug impregnated with  nicotine Mouthpiece Nicotine  cartridge Air/nicotine mixture out Sharp point that  breaks the seal Sharp point that  breaks the seal NICOTINE INHALER: SCHEMATIC DIAGRAM Reprinted with permission from Schneider et al. (2001). Clinical Pharmacokinetics 40:661–684. Adis International, Inc.
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NICOTINE INHALER: DIRECTIONS for USE Align marks on the mouthpiece
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NICOTINE INHALER: DIRECTIONS for USE   (cont’d) Pull and separate mouthpiece into two parts
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NICOTINE INHALER: DIRECTIONS for USE   (cont’d) Press nicotine cartridge firmly into bottom of  mouthpiece until seal breaks
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NICOTINE INHALER: DIRECTIONS for USE  (cont’d) Put top on mouthpiece and align marks to close Press down firmly to break top seal of cartridge Twist top to misalign marks and secure unit
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During inhalation, nicotine is vaporized and  absorbed across oropharyngeal mucosa Inhale into back of throat or puff in short breaths Nicotine in cartridges is depleted after about 20  minutes of active puffing Cartridge does  not  have to be used all at once Open cartridge retains potency for 24 hours Mouthpiece is reusable; clean regularly with mild  detergent NICOTINE INHALER: DIRECTIONS for USE  (cont’d)
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NICOTINE INHALER: ADDITIONAL PATIENT  EDUCATION Side effects associated with the nicotine inhaler include: Mild irritation of the mouth or throat Cough Headache Rhinitis Dyspepsia Severity generally rated as mild, and frequency of  symptoms declined with continued use
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NICOTINE INHALER: ADD’L PATIENT EDUCATION  (cont’d) The inhaler may not be as effective in very cold  (<59 ° F) temperatures—delivery of nicotine vapor  may be compromised
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