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

Clinical practice guideline rockville md usdhhs phs

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Clinical Practice Guideline. Rockville, MD: USDHHS, PHS, May 2008. Recommended treatment is behavioral counseling.
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NRT: RATIONALE for USE Reduces physical withdrawal from nicotine Eliminates the immediate, reinforcing effects of  nicotine that is rapidly absorbed via tobacco  smoke Allows patient to focus on behavioral and  psychological aspects of tobacco cessation NRT products approximately doubles quit rates. NRT products approximately doubles quit rates.
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Polacrilex gum Nicorette ( OTC) Generic nicotine gum (OTC) Lozenge Commit (OTC) Generic nicotine lozenge (OTC) Transdermal patch NicoDerm CQ   (OTC) Generic nicotine patches  (OTC,  Rx) Nasal spray Nicotrol NS (Rx) Inhaler Nicotrol (Rx) NRT: PRODUCTS Patients should stop using all forms of tobacco upon initiation of the NRT regimen.
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PLASMA NICOTINE  CONCENTRATIONS for NICOTINE- CONTAINING PRODUCTS 0 5 10 15 20 25 1/0/1900 1/10/1900 1/20/1900 1/30/1900 2/9/1900 2/19/1900 2/29/1900 Plasma nicotine (mcg/l) Cigarette Moist snuff Nasal spray Inhaler Lozenge (2mg) Gum (2mg) Patch 0 10 20 30 40 50 60 Time (minutes) Cigarette Moist snuff
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NRT: PRECAUTIONS Patients with underlying cardiovascular  disease Recent myocardial infarction (within past 2  weeks) Serious arrhythmias Serious or worsening angina NRT products may be appropriate for these patients if they are under medical supervision.
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NICOTINE GUM Nicorette (GlaxoSmithKline); generics Resin complex Nicotine  Polacrilin Sugar-free chewing gum base Contains buffering agents to enhance  buccal absorption of nicotine Available: 2 mg, 4 mg; original, cinnamon,  fruit, mint (various), and orange flavors
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NICOTINE GUM: DOSING  Dosage based on current smoking patterns: If patient smokes Recommended strength 25 cigarettes/day 4 mg <25 cigarettes/day 2 mg
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NICOTINE GUM: DOSING  (cont’d) Recommended Usage Schedule for Nicotine Gum Weeks 1–6 Weeks 7–9 Weeks 10–12 1 piece q 1–2 h 1 piece q 2–4 h 1 piece q 4–8 h DO NOT USE MORE THAN 24 PIECES PER DAY.
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NICOTINE GUM:   CHEWING TECHNIQUE  SUMMARY   Park between  cheek & gum Stop chewing at  first sign of  peppery taste or  tingling sensation Chew slowly Chew again  when peppery  taste or tingle  fades
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NICOTINE GUM: ADDITIONAL  PATIENT EDUCATION To improve chances of quitting, use at least nine  pieces of gum daily The effectiveness of nicotine gum may be reduced  by some foods and beverages:   Coffee     Juices  Wine   Soft drinks Do NOT eat or drink for 15 minutes BEFORE or  while using nicotine gum.
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NICOTINE GUM: ADD’L PATIENT EDUCATION   (cont’d) Chewing gum will  not  provide same rapid  satisfaction that smoking provides Chewing gum too rapidly can cause excessive  release of nicotine, resulting in
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