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

Use the inhaler longer and more often at first to

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Use the inhaler longer and more often at first to  help control cravings (best results are achieved  with frequent continuous puffing over 20 minutes) Effectiveness of the nicotine inhaler may be  reduced by some foods and beverages Do NOT eat or drink for 15 minutes BEFORE or  while using the nicotine inhaler.
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NICOTINE INHALER:  SUMMARY DISADVANTAGES Need for frequent dosing can  compromise compliance. Initial throat or mouth  irritation can be bothersome. Cartridges should not be  stored in very warm  conditions or used in very  cold conditions. Patients with underlying  bronchospastic disease must  use the inhaler with caution. ADVANTAGES Patients can easily titrate  therapy to manage  withdrawal symptoms. The inhaler mimics the  hand-to-mouth ritual of  smoking.
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BUPROPION SR   Zyban (GlaxoSmithKline); generic Nonnicotine  cessation aid Sustained-release  antidepressant Oral formulation
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BUPROPION: MECHANISM of ACTION Atypical antidepressant thought to affect levels  of various brain neurotransmitters Dopamine Norepinephrine Clinical effects  craving for cigarettes  symptoms of nicotine withdrawal
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BUPROPION: PHARMACOKINETICS Absorption Bioavailability: 5–20% Metabolism Undergoes extensive hepatic metabolism (CYP2B6) Elimination Urine (87%) and feces (10%) Half-life Bupropion (21 hours); metabolites (20–37 hours)
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BUPROPION: CONTRAINDICATIONS Patients with a seizure disorder Patients taking Wellbutrin, Wellbutrin SR, Wellbutrin XL MAO inhibitors in preceding 14 days Patients with a current or prior diagnosis of anorexia  or bulimia nervosa Patients undergoing abrupt discontinuation of  alcohol or sedatives (including benzodiazepines)
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BUPROPION: WARNINGS and PRECAUTIONS Bupropion should be used with caution in the  following populations: Patients with a history of seizure Patients with a history of cranial trauma Patients taking medications that lower the seizure  threshold (antipsychotics, antidepressants,  theophylline, systemic steroids) Patients with severe hepatic cirrhosis Patients with depressive or psychiatric disorders
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BUPROPION SR: DOSING Initial treatment 150 mg po q  AM  x 3 days Then…   150 mg po bid  Duration, 7–12 weeks Patients should begin therapy 1 to 2 weeks PRIOR  to their quit date to ensure that therapeutic plasma levels  of the drug are achieved.
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BUPROPION: ADVERSE EFFECTS Common side effects include the following: Insomnia (avoid bedtime dosing) Dry mouth Less common but reported effects: Tremor Skin rash
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BUPROPION:  ADDITIONAL PATIENT  EDUCATION Dose tapering not necessary when discontinuing  treatment
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