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

Transdermal nicotine patch addl patient education

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TRANSDERMAL NICOTINE  PATCH: ADD’L PATIENT EDUCATION   (cont’d) After patch removal, skin may appear red for 24  hours If skin stays red more than 4 days or if it swells or a  rash appears, contact health care provider—do not  apply new patch Local skin reactions (redness, burning, itching) Usually caused by adhesive Up to 50% of patients experience this reaction Fewer than 5% of patients discontinue therapy Avoid use in patients with dermatologic conditions  (e.g., psoriasis, eczema, atopic dermatitis)
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TRANSDERMAL NICOTINE  PATCH: SUMMARY DISADVANTAGES Patients cannot titrate the  dose to acutely manage  withdrawal symptoms. Allergic reactions to the  adhesive may occur. Patients with dermatologic  conditions should not use  the patch. ADVANTAGES Provides consistent  nicotine levels. Easy to use and  conceal. Once daily dosing  associated with fewer  compliance problems.
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NICOTINE NASAL SPRAY Nicotrol NS   (Pfizer) Aqueous solution of nicotine  in a 10-ml spray bottle Each metered dose  actuation delivers 50  mcL  spray 0.5 mg nicotine ~100 doses/bottle Rapid absorption across  nasal mucosa
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NICOTINE NASAL SPRAY: DOSING & ADMINISTRATION One dose = one spray in  each  nostril = 1mg  of nicotine Start with 1–2 doses per hour For best results, patients should use at least  8 doses daily for the first 6–8 weeks Termination:   Gradual tapering over an additional 4–6  weeks
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NICOTINE NASAL SPRAY:  DIRECTIONS for USE   (cont’d) Prime the pump (before first use) Re-prime (1-2 sprays) if spray not used for  24 hours Blow nose (if not clear) Tilt head back slightly and insert tip of  bottle into nostril as far as comfortable Breathe through mouth, and spray  once in each nostril Do not sniff or inhale while spraying
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NICOTINE NASAL SPRAY: DIRECTIONS for USE   (cont’d) If nose runs, gently sniff to keep nasal spray in nose Wait 2–3 minutes before blowing nose Wait 5  minutes before driving or operating heavy  machinery (s pray may cause tearing, coughing, and  sneezing) Avoid contact with skin, eyes, and mouth If contact occurs, rinse with water immediately Nicotine is absorbed through skin and mucous membranes
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NICOTINE NASAL SPRAY: ADDITIONAL PATIENT  EDUCATION What to expect (first week): Hot peppery feeling in back of throat or nose Sneezing Coughing Watery eyes Runny nose Side effects should lessen over a few days Regular use during the first week will help in development of  tolerance to the irritant effects of the spray If side effects do not decrease after a week,  contact health care provider
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