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Paper 4
Published in Aalia Khan, Ramsey Jabbour, Almas Rehman, nMRCGP Applied Knowledge Test Study Guide, 2021
Aalia Khan, Ramsey Jabbour, Almas Rehman
Nicotine replacement therapy (NRT) is the mainstay of helping patients stop smoking. Guidelines from the BTS advise the usage of combinations of NRT in individual cases who may benefit from this. Most pharmacy-led smoking-cessation programmes are run for 4–6 weeks, but it may be necessary for a GP to prescribe NRT on an FP-10 as a longer-term measure for some patients. There are no specific indications for buproprion rather than NRT and hence it is usually after lengthy discussion with the patient that this is started. Remember, caution is needed, especially in patients with a history of seizures. Pregnant women may use some forms of NRT as smoking is considered more harmful to the fetus. www.brit-thoracic.org.uk
Preparing for the next pregnancy
Published in Janetta Bensouilah, Pregnancy Loss, 2021
The most effective way of stopping smoking at present appears to be a combination of behavioural support and nicotine replacement therapy (NRT). However, it is difficult for health professionals to provide clear unequivocal guidance to pregnant women on the safety of using NRT, as it has yet to be studied thoroughly during pregnancy. What evidence there is remains inconclusive, although there is expert consensus that NRT is safer than smoking in pregnancy so long as the levels of nicotine remain lower than those obtained by smoking.6 It may be worth considering alternative methods of encouraging smoking cessation, such as hypnosis or acupuncture, and there are practitioners who are experts in this field. Whatever their stage of pregnancy, it is always worthwhile for pregnant women to reduce their cigarette consumption, and although total cessation is the aim, any reduction is better than none.
Pharmacological Approaches for Tobacco Cessation
Published in Rajmohan Panda, Manu Raj Mathur, Tobacco Cessation, 2019
Binod Kumar Patro, Suravi Patra
Nicotine replacement therapy (NRT) was the first proven effective agent for the treatment of tobacco dependence. NRT alleviates tobacco withdrawal symptoms and craving experienced by tobacco users, making quitting a little easier.6 There are various types of NRT such as patch, gum, tablet, lozenge, spray, and so on. In India nicotine gum and nicotine patch are available in different doses (Table 5.2).
Disparities in hospital smoking cessation treatment by immigrant status
Published in Journal of Ethnicity in Substance Abuse, 2020
Jenny Chen, Ellie Grossman, Alissa Link, Binhuan Wang, Scott Sherman
The use of medications, including nicotine replacement therapy (NRT), has been shown to significantly assist with smoking cessation and improve quit rates (Fiore et al., 2008). Despite the importance of this health concern, few studies have been performed to ensure adequate NRT prescribing rates among vulnerable minority populations in the United States. The aim of our study is to explore whether there are differences in NRT prescribing behavior for immigrants as compared to nonimmigrants (i.e.,. U.S. born) and determine whether this relationship is explained by other socioeconomic/demographic factors. Our study fills a gap regarding a critical preventive health concern among immigrants, a high-risk vulnerable population. We hypothesized that, after adjusting for potential confounders, immigrant smokers were less likely to be prescribed NRT during hospitalization and at discharge.
Bridging inhaled aerosol dosimetry to physiologically based pharmacokinetic modeling for toxicological assessment: nicotine delivery systems and beyond
Published in Critical Reviews in Toxicology, 2019
A. R. Kolli, A. K. Kuczaj, F. Martin, A. W. Hayes, M. C. Peitsch, J. Hoeng
Nicotine replacement therapy (NRT) aims to reduce the motivation to consume tobacco and the physiological and psychomotor withdrawal symptoms while still delivering nicotine and has been shown to be less harmful than consuming tobacco (Silagy et al. 2004; Prochaska 2015). NRT products are delivered in various forms, including gum, transdermal patch, nasal spray, oral inhaler, and tablet. Transdermal delivery of nicotine via a patch is successful, as the nicotine penetrates rapidly, allowing the delivery of fairly large doses. The nicotine patch is a slow, sustained-release form of nicotine delivery that is intended to gradually lower users’ dependence on tobacco and ultimately eliminate this dependence (Figure 1) (Benowitz et al. 2009). Acute dosing products allow users to titrate the timing and dose of nicotine. Products such as nicotine gum and lozenges are buffered to alkaline pH to facilitate increased absorption. Despite their formulations, NRTs were unable to mimic the plasma concentrations of nicotine following inhalation, as the absorption of nicotine from the buccal cavity is slower, and a portion of the dose is swallowed and subjected to first-pass metabolism (Benowitz et al. 2009). Nicotine nasal spray is absorbed more rapidly than other NRTs but does not reach the maximum nicotine concentration (Cmax) of inhaled nicotine, thus requiring larger doses (Lunell et al. 2000).
Considerations when selecting pharmacotherapy for nicotine dependence
Published in Expert Opinion on Pharmacotherapy, 2019
Seetal Dodd, Lauren Arancini, Nieves Gómez-Coronado, Rudi Gasser, Dan I Lubman, Olivia M Dean, Michael Berk
NRT as an effective smoking cessation aide, whether formulated as gum, transdermal patch, nasal spray, inhaler or sublingual tablets/lozenges, is evidenced by over 150 randomized clinical trials totaling over 50,000 trial participants. NRTs increase the chances of successfully stopping smoking for a quit attempt by 50% to 70% compared to placebo. Highly dependent smokers showed greater benefit from 4 mg gum than from 2 mg gum, but not from higher doses of patch. Combining a patch with rapid delivery NRT was more effective than a single type of NRT. Treatment with NRT was shown to be as effective as bupropion, and combination NRT with bupropion was more effective than bupropion monotherapy [6]. Meta-analyses suggest that varenicline and combined forms of NRT are associated with higher quit rates than bupropion or single-form NRT [7]. Varenicline was associated with greater continuous abstinence from smoking during weeks 15 to 24 compared to placebo (37.8% for varenicline; 6.9% for placebo) in an RCT of smokers willing to reduce cigarette consumption and make a quit attempt within 3 months [8].