Question 1

Varenicline (Chantix) may be prescribed for tobacco cessation. Instructions to a patient who is starting varenicline include:&#10;A)The maximum time varenicline can be used is 12 weeks.&#10;B)Nausea is a sign of varenicline toxicity and should be reported to the provider.&#10;C)The starting regimen for varenicline is 1 mg twice a day a week before the quit date.&#10;D)Neuropsychiatric symptoms may occur.&#10;

Accepted Answer

Neuropsychiatric symptoms, including changes in behavior, hostility, agitation, depressed mood, and suicidal thoughts or actions, have been reported in patients attempting to quit smoking with varenicline (Chantix). Patients are advised to be alert for the emergence of such symptoms and to report them to their healthcare provider.

Question 2

Nicotine withdrawal symptoms include:&#10;A)Somnolence&#10;B)Decreased appetite&#10;C)Diarrhea&#10;D)Irritability&#10;

Accepted Answer

Irritability is a common symptom of nicotine withdrawal, while the other options are not typically associated with it.

Question 3

When a patient is prescribed nicotine nasal spray for tobacco cessation, instructions include:&#10;A)Inhale deeply with each dose to ensure deposition in the lungs.&#10;B)The dose is one to two sprays in each nostril per hour, up to 40 sprays per day.&#10;C)A sensation of &#34;head rush&#34; indicates the medication is working well.&#10;D)Nicotine spray may be used daily for up to 12 continuous months.&#10;

Accepted Answer

The correct dosing for nicotine nasal spray is typically one to two sprays in each nostril per hour, with a maximum of 40 sprays per day.

Question 4

Transdermal nicotine replacement (the patch) is an effective choice in tobacco cessation because:&#10;A)The patch provides a steady level of nicotine without reinforcing oral aspects of smoking.&#10;B)There is the ability to &#34;fine tune&#34; the amount of nicotine that is delivered to the patient at any one time.&#10;C)There is less of a problem with nicotine toxicity than with other forms of nicotine replacement.&#10;D)Transdermal nicotine is safer in pregnancy.&#10;

Accepted Answer

The patch provides a steady level of nicotine, which helps reduce withdrawal symptoms without reinforcing the oral habits associated with smoking.

Question 5

Instructions for a patient who is starting nicotine replacement therapy include:&#10;A)Smoke less than 10 cigarettes a day when starting nicotine replacement.&#10;B)Nicotine replacement will help with the withdrawal cravings associated with quitting tobacco.&#10;C)Nicotine replacement can be used indefinitely.&#10;D)Nicotine replacement therapy is generally safe for all patients.&#10;

Accepted Answer

Nicotine replacement therapy (NRT) is designed to help manage nicotine withdrawal symptoms and cravings when someone is trying to quit smoking or using tobacco products. It does not require or advise continuing to smoke a certain number of cigarettes per day upon starting therapy, nor is it intended for indefinite use. While NRT is widely considered safe, it may not be appropriate for all patients, such as those with certain medical conditions, hence the need for medical advice before starting.

Question 6

Nicotine replacement therapy should not be used in which patients?&#10;A)Pregnant women&#10;B)Patients with worsening angina pectoris&#10;C)Patients who have just suffered an acute myocardial infarction&#10;D)All of the above&#10;

Accepted Answer

Nicotine replacement therapy (NRT) is generally not recommended for pregnant women due to potential risks to the fetus, patients with worsening angina pectoris, and those who have recently suffered an acute myocardial infarction, as nicotine can increase heart rate and blood pressure, potentially exacerbating these conditions.

Question 7

Patients who choose the nicotine lozenge to assist in quitting tobacco should be instructed:&#10;A)Chew the lozenge well.&#10;B)Drink at least 8 oz of water after the lozenge dissolves.&#10;C)Use one lozenge every 1 to 2 hours (at least nine per day with a maximum of 20 per day).&#10;D)A tingling sensation in the mouth should be reported to the provider.&#10;

Accepted Answer

Nicotine lozenges are designed to dissolve slowly in the mouth over a period of 20 to 30 minutes, releasing nicotine to help reduce the urge to smoke. Patients are typically instructed to use one lozenge every 1 to 2 hours, with at least nine lozenges per day to manage withdrawal symptoms effectively, and not to exceed 20 lozenges per day to avoid nicotine overdose. This method helps maintain a steady level of nicotine in the body, aiding in the reduction of withdrawal symptoms and cravings associated with quitting smoking.

Question 8

If prescribing bupropion (Zyban) for tobacco cessation, the instructions to the patient include:&#10;A)Bupropion (Zyban) is started 1 to 2 weeks before the quit date.&#10;B)Nicotine replacement products should not be used with bupropion.&#10;C)If they smoke when taking bupropion they may have increased anxiety and insomnia.&#10;D)Because they are not using bupropion as an antidepressant, they do not need to worry about increased suicide ideation when starting therapy.&#10;

Accepted Answer

Bupropion (Zyban) is typically started 1 to 2 weeks before the quit date to allow the medication to reach therapeutic levels in the body.

Question 9

Instructions for the use of nicotine gum include:&#10;A)Chew the gum quickly to get a peak effect.&#10;B)The gum should be &#34;parked&#34; in the buccal space between chews.&#10;C)Acidic drinks such as coffee help with the absorption of the nicotine.&#10;D)The highest abstinence rates occur if the patient chews the gum when he or she is having cravings.&#10;

Accepted Answer

Nicotine gum should be chewed slowly until a tingling sensation is felt, then "parked" in the buccal space (between the gum and cheek) to allow for the absorption of nicotine through the oral mucosa. Chewing the gum quickly or consuming acidic drinks can hinder the proper absorption of nicotine.

Question 10

The most appropriate smoking cessation prescription for pregnant women is:&#10;A)A nicotine replacement patch at the lowest dose available&#10;B)Bupropion (Zyban)&#10;C)Varenicline (Chantix)&#10;D)Nonpharmacologic measures&#10;

Accepted Answer

Nonpharmacologic measures are the most appropriate and safest option for smoking cessation in pregnant women. Pharmacologic treatments, including nicotine replacement, bupropion, and varenicline, carry potential risks to the fetus and are generally not recommended unless the benefits outweigh the risks and nonpharmacologic measures have failed.

Question 11

If a patient is exhibiting signs of nicotine toxicity when using transdermal nicotine, they should remove the patch and:&#10;A)Wash the area thoroughly with soap and water.&#10;B)Flush the area with clear water.&#10;C)Reapply a new patch in eight hours.&#10;D)Take acetaminophen for the headache associated with toxicity.&#10;

Accepted Answer

The answer of If a patient is exhibiting signs of...

Question 12

The most common adverse effect of the transdermal nicotine replacement patch is:&#10;A)Nicotine toxicity&#10;B)Tingling at the site of patch application&#10;C)Skin irritation under the patch site&#10;D)Life-threatening dysrhythmias&#10;

Accepted Answer

The answer of The most common adverse effect of the...

Question 13

If a patient wants to quit smoking, nicotine replacement therapy is recommended if the patient:&#10;A)Smokes more than 10 cigarettes a day&#10;B)Smokes within 30 minutes of awakening in the morning&#10;C)Smokes when drinking alcohol&#10;D)&#34;Binge smokes&#34; while out with friends&#10;

Accepted Answer

The answer of If a patient wants to quit smoking,...

Deck 46: Smoking Cessation