Mosby's 2014 Nursing Drug Reference (289 page)

BOOK: Mosby's 2014 Nursing Drug Reference
3.97Mb size Format: txt, pdf, ePub

Canada only   Side effects:
italics
= common;
bold
= life-threatening   
Nurse Alert

nicotine

(nik′o-teen)

nicotine chewing gum

CVS Nicotine Polacrilex, Equate Nicotine, GNP Nicotine, Good Sense Nicotine, Leader Nicotine Gum, NICOrelief, Nicorette, Publix Stop Smoking Aid, TopCare Nicotine, Walgreens Nicotine

nicotine inhaler (
OTC
, Rx)

Nicotrol

nicotine lozenge (
OTC
)

CVS Nicotine Polacrilex, GNP Nicotine Polacrilex, Good Sense Nicotine, Polacrilex, TopCare Nicotine Polacrilex, Walgreens Nicotine Polacrilex

nicotine nasal spray (Rx)

Nicotrol NS

nicotine transdermal (
OTC
, Rx)

CVS Nicotine Transdermal System, Equate Nicotine Transdermal System, Habitrol
, Leader Nicotine Transdermal Patch, Nicoderm CQ, Sunmark Nicotine Transdermal System, Walgreens Nicotine Transdermal Patch

Func. class.:
Smoking deterrent

Chem. class.:
Ganglionic cholinergic agonist

ACTION:

Agonist at nicotinic receptors in peripheral, central nervous systems; acts at sympathetic ganglia, on chemoreceptors of aorta, carotid bodies; also affects adrenalin-releasing catecholamines

USES:

Deter cigarette smoking

Unlabeled uses:
Gilles de la Tourette’s syndrome, ulcerative colitis

CONTRAINDICATIONS:

Pregnancy (D) (transdermal, inhaler); hypersensitivity, immediate post-MI recovery period, severe angina pectoris

Precautions:
Pregnancy (C) (gum); breastfeeding, vasospastic disease, dysrhythmias, diabetes mellitus, hyperthyroidism, pheochromocytoma, esophagitis, peptic ulcer, coronary/renal/hepatic disease; MRI (patch)

DOSAGE AND ROUTES
Calculator
Nicotine chewing gum

• Adult:
Chew 1 piece of gum (2 mg nicotine) whenever urge to smoke occurs; dose varies; usually 20 mg/day during first mo, max 24 pieces/day, max 3 mo

Nicotine inhaler

• Adult:
INH
6 cartridges/day for first 3-6 wk, max 16 cartridges/day × 12 wk

Nicotine lozenge

• Adult:
If cigarette is desired >30 min after awakening, start with 2-mg lozenge; if <30 min after awakening, start with 4-mg lozenge then again q1-2hr, max 20 lozenges/day or 5 lozenges/6 hr × 6 wk, then 1 lozenge q2-4hr × 2 wk, then 1 lozenge q4-8hr × 2 wk, then discontinue

Nicotine nasal spray

• Adult:
1 spray in each nostril 1-2×/hr, max 5×/hr or 40×/day, max 3 mo

Nicotine transdermal/inhaler system

• Habitrol
, nicoderm:
21 mg/day × 4-8 wk; 14 mg/day × 2-4 wk; 7 mg/day × 2-4 wk

• Nicotrol:
15 mg/day × 12 wk; 10 mg/day × 2 wk; 5 mg/day × 2 wk

• Nicotrol inhaler:
delivers 30% of nicotine that smoker receives from an actual cigarette

Gilles de la Tourette’s syndrome (unlabeled)

• Adult and child:
Chewing gum
2 mg chewed × 30 min bid for 1-6 mo;
TRANSDERMAL
7- or 10-mg patch daily × 2 days

Available forms:
Transdermal patch
(Habitrol
, Nicoderm, nicotine transdermal system) delivering 7, 14, 21 mg/day; (Nicoderm) 5, 10, 15 mg/day;
nicotine inhaler
4 mg delivered;
nasal spray
0.5 mg nicotine/actuation;
gum
2, 4 mg/piece;
lozenge
2 mg, 4 mg

Administer:

• 
Gum:
chew gum slowly for 30 min to promote buccal absorption of product; do not chew >45 min

• 
Begin product withdrawal after 3 mo of use; do not exceed 6 mo

• 
Transdermal patch:
1×day to nonhairy, clean, dry area of skin on upper body or upper outer arm; rotate sites to prevent skin irritation

• 
Inhaler:
puffing on mouthpiece delivers nicotine through mouth

SIDE EFFECTS

CNS:
Dizziness, vertigo, insomnia, headache, confusion, seizures, depression, euphoria, numbness, tinnitus, strange dreams

CV:
Dysrhythmias,
tachycardia, palpitations, edema, flushing, hypertension

EENT:
Jaw ache, irritation in buccal cavity

GI:
Nausea, vomiting, anorexia, indigestion
, diarrhea, abdominal pain, constipation, eructation, irritation

RESP:
Breathing difficulty, cough, hoarseness, sneezing, wheezing, bronchial spasm

PHARMACOKINETICS

Onset 15-30 min, metabolized in liver, excreted in urine, half-life 2-3 hr, 30-120 hr (terminal)

INTERACTIONS

Increase:
vasoconstriction—ergots, bromocriptine, cabergoline

Increase:
effect of—adenosine

Increase:
B/P—buPROPion

Decrease:
effect of—α-blockers, insulin

Decrease:
nicotine clearance—cimetidine

Drug/Food

• 
Avoid use of gum with acidic foods (colas, coffee) and for 15 min after

NURSING CONSIDERATIONS
Assess:

• 
Smoking:
number of cigarettes smoked, years used;
withdrawal:
headache, cravings, restlessness, irritation, drowsiness, insomnia, sore throat, increased appetite

• 
Adverse reaction:
irritation of buccal cavity, dislike of taste, jaw ache

Evaluate:

• 
Therapeutic response: decrease in urge to smoke, decreased need for gum after 3-6 mo

Teach patient/family:

• 
Gum:
about all aspects of product use; give package insert to patient and explain

• 
That gum will not stick to dentures, dental appliances

• 
That gum is as toxic as cigarettes; that it is to be used only to deter smoking, call prescriber immediately, stop use if difficulty breathing or rash occur

• 
To avoid use during pregnancy

• 
Transdermal patch:
that patch is as toxic as cigarettes; to be used only to deter smoking

• 
Not to use during pregnancy because birth defects may occur; not to breastfeed

• 
To keep used and unused system out of reach of children and pets

• 
To stop smoking immediately when beginning patch treatment

• 
To apply promptly after removing from protective patch because system may lose strength

• 
Nasal spray:
to tilt head back; not to swallow or inhale during administration; after smoking is stopped, to use spray up to 8 wk then discontinue over 6 wk by tapering

• 
Lozenges:
to allow to dissolve; to avoid swallowing

• 
Inhalation:
to use by inhaler for 20 min

Canada only   Side effects:
italics
= common;
bold
= life-threatening   
Nurse Alert

Other books

Detonator by Andy McNab
Kindred by Octavia Butler
Real Food by Nina Planck
Manifestations by David M. Henley
Everything Forbidden by Jess Michaels
Man on the Ice by Rex Saunders
The Institute by Kayla Howarth
Cat on a Hot Tiled Roof by Anna Nicholas