Mosby's 2014 Nursing Drug Reference (289 page)

• 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

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

• 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

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

• 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

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

• 
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

Increase:
vasoconstriction—ergots, bromocriptine, cabergoline

Increase:
effect of—adenosine

Increase:
B/P—buPROPion

Decrease:
effect of—α-blockers, insulin

Decrease:
nicotine clearance—cimetidine

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

• 
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

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

• 
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