Nicotine abuse/dependence
SX â smoking, abuse, dependence.
PE â mood.
Next Steps
DX â Based on Hx.
Health Tips
TX â ⢠Nicotine nasal spray (Nicotrol NS) 1-2 sprays Q1hr initially, then up to 5 sprays/hr PRN. ⢠Bupropion hydrochloride 150mg ER PO QD x 3 days, then 150mg ER PO BID x 7-12 weeks. Other options for Nicotine replacement: Nicotine Gum: 2mg Q1-2hrs x 6 weeks, then 2-4hrs x 3 weeks, then Q4-8hrs x 3 weeks. Nicotine Lozenge: 2mg Q1-2hrs x 6 weeks, then 2-4hrs x 3 weeks, then Q4-8hrs x 3 weeks. Nicotine Patch: 14mg patch QD, 21 mg patch QD. Nicotine Inhaler: 6-16 cartridges/day inhaled x 6-12 weeks. "Five A's" to help patients stop smoking: Ask, Advise, Assess, Assist, and Arrange. 1. Ask. "'Do you smoke?â. 2. Advise. "Quitting smoking now is the most important action you can takeâ. 3. Assess. Patient's level of readiness to quit. 4. Assist. First-line pharmacologic treatment usually involves bupropion and/or nicotine replacement products in gum, skin patch, nasal spray, or inhaler form. 5. Arrange. Set an appointment to see the patient for follow-up.