A patient has been using a nicotine patch for several weeks and ...

[tnt_battle]

A patient has been using a nicotine patch for several weeks and uses the 15 mg/16 hour patch. The patient reports having frequent continual cravings for cigarettes, especially on awakening in the morning. The primary care NP should:
 
  a. prescribe varenicline (Chantix).
  b. prescribe bupropion (Wellbutrin).
  c. change to a 21 mg/24 hour nicotine patch.
  d. suggest adding nicotine nasal spray for cravings.

Question 2

A patient who is using a nicotine patch for smoking cessation is in the clinic for a follow-up examination. The primary care NP notes a heart rate of 96 beats per minute and a blood pressure of 140/90 mm Hg.
 
  The patient reports feeling dizzy and complains of ringing in both ears. The NP should suspect: a. nicotine withdrawal symptoms.
  b. that the patient has been smoking.
  c. hypersensitivity reaction to the nicotine patch.
  d. minor cardiovascular effects of the nicotine patch.

[Heffejeff]

Answer to Question 1

C
It is important to begin therapy with a dose sufficient to deliver enough nicotine so that patients will not want to smoke. Patients who awaken with nicotine cravings should wear a 24-hour patch. Prescribing varenicline or bupropion may be necessary if the patch fails after appropriate dosing is established. Whichever nicotine replacement method is chosen, the patient should use only one particular product to avoid nicotine toxicity.

Answer to Question 2

B
Patients who are using the patch should be cautioned not to smoke while using it because of the risk of nicotine overdose. This patient is not having symptoms of nicotine withdrawal or of hypersensitivity of the patch or of minor cardiovascular effects.

[tnt_battle]

Excellent

[FergA]

Gracias!