Discussion Question: Tobacco Cessation Paper
Discussion Question: Tobacco Cessation
This discussion provides the nicotine replacement therapy for a 68-year-old Caucasian male patient, in addition to off-label use of the medication other than psychosis and depression.
Nicotine Replacement Therapy
Given that the patient has been using tobacco for quite a long time, he might be subjected to long-term care for a desirable outcome. The FDA recommends the use of bupropion SR for the long-term management of nicotine dependence (Engelmann et al., 2020). Consequently, the American Psychological Association Treatment Guideline for management of nicotine dependency recommends the use of Bupropion as the first-line therapy in smoking cessation. A study conducted by Kertes et al. (2021), reported that highly nicotine-dependent smokers receiving bupropion are more likely to exhibit reduced depressive symptoms among other nicotine withdrawal symptoms. Bupropion is a norepinephrine–dopamine reuptake inhibitor (NDRI) that acts by antagonizing several nicotinic acetylcholine receptors in tobacco cessation (Giulietti et al., 2020). Common side effects include anxiety, drowsiness, headache, excitement, and dry mouth. The drug does not require monitoring through serum testing, however, it is necessary to assess the patient’s risks of suicide. Bupropion can also interact with steroids leading to an increased risk of seizure among older adults.
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Off-label Use
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One of the off-label uses of bupropion is in the management of neuropathic pain. According to the study findings conducted by Urits et al. (2019), bupropion SR was associated with significant effectiveness in the management of nerve pain in 73% of the participants, within only 6 weeks. More recent pieces of evidence have also proven the effectiveness of bupropion in the management of chronic pain associated with inflammatory bowel disease (IBD) (Giulietti et al., 2020). However, the mechanism of action behind this indication is still not well understood.
References
Engelmann, J. M., Karam-Hage, M., Rabius, V. A., Robinson, J. D., & Cinciripini, P. M. (2020). Nicotine dependence: current treatments and future directions. In Abeloff’s Clinical Oncology (pp. 399-410). Elsevier. https://doi.org/10.1016/B978-0-323-47674-4.00024-4
Giulietti, F., Filipponi, A., Rosettani, G., Giordano, P., Iacoacci, C., Spannella, F., & Sarzani, R. (2020). Pharmacological approach to smoking cessation: an updated review for daily clinical practice. High Blood Pressure & Cardiovascular Prevention, 27(5), 349-362. https://doi.org/10.1007/s40292-020-00396-9
Kertes, J., Stein Reisner, O., Grunhaus, L., & Neumark, Y. (2021). Adherence to smoking cessation guidelines (5As) by psychiatrists and primary care physicians for persons with serious mental illness. Journal of addictive diseases, 1-9. https://doi.org/10.1080/10550887.2021.2017203
Urits, I., Peck, J., Orhurhu, M. S., Wolf, J., Patel, R., Orhurhu, V., … & Viswanath, O. (2019). Off-label antidepressant use for treatment and management of chronic pain: evolving understanding and comprehensive review. Current pain and headache reports, 23(9), 1-10. DOI: 10.1007/s11916-019-0803-z.
please answer discussion question below, minimum 250 words thank you
Assessment Description
Joe is a 68-year-old Caucasian male who presents for assistance with tobacco cessation. He began smoking when he was 12 years old. He smoked 2 packs per day until last year when he began reducing the number of cigarettes he smokes per day. He is currently at 8 cigarettes per day. He smokes when he gets up in the morning, with coffee, after breakfast, midmorning, after lunch, midafternoon, after supper, and before bed. He states that the cigarettes help him focus. He describes that abrupt cessation creates increased craving, irritability, increased hunger, and anxiety.
Select a Nicotine replacement therapy or medication that is used for nicotine dependence. Please include the available evidence and treatment guidelines. Share the mechanism of action of this medication and hints for monitoring, side effects, and drug interactions, including interactions with CAM. Identify an additional (possibly off-labeled) use of the medication not related to depression or psychosis. Include the name of the medication in the subject line so that the medications can be followed. Include references using APA format.