nicotine Nursing Considerations & Management

Drug Name

Generic Name : nicotine

Brand Name: Nicoderm CQ, Nicotrol, Nicotrol Inhaler, Nicotrol NS

Classification: Smoking deterrent

Pregnancy Category D 

Dosage & Route

Available forms : Transdermal system—7, 14, 21 mg/day; 5, 10, 15 mg/16 hr (Nicotrol); nasal spray— 0.5 mg/actuation (10 mg/mL); inhaler—4 mg/actuation

ADULTS

Topical

  • Apply system, 5–21 mg, once every 24 hr. Dosage is based on response and stage of withdrawal. Nicoderm: 21 mg/day for first 6 wk; 14 mg/day for next 2 wk; 7 mg/day for next 2 wk. Nicotrol: 15 mg/day for 6 wk.

Nasal spray

  • 1 spray in each nostril as needed, one to two doses each hour, up to five doses/hr and 40 doses/day.

Nasal inhaler

  • 1 spray in each nostril, one to two doses/hr to a maximum five doses/hr or 40 doses/day. Dosage is individualized; in studies, best results were achieved by continuous, frequent puffing over 20 min. Do not use longer than 6 mo. Patients are treated for 12 wk, then weaned off the daily dose over next 6–12 wk.
PEDIATRIC PATIENTS
  • Safety and efficacy in children and adolescents who smoke have not been established.
Therapeutic actions
  • Nicotine is a potent ganglionic and CNS stimulant. It paralyses all autonomic ganglia after stimulation of the respiratory system (a central effect of small doses). Larger doses produce medullary-type convulsions then paralysis. The actions of nicotine are mediated via nicotine-specific receptors.
Indications
  • Temporary aid to the cigarette smoker seeking to give up smoking while in a behavioral modification program under medical supervision
  • Unlabeled use: Improvement of symptoms of Tourette syndrome
Adverse effects
  • Headache, cold and flu-like symptoms; insomnia; nausea; myalgia and dizziness; palpitations; dyspepsia, hiccups; vivid dreams; chest pain; anxiety and irritability; somnolence and impaired concentration; abnormal hunger; dysmenorrhoea; rash. Patches: Skin reactions (discontinue if severe), vasculitis. Spray: Nasal irritation, nose bleeds, watery eyes, ear sensations. Gum, lozenges, SL tab or inhalator: Apthous ulceration, throat irritation. Inhalator: Cough, rhinitis, pharyngitis, stomatitis, sinusitis, dry mouth.
Contraindications
  • Nonsmokers, children and occasional smokers. Recent cerebrovascular accident, acute MI, unstable or worsening angina pectoris, severe cardiac arrhythmias, active temporomandibular joint disease (gum).
Nursing considerations
Assessment
  • History: Allergy to nicotine; nonsmoker; post-MI period; arrhythmias; angina pectoris; hyperthyroidism, pheochromocytoma, type 2 diabetes; hypertension, peptic ulcer disease; pregnancy; lactation
  • Physical: Orientation, affect; P, auscultation, BP; oral mucous membranes, abdominal examination; thyroid function tests
Interventions
  • Protect systems from heat; slight discoloration of system is not significant.
  • Apply system to nonhairy, clean, dry skin site on upper body or upper outer arm; use only when the pouch is intact; use immediately after removal from pouch; use each system only once.
  • Wash hands thoroughly after application; do not touch eyes.
  • Wrap used system in foil pouch of newly applied system; fold over and dispose of immediately to prevent access by pets or children.
  • Apply new system after 24 hr; do not reuse same site for at least 1 wk. Nicotrol: Apply a new system each day after waking, and remove at bedtime.
  • WARNING: Handle nasal spray carefully; if it comes in contact with skin, flush immediately; dispose of bottle with cap in place.
  • Ensure that patient has stopped smoking; if the patient is unable to stop smoking within the first 4 wk of therapy, drug therapy should be stopped.
  • Encourage patients who have been unsuccessful at any dose to take a “therapy holiday” before trying again; counseling should explore factors contributing to their failure and other means of success.
Teaching points
  • Protect systems from heat; slight discoloration of system is not significant.
  • Apply system to nonhairy, clean, dry skin site on upper body or upper outer arm; use only when the pouch is intact; use immediately after removal from pouch; use each system only once.
  • Wash hands thoroughly after application; do not touch eyes. Wrap used system in foil pouch of newly applied system; fold over and dispose of immediately to prevent access by pets or children.
  • Apply new system after 24 hours; do not reuse same site for at least 1 week. Nicotrol: Apply a new system each day after waking, and remove at bedtime.
  • Tilt head back to administer spray; do not sniff, swallow, or inhale while spray is administered. If spray comes in contact with skin, flush immediately; discard bottle with cap in place.
  • Store reusable mouthpiece for inhaler in plastic case; wash with soap and water. Throw inhaler cartridge away out of reach of children and pets.
  • Abstain from smoking.
  • You may experience these side effects: Dizziness, headache, light-headedness (use caution driving or performing tasks that require alertness); nausea, vomiting, constipation or diarrhea (frequent small meals, regular mouth care may help); skin redness, swelling at application site (good skin care, switching sites daily may help).
  • Report nausea and vomiting, diarrhea, cold sweat, chest pain, palpitations, burning or swelling at application site.