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. It is understandable that anyone who plans on giving up smoking may find it challenging at first, but with methods such as nicotine patches, nicotine gum, vaping and e liquid for beginners, it has never been easier to finally become a non smoker.
  • 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 using a suitable solution for the individual. This may include using nicotine patches, products from different vaping companies like Pure E-Liquids, or visiting a therapist.
  • 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.