NUR 635 Topic 4 DQ 2

Sample Answer for NUR 635 Topic 4 DQ 2 Included After Question

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 two packs per day until last year when he began reducing the number of cigarettes he smokes per day. He is currently at eight 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. Use the guidelines and relevant literature in your topic Resources to discuss the following:

  • What are considered the seven first-line medications?
  • How would one characterize Joe’s behavior regarding smoking cessation, willing to quit or unwilling to quit? Explain your rationale.
  • Based on his willingness or unwillingness, determine a treatment strategy and appropriate therapeutic options, as it relates to your motivational technique when interviewing the patient, medication plan, reduction of cigarette use, and frequency of follow-up appointments.
  • Explain the rationale for using a combination NRT, and discuss the pros and cons associated with combination therapy.
  • What vaccination(s) should be recommended to Joe based on his addiction? Explain your rationale.
  • Based on their mechanism of action, how do bupropion and varenicline help treat tobacco cessation?
  • Regarding NRTs, what are generalized adverse effects the patient may experience? Are there other side effects associated with the administration type (e.g., patch, inhaler, or nasal spray)?

Participate in follow-up discussion by reviewing the case discussed by classmates that is different than the one assigned to you.

American Association of Colleges of Nursing Core Competencies for Professional Nursing Education 

This assignment aligns to AACN Core Competencies 1.1, 1.2, 1.3, 2.2, 2.4, 2.5, 4.2, 9.2, 9.6

A Sample Answer For the Assignment: NUR 635 Topic 4 DQ 2

Title: NUR 635 Topic 4 DQ 2

What are considered the seven first-line medications?

-The seven FDA-approved medications include five forms of NRT: the patch, gum, inhaler, nasal spray, and lozenge; as well as two non-NRT medications, bupropion SR (brand name Zyban®), and varenicline (brand name Chantix).

How would one characterize Joe’s behavior regarding smoking cessation, willing to quit or unwilling to quit? Explain your rationale.

– In this situation, Joe comes forward with a goal to quit smoking. However, he mentions that quitting suddenly leads to cravings, irritability, heightened appetite, and anxiety. Joe has been smoking two packs of cigarettes daily since the age of 12, but he has managed to reduce his daily intake to eight cigarettes. It appears that he has the intention to completely quit smoking, but he is experiencing undesirable side effects when attempting to do so.

Based on his willingness or unwillingness, determine a treatment strategy and appropriate therapeutic options, as it relates to your motivational technique when interviewing the patient, medication plan, reduction of cigarette use, and frequency of follow-up appointments.

– Short-term interventions for tobacco dependence have proven effectiveness. Joe should be provided with these concise treatments. This may include individual or group counseling, as well as telephone counseling, which have all demonstrated efficacy. Additionally, practical counseling that encompasses problem-solving and skills training, along with social support, should be integrated into the treatment plan. It’s also recommended to incorporate one or more of the seven primary medications in specific combinations.

Explain the rationale for using a combination NRT, and discuss the pros and cons associated with combination therapy.

– Combination Nicotine Replacement Therapy (NRT) involves using two or more forms of NRT simultaneously to help individuals quit smoking. The rationale behind this approach is to address nicotine withdrawal symptoms more effectively by providing a steady supply of nicotine while reducing the need for cigarettes.  Combination NRT can be a valuable tool for individuals who are highly dependent on nicotine and have struggled with quitting in the past. Additionally, proper education and guidance on using NRT products as directed are crucial to maximize their effectiveness and minimize potential risks.

What vaccination(s) should be recommended to Joe based on his smoking addiction? Explain your rationale.

-Influenza, Pneumococcal, COVID-19 (respiratory related d/t his risk for respiratory deficiencies.  

  • Based on their mechanism of action, how do bupropion and varenicline help treat tobacco cessation?

-Bupropion SR (sustained-release) and varenicline are non-nicotine medications prescribed for treating tobacco dependence. Bupropion SR appears to influence its effects by acting on the noradrenergic and dopaminergic systems, competitively inhibiting nicotinic acetylcholine receptors. On the other hand, varenicline is a partial agonist with a strong binding affinity and selectivity for α4β2 neuronal nicotinic acetylcholine receptors. Combining these two medications offers opportunities for potential additive or synergistic therapeutic effects in tobacco cessation treatment.

References:

S. Department of Health and Human Services. Smoking Cessation. A Report of the Surgeon General. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion, Office on Smoking and Health; 2020. https://www.cdc.gov/tobacco/data_statistics/sgr/2020-smoking-cessation/index.html.

Barua, R. S., Rigotti, N. A., Benowitz, N. L., Cummings, M., Mohammad-Ali, J., Morris, P. B., Rathcford, E. V., Sarna, L., Stecker, E. C., Wiggins, B. S. (2018). 2018 ACC Expert Consensus Decision Pathway on Tobacco Cessation Treatment. A Report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents. Journal of the American College of Cardiology, 72(25). DOI: 10.1016/j.jacc.2018.10.027. http://www.onlinejacc.org/content/72/25/3332

A Sample Answer For the Assignment: NUR 635 Topic 4 DQ 2

Title: NUR 635 Topic 4 DQ 2

Hi Marco, Thank you for your insights. In relation to the topic of vaccination, I have been contemplating the concept of a revolutionary therapeutic vaccine specifically designed for those who smoke. According to the World Health Organization (WHO, 2011), the global population of tobacco smokers exceeds 1 billion individuals, with a projected mortality rate of at least 50% due to smoking-related illnesses. In accordance with Raupach’s (2012) findings, the act of tobacco smoking has been linked to the development of cardiovascular, pulmonary, and malignant diseases. Consequently, the cessation of smoking has emerged as a crucial medical intervention aimed at reducing the global prevalence of these conditions.

Nevertheless, the addictive nature of smoking cigarettes, which involves the intake of nicotine, often leads to a high rate of failure in efforts to stop. Therapeutic interventions, such as the integration of counseling and medication, provide long-term sustained abstinence rates that do not exceed 30%.  One captivating treatment thought that warrants attention is the notion of using vaccination as a means to combat nicotine addiction. The fundamental tenet behind this methodology is that, subsequent to entering the systemic circulation, a significant part of nicotine has the capacity to form complexes with antibodies. Upon binding to antibodies, nicotine loses its ability to traverse the blood-brain barrier.

Accordingly, the lower rewarding effects of nicotine lead to a decreased likelihood of recurrence to smoking (Raupach, et.al. 2012). NicVAX is a nicotine conjugate vaccination that has been developed with the objective of reducing or eliminating the physiological addiction to nicotine. The vaccine is composed of antibodies that specifically target nicotine, which may potentially assist in facilitating this physiological mechanism. Moreover, it may function as a proactive measure to protect the body from the onset of addiction. The medicinal molecule consists of the hapten 3′-aminomethylnicotine in conjunction with recombinant Pseudomonas aeruginosa exoprotein A. The process of administering the vaccination entails the injection of six doses, which are equally spaced over a period of six months.

The method of action entails the stimulation of the body’s immune system to elicit the synthesis of certain antibodies. According to a study conducted by Clinical Trial Arena in 2010, it was shown that the antibodies produced by the vaccination have the ability to attach to nicotine molecules. This binding process results in an increase in the size of the nicotine molecules, rendering them incapable of crossing the blood-brain barrier. Nevertheless, the vaccine failed to fulfill its primary purpose during a phase III clinical study that assessed its efficacy as a smoking cessation intervention (Lengel, D. & Kenny, P., 2023). 

References:

Clinical Trials Arena (2010). NicVax for nicotine addiction. 

Lengel, D. & Kenny, P. (2023). New medications development for smoking cessation. Addiction neuroscience. Elsevier. https://doi.org/10.1016/j.addicn.2023.100103.

(https://www.sciencedirect.com/science/article/pii/S2772392523000469)

Raupach, T., Hoogsteder, P. H., & Onno van Schayck, C. P. (2012). Nicotine vaccines to assist with smoking cessation: current status of research. Drugs, 72(4), e1–e16. https://doi.org/10.2165/11599900-000000000-00000

WHO. WHO report on the global tobacco epidemic, 2011: warning about the dangers of tobacco. Geneva: WHO, 2011 [online]. Available from URL: http://whqlibdoc.who.int/publications/2011/9789240687813_eng.pdf [Accessed 2012 Feb 14]