1. NC STEP/Mission Hospitals School Cessation and Treatment Guide

2. Cessation Guide

3. Treatment Guide

4. Recommended ST Treatment Approach 1) Behavioral treatment –Oral examination –+/- oral replacement products 2) Bupropion –150 mg po qd x 3 days then bid –Quit 1 week later –Continue for 3-6 months 3) Tailored nicotine patch therapy –+/- gum/lozenge for self-titration

5. Smokeless Tobacco Pharmacology Potential available nicotine is twice that obtained from smoking a cigarette (per unit dose): Potential available nicotine is twice that obtained from smoking a cigarette (per unit dose): chewing tobacco4.5 mg moist snuff3.6 mg 4 mg nicotine gum1.9 mg cigarette 1.8 mg

6. Nicotine Gum for ST Use Should not be used as monotherapy Should not be used as monotherapy 4 mg 4 mg Frequent use initially (10-15/day) Frequent use initially (10-15/day)

7. Nicotine Lozenge for ST Use Nicotine Polacrilex Nicotine Polacrilex –2 mg –4 mg 1-2 lozenges every 1- 2 hours 1-2 lozenges every 1- 2 hours Minimum of 9/day Minimum of 9/day Taper over 12 weeks Taper over 12 weeks

8. Pharmacologic Treatment: Nicotine Patch Percentage Replacement

9. Peak serum nicotine concentrations (ng/mL) Cans or pouches per week Patch dose Low 0-10 = 1 14 mg/d Intermediate 11-20 2-3 21or 22 mg/d High > 20 > 3 42 or 44 mg/d NRT for ST Users

10. Bupropion SR for ST Use Dosing 150 mg daily for 3-4 days then 150 mg twice a day for 3-4 days THEN STOP Tobacco