Treatment Goals of Nicotine Replacement Therapy (NRT) - Reduce nicotine withdrawal, decrease cravings, support complete
smoking cessation, prevent relapse
Three Modalities of Smoking Cessation - Behavioral counseling, Nicotine replacement therapy (NRT), Non-nicotine
pharmacotherapy
Five Forms of Nicotine Replacement Therapy - Gum, Lozenge, Transdermal patch, Nasal spray, Oral inhaler
Active Ingredient in Nicotine Gum - Nicotine polacrilex
Nicotine Gum Dose/Max/Duration/Contraindications - 2 mg (<25 cigarettes/day), 4 mg (≥25 cigarettes/day); Max 24 pieces/day;
Use up to 12 weeks; Avoid with TMJ disorders, recent MI, serious arrhythmias, unstable angina
Nicotine Gum Instructions - Chew until tingling, "park" between cheek and gum, repeat for 30 minutes; Avoid food/drinks 15
minutes before and during use
Nicotine Lozenge Dose/Use/Duration - 2 mg or 4 mg based on time to first cigarette; Dissolve slowly, do not chew/swallow; Use
up to 12 weeks
Nicotine Patch Dose/Removal - 21 mg/day (heavy smokers), 14 mg/day, or 7 mg/day based on smoking history; Apply daily,
rotate sites; Remove after 24 hours (or bedtime if insomnia)
Nicotine Patch Side Effects - Skin irritation, insomnia, vivid dreams, headache
Nicotine Nasal Spray Dose - 1 dose = 2 sprays (1/nostril); Max 5 doses/hour or 40 doses/day; Use for 3–6 months
Nicotine Inhaler Dose - 6–16 cartridges/day; Approximately 80 puffs/cartridge over 20 minutes; Gradually taper after 3 months
Antidepressants for Smoking Cessation - Bupropion SR 150 mg daily × 3 days, then 150 mg BID; SE: Insomnia, dry mouth,
seizure risk
Partial Agonist for Smoking Cessation - Varenicline; 0.5 mg daily → titrate to 1 mg BID for 12 weeks; SE: Nausea, insomnia,
abnormal dreams
Other Smoking Cessation Agents - Nicotine replacement products; Nortriptyline and clonidine (off-label)
FDA Black Box Warning (Smoking Cessation Medications) - Previous neuropsychiatric warning removed for varenicline and
bupropion; Continue monitoring for mood or behavioral changes
GOLD Group A - Low symptoms (CAT <10 or mMRC 0–1), 0–1 exacerbations without hospitalization; Initial therapy: LABA or
LAMA
GOLD Group B - High symptoms (CAT ≥10 or mMRC ≥2), 0–1 exacerbations without hospitalization; Initial therapy: LABA + LAMA
GOLD Group E - ≥2 moderate exacerbations or ≥1 hospitalization regardless of symptoms; Initial therapy: LABA + LAMA; Consider
LABA + LAMA + ICS if eosinophils ≥300 cells/µL
Spirometric Grades (FEV₁) - GOLD 1 ≥80%; GOLD 2 50–79%; GOLD 3 30–49%; GOLD 4 <30%
Preferred Antibiotic for Former Smokers (COPD Exacerbation) - Amoxicillin/clavulanate; Alternatives: Doxycycline or
azithromycin based on risk factors/local resistance
Short-Acting Bronchodilators (SABA/SAMA) - Albuterol, Levalbuterol, Ipratropium; Rescue therapy for acute symptom relief
Beta₂-Agonists (LABA/SABA) - Stimulate β₂ receptors → bronchodilation; Indications: COPD and asthma; LABA monotherapy
should never be used in asthma without an ICS
Anticholinergics (LAMA/SAMA) - Block muscarinic receptors → bronchodilation and reduced mucus secretion; Indications: COPD
maintenance; SE: Dry mouth, urinary retention, constipation, blurred vision
LAMA/LABA Combination - Dual bronchodilation improves lung function and symptom control; SE: Dry mouth, tremor,
palpitations; LABA component should not be used alone in asthma
Methylxanthines - Theophylline; Reserved for refractory COPD/asthma due to narrow therapeutic index; SE: Arrhythmias,
seizures, nausea, insomnia
Inhaled Corticosteroids (ICS) - Reduce airway inflammation; Indicated for persistent asthma and select COPD patients with
frequent exacerbations/eosinophilia; Rinse mouth after use
Systemic Corticosteroids - Used for acute asthma/COPD exacerbations; Improve recovery and lung function; SE: Hyperglycemia,
mood changes, osteoporosis, infection risk
Asthma Severity Classifications - Intermittent, Mild Persistent, Moderate Persistent, Severe Persistent
GINA Step 1 - As-needed low-dose ICS-formoterol (preferred)
GINA Step 2 - Daily low-dose ICS or as-needed ICS-formoterol
GINA Step 3 - Low-dose ICS/LABA
GINA Step 4 - Medium-dose ICS/LABA
GINA Step 5 - High-dose ICS/LABA ± LAMA or biologic therapy; Refer to specialist
GINA Landmark Recommendation - ICS-containing therapy for all adolescents and adults; Avoid SABA-only treatment
Drug Classes Used to Treat Asthma - SABA, LABA, ICS, Systemic corticosteroids, LAMA, Leukotriene modifiers, Mast cell
stabilizers, Methylxanthines, Biologics
Leukotriene Modifiers - Montelukast, Zafirlukast, Zileuton; Used for persistent asthma and allergic rhinitis; Monitor for
neuropsychiatric effects (montelukast)
smoking cessation, prevent relapse
Three Modalities of Smoking Cessation - Behavioral counseling, Nicotine replacement therapy (NRT), Non-nicotine
pharmacotherapy
Five Forms of Nicotine Replacement Therapy - Gum, Lozenge, Transdermal patch, Nasal spray, Oral inhaler
Active Ingredient in Nicotine Gum - Nicotine polacrilex
Nicotine Gum Dose/Max/Duration/Contraindications - 2 mg (<25 cigarettes/day), 4 mg (≥25 cigarettes/day); Max 24 pieces/day;
Use up to 12 weeks; Avoid with TMJ disorders, recent MI, serious arrhythmias, unstable angina
Nicotine Gum Instructions - Chew until tingling, "park" between cheek and gum, repeat for 30 minutes; Avoid food/drinks 15
minutes before and during use
Nicotine Lozenge Dose/Use/Duration - 2 mg or 4 mg based on time to first cigarette; Dissolve slowly, do not chew/swallow; Use
up to 12 weeks
Nicotine Patch Dose/Removal - 21 mg/day (heavy smokers), 14 mg/day, or 7 mg/day based on smoking history; Apply daily,
rotate sites; Remove after 24 hours (or bedtime if insomnia)
Nicotine Patch Side Effects - Skin irritation, insomnia, vivid dreams, headache
Nicotine Nasal Spray Dose - 1 dose = 2 sprays (1/nostril); Max 5 doses/hour or 40 doses/day; Use for 3–6 months
Nicotine Inhaler Dose - 6–16 cartridges/day; Approximately 80 puffs/cartridge over 20 minutes; Gradually taper after 3 months
Antidepressants for Smoking Cessation - Bupropion SR 150 mg daily × 3 days, then 150 mg BID; SE: Insomnia, dry mouth,
seizure risk
Partial Agonist for Smoking Cessation - Varenicline; 0.5 mg daily → titrate to 1 mg BID for 12 weeks; SE: Nausea, insomnia,
abnormal dreams
Other Smoking Cessation Agents - Nicotine replacement products; Nortriptyline and clonidine (off-label)
FDA Black Box Warning (Smoking Cessation Medications) - Previous neuropsychiatric warning removed for varenicline and
bupropion; Continue monitoring for mood or behavioral changes
GOLD Group A - Low symptoms (CAT <10 or mMRC 0–1), 0–1 exacerbations without hospitalization; Initial therapy: LABA or
LAMA
GOLD Group B - High symptoms (CAT ≥10 or mMRC ≥2), 0–1 exacerbations without hospitalization; Initial therapy: LABA + LAMA
GOLD Group E - ≥2 moderate exacerbations or ≥1 hospitalization regardless of symptoms; Initial therapy: LABA + LAMA; Consider
LABA + LAMA + ICS if eosinophils ≥300 cells/µL
Spirometric Grades (FEV₁) - GOLD 1 ≥80%; GOLD 2 50–79%; GOLD 3 30–49%; GOLD 4 <30%
Preferred Antibiotic for Former Smokers (COPD Exacerbation) - Amoxicillin/clavulanate; Alternatives: Doxycycline or
azithromycin based on risk factors/local resistance
Short-Acting Bronchodilators (SABA/SAMA) - Albuterol, Levalbuterol, Ipratropium; Rescue therapy for acute symptom relief
Beta₂-Agonists (LABA/SABA) - Stimulate β₂ receptors → bronchodilation; Indications: COPD and asthma; LABA monotherapy
should never be used in asthma without an ICS
Anticholinergics (LAMA/SAMA) - Block muscarinic receptors → bronchodilation and reduced mucus secretion; Indications: COPD
maintenance; SE: Dry mouth, urinary retention, constipation, blurred vision
LAMA/LABA Combination - Dual bronchodilation improves lung function and symptom control; SE: Dry mouth, tremor,
palpitations; LABA component should not be used alone in asthma
Methylxanthines - Theophylline; Reserved for refractory COPD/asthma due to narrow therapeutic index; SE: Arrhythmias,
seizures, nausea, insomnia
Inhaled Corticosteroids (ICS) - Reduce airway inflammation; Indicated for persistent asthma and select COPD patients with
frequent exacerbations/eosinophilia; Rinse mouth after use
Systemic Corticosteroids - Used for acute asthma/COPD exacerbations; Improve recovery and lung function; SE: Hyperglycemia,
mood changes, osteoporosis, infection risk
Asthma Severity Classifications - Intermittent, Mild Persistent, Moderate Persistent, Severe Persistent
GINA Step 1 - As-needed low-dose ICS-formoterol (preferred)
GINA Step 2 - Daily low-dose ICS or as-needed ICS-formoterol
GINA Step 3 - Low-dose ICS/LABA
GINA Step 4 - Medium-dose ICS/LABA
GINA Step 5 - High-dose ICS/LABA ± LAMA or biologic therapy; Refer to specialist
GINA Landmark Recommendation - ICS-containing therapy for all adolescents and adults; Avoid SABA-only treatment
Drug Classes Used to Treat Asthma - SABA, LABA, ICS, Systemic corticosteroids, LAMA, Leukotriene modifiers, Mast cell
stabilizers, Methylxanthines, Biologics
Leukotriene Modifiers - Montelukast, Zafirlukast, Zileuton; Used for persistent asthma and allergic rhinitis; Monitor for
neuropsychiatric effects (montelukast)
