A patient has been using a nicotine patch for several weeks and uses the 15 mg/16 hour patch. The patient reports having frequent continual cravings for cigarettes, especially on awakening in the morning. The primary care NP should:
a. prescribe varenicline (Chantix).
b. prescribe bupropion (Wellbutrin).
c. change to a 21 mg/24 hour nicotine patch.
d. suggest adding nicotine nasal spray for cravings.
C
It is important to begin therapy with a dose sufficient to deliver enough nicotine so that patients will not want to smoke. Patients who awaken with nicotine cravings should wear a 24-hour patch. Prescribing varenicline or bupropion may be necessary if the patch fails after appropriate dosing is established. Whichever nicotine replacement method is chosen, the patient should use only one particular product to avoid nicotine toxicity.
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