1. Borrello, Sally Jo MSN, RN, CTTS

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A: Nicotine is the addictive substance in cigarettes-one of the hardest addictions for our patients to overcome. There are two reasons why it's so difficult to quit smoking: the psychological strength of the habit and the physiologic strength of the withdrawal symptoms. NRT provides clean nicotine in a pharmaceutical form and can be used to assist patients in breaking the habit of smoking by easing their cravings for nicotine and lessening withdrawal symptoms such as irritability, restlessness, depression, anxiety, difficulty concentrating, hunger, and poor sleep. If your patient uses a sufficient dose of NRT in the right way, the cravings and withdrawal symptoms are reduced by 50%, allowing him the freedom to work on the behavioral habits that trigger cigarette use.


You should familiarize yourself with the various types of NRT that are available so you can educate your patients about their proper use. Many smokers don't use NRT correctly and, therefore, won't achieve relief when using it. Nicotine patches, gum, and lozenges are available over the counter. Nicotine nasal sprays and inhalers (also known as puffers) require a healthcare provider's order. The nicotine patch can be used in conjunction with other NRT; in fact, combining the use of two types of NRT at the same time is proven safe and effective and will increase your patient's quit rate.

Figure. Q: Last issu... - Click to enlarge in new windowFigure. Q: Last issue you discussed the importance of helping patients with smoking cessation. How can nicotine replacement therapy (NRT) be used to do so?

NRT should only be used for patients who smoke 10 or more cigarettes a day. It's intended to complement other smoking cessation treatments, such as counseling, online programs, and quit lines; NRT shouldn't be viewed as a treatment unto itself. Stress to your patient that NRT doesn't make him stop smoking; behavior change and other types of support are essential. Instruct your patient not to smoke while using NRT because this can increase his chance of a cardiac event, although this is rare. It's recommended that patients use NRT for at least 8 to 12 weeks to have the best chance of quitting smoking. Patients usually have no problem discontinuing NRT use.


Patients who are pregnant or plan to become pregnant and those with heart disease should consult their healthcare provider before starting NRT. Instruct your patient to notify his healthcare provider of his decision to quit smoking because both quitting and the use of NRT will usually require a change in the dosages of other medication he may be taking. Also, if your patient is using the nicotine patch, instruct him to inform his healthcare provider before undergoing magnetic resonance imaging because transdermal medication patches may cause burns during the procedure.


NRT is a safe and effective way to help your patients kick the habit. The consistent use of NRT doubles a patient's chances of quitting smoking.


Learn more about it


American Heart Association. Nicotine substitutes/nicotine replacement therapy.