ABC | Volume 113, Nº4, October 2019

Updated Updated Cardiovascular Prevention Guideline of the Brazilian Society Of Cardiology – 2019 Arq Bras Cardiol. 2019; 113(4):787-891 • Care in administration: application to upper chest, anterior and posterior region, and upper lateral region of arm. • Adverse reactions: itching and redness at the application site, nausea, feeling sick, tachycardia with overdose. • Contraindications: Dermatological disorders that prevent the application of the patch, 15 days after episode of acute myocardial infarction (AMI), pregnancy and breastfeeding. • Overdose (toxicity): nausea, feeling sick, tachycardia, hypertensive crisis. 3. Nicotine for oral use - nicotine gum or lozenge Effectiveness - compared to placebo RR = 2.2 (95% CI 1.5-3.2). 6-Month abstinence rate - RR= 26.1 (95% CI 19.7-33.6). • Doses: 2 and 4 mg. • Presentation: chewing gum or lozenge. • Route(s) of administration: oral. • Dose schedule: use at times of craving, intense desire to smoke, instead of cigarettes (1 to 15 gums/day). • Care in administration: Swallow with a glass of water before use to neutralize oral pH, which may be altered by food intake and food residue removal, which may decrease absorption by the oral mucosa. • Adverse reactions: nicotine gum - temporomandibular joint pain when chewed quickly and incessantly; oropharyngeal irritation and nausea when chewed quickly and frequently. • Adverse reactions: nicotine lozenge - oropharyngeal irritation and nausea when chewed rather than allowed to dissolve in the mouth or overuse. • Contraindications: Nicotine gum - Inability to chew, active peptic ulcer, 15 days after AMI. Nicotine lozenge - active peptic ulcer, 15 days after AMI. • Overdose (toxicity): nausea, feeling sick, tachyhardia, hypertensive crisis. 4. Bupropion hydrochloride (Chart 7.2) Bupropion is a dopamine and norepinephrine reuptake inhibitor that is effective in smoking cessation, 268,276 decreasing nicotine withdrawal symptoms. Because it is an antidepressant, it can help control depressive symptoms that may arise during the smoking cessation process. Chart 7.1 – Initial evaluation in approach to smoking 300 Anamnesis • Scales: Fagerström (for nicotine dependence) 265 – Table 7.2 • Prochaska and DiClementi (for motivation) 263 - check the patient’s counseling techniques - Table 7.3 • Clinical and/or psychiatric comorbidites (diabetes, hypertension, depression, alcoholism, stroke, convulsion, cancer) • Continuous use medications • Risk factors for CVD (dyslipidemia, uso of oral contraceptives or estrogen) • Pregnancy or breastfeeding • Questions about smoking: - How long have you been smoking - How many cigarettes do you smoke per day - Have you tried to quit smoking and what was the result - Are you interested (or thinking) about quitting smoking? • Questions about smoking cessation: - Are you considering a date to quit smoking and would you like help - If you have tried to quit, if you have succeeded, if you have taken any medication and how long you have been without smoking Physical examination • Monitor BP, especially during bupropion use • Monitor weight: weight gain can be a barrier to starting smoking cessation and a predictor of relapse Complementary examinations • Complete blood count, liver function tests, blood glucose, lipid profile and serum biochemistry • Chest X-ray • Electrocardiogram • Spirometry (not always readily available) • Measurement of COex, if possible. This parameter is directly related to carboxyhemoglobin and cigarettes smoked per day. The cutoff point is 6 ppm COex: carbon monoxide; CVD: cardiovascular disease; BP: blood pressure. 824