Autonomic Nervous System Regulation
4.6 Nicotine Receptor Agonists
Mechanism of Action: Nicotine binds to and activates nicotinic acetylcholine receptors, mimicking the effect of acetylcholine at these receptors.
Indications for Use: Nicotine patches are used as an aid to smoking cessation and for the relief of nicotine withdrawal signs and symptoms as part of a comprehensive behavioral smoking cessation program.
Nursing Considerations Across the Lifespan: Nicotine is not recommended for children or pregnant women. Based on available data, pregnancy outcomes are similar following maternal nicotine replacement therapy (NRT) when compared to cigarette smoking.[1]
Nicotine is a hazardous drug; use safe handling and disposal precautions. Apply one new patch every 24 hours on skin that is dry, clean, and hairless. Remove backing from patch and immediately press onto skin. Hold for 10 seconds. Wash hands after applying or removing the patch. Dispose of the used patches by folding sticky ends together and putting in pouch. The used patch should be removed and a new one applied to a different skin site at the same time each day. Do not apply more than one patch at a time. Discontinue use and call provider if an allergic reaction occurs, such as difficulty breathing or rash, or symptoms of nicotine overdose occur, such as nausea, vomiting, dizziness, weakness, and rapid heartbeat. It may also cause vivid dreams or sleep disturbances. If these occurrences occur, clients should be counselled to remove the patch at bedtime and apply a new one in the morning.
Patient Teaching & Education: Emphasize that the client should stop smoking completely while on nicotine replacement therapy to avoid additive nicotine levels higher than smoking alone. Advise clients that participating in a comprehensive smoking cessation program improves success. If using a nicotine patch, client should be aware that skin sensitivity at the site of patch placement typically resolves within one hour.[2]
Alert: Advise client to keep all nicotine products, including used inhaler cartridges, nasal spray bottles, and patches out of the reach of children and pets.
Nicotine Patch Medication Card
Now let’s take a closer look at the medication card on nicotine patch.[3][4] Medication cards assist students to learn key points about each medication class. Basic information related to a common generic medication in this class is outlined, including administration considerations, therapeutic effects, and side effects/adverse effects. Because information about medication is constantly changing, nurses should always consult evidence-based resources to review current recommendations before administering specific medication.
Medication Card 4.6.1: Nicotine Patch (ANS Medications)
Class: Nicotinic Agonist
Prototypes: Nicotine patch
Therapeutic Effects
- Used for nicotine addiction by slowly reducing dose and avoiding withdrawal effects
Administration
- Hazardous drug; use safe handling and disposal precautions
- Check for allergy to adhesives
- Use cautiously in patients with recent myocardial infarction, serious arrhythmias, coronary artery disease, severe or worsening angina, hypertension, vasospastic diseases, or peripheral vascular disease
- Patients taking monoamine oxidase inhibitors (MAOIs) require lower dosage
- Can cause fetal harm
Indications
- aid smoking cessation
- relief of nicotine withdrawal
Side Effects
- rash at site of application
- irregular heart rate/palpitations
- nicotine overdose (see nursing considerations)
Nursing Considerations
- Discontinue use and call provider if:
- Allergic reaction such as difficulty breathing or rash
- Irregular heartbeat or palpitations
- Symptoms of nicotine overdose such as nausea, vomiting, dizziness, weakness, and rapid heartbeat
- ensure client is not smoking while on patch (risk for nicotine overdose)
- UpToDate. (2021). Nicotine: Drug Information. https://www.uptodate.com/contents/search ↵
- uCentral from Unbound Medicine. https://www.unboundmedicine.com/ucentral ↵
- This work is a derivative of Daily Med by U.S. National Library of Medicine in the public domain. ↵
- UpToDate. (2021). Nicotine: Drug Information. https://www.uptodate.com/contents/search ↵