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.

Now let’s take a closer look at the medication card on nicotine patch in Table 4.6.^[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.

Table 4.6 Nicotine Patch Medication Card