4.5 Nicotine Receptor Agonists

A nicotine patch is a nicotine receptor agonist.

Mechanism of Action: Nicotine binds to and activates nicotinic acetylcholine receptors, mimicking the effect of acetylcholine at these receptors.

Indications: 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: 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. Save pouch to use for patch disposal. 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 wear more than one patch at a time. The patch may also cause vivid dreams or sleep disturbances. If these side effects occur, clients should be counseled to remove the patch at bedtime and apply a new one in the morning. Clients should also be counseled to not concurrently use other nicotine products due to potential toxicity.

Side Effects/Adverse Effects: Discontinue use and call provider if an allergic reaction occurs, such as difficulty breathing or rash, or if symptoms of nicotine overdose occur, such as nausea, vomiting, dizziness, weakness, and rapid heartbeat. Individuals may also experience vivid dreams or sleep disturbances.

Health Teaching & Health Promotion: 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, clients should be aware that skin sensitivity at the site of patch placement typically resolves within one hour.^[1]

Alert: Advise the client to keep all nicotine products, including used patches, out of the reach of children and pets.

Now let’s take a closer look at the medication grid on nicotine patch in Table 4.5.^[2] Medication grids 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. Prototype/generic medication listed in the medication grid is also linked directly to a free resource from the U.S. National Library of Medicine called DailyMed. Because information about medication is constantly changing, nurses should always consult evidence-based resources to review current recommendations before administering specific medication.

Table 4.5 Nicotine Patch Medication Grid