NAPLEX Question of the Week: Smoking Cessation

Pharmacists get questions constantly in the area of smoking cessation. Today's question of the week focuses on this important topic.

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BT is a 38 year old female who presents for yearly annual checkup. Her past medical history is significant for hyperlipidemia, hypertension, epilepsy, GERD, and allergic rhinitis. She is a current smoker and drinks socially. She currently takes atorvastatin 40mg daily, lisinopril 40mg daily, levetiracetam 1000mg twice daily, omeprazole 20mg daily, and loratadine 10mg daily. After discussion with her primary care provider, she agrees to undergo an intensive smoking cessation program including counseling. Which of the following agents would be contraindicated for her smoking cessation?

A. Bupropion

B. Nicotine gum

C. Nicotine patches

D. Varenicline

Answer with Rationale

The correct answer is A. Bupropion is a well known agent used for major depressive disorder under the brand name Wellbutrin. It also is used as a smoking cessation therapy due to its dopamine promoting effects. However, bupropion would not be appropriate for our patient due to their history of epilepsy as this agent could lower the seizure threshold and there are other available agents. All of the other agents listed would be appropriate. Nicotine replacement products including gum, lozenges, and patches are all appropriate and dosed based on amount of nicotine the patient typically consumes daily. Additionally they are available OTC which makes for a lot of pharmacist questions in the community setting.  Monitoring for withdrawal or excessive nicotine effects are important. Varenicline (Chantix) is a nicotinic receptor partial agonist used in the management of smoking cessation. While seizures have been reported in patients receiving Chantix, it is not contraindicated in patients with epilepsy but should be used with caution.

An important principle is that medication alone has a much lower success rate that medication in conjunction with an intensive counseling program. A number of pharmacists are now involved in these clinics providing outstanding care in this disease.

Have a great weekend!

Dr. B

Christopher M. Bland

Clinical Professor, University of Georgia College of Pharmacy

Dr. Christopher M. Bland is a Clinical Professor at the University of Georgia College of Pharmacy at the Southeast GA campus in Savannah, GA. Dr. Bland has over 20 years of academic and clinical experience in a number of clinical areas. He is a Fellow of both the Infectious Diseases Society of America as well as the American College of Clinical Pharmacy. He is co-founder of the Southeastern Research Group Endeavor, SERGE-45, with over 80 practitioners across 14 states involved. Dr. Bland serves as Associate Editor for the NAPLEX Review Guide 4th edition as well as Editor-In-Chief for the Question of the Week. He has provided live, interactive reviews for more than 10 Colleges/Schools of Pharmacy over the course of his career.