NAPLEX® Review Question of the Week: Clearing the Air
PB is a 31-year-old male who presents to your pharmacy to discuss smoking cessation. He expresses his frustrations at checkout stating that he had been taking Zyban for smoking cessation, and he didn’t feel like it was working for him so he stopped therapy with consultation with his provider. He has tried both the nicotine gum and the patch in the past and is not interested in trying these again.
PMH:
Nicotine dependence
Hypertension
Current Medications:
Edarbyclor 40mg/25mg PO daily
PB mentions his friend used Chantix to help him quit smoking and wants to know more about it.
Which of the following is true regarding Chantix?
A. Chantix is a partial nicotinic receptor antagonist
B. Chantix unlike Zyban is not associated with seizures
C. Chantix should be started 7 days prior to the patient’s quit date
D. Chantix is contraindicated in patients with kidney impairment
Answer with rationale
Smoking tobacco is the leading cause of preventable disease and death, and 1 in 5 adults still use tobacco products. With tobacco’s widespread use and e-cigarettes rapidly on the rise, Pharmacists should be able to confidently counsel patients on smoking cessation and the cessation aid options that are available. Chantix binds to nicotine receptors and still triggers some dopamine release, so patients experience less withdrawal symptoms. Unlike nicotine replacement therapy, it is available by prescription only. Chantix has a warning/precaution surrounding neuropsychiatric events, so be sure to counsel patients to notify their HCP if they experience changes in mood, agitation, suicidal ideation, etc. Let's go through each answer choice to see which one is correct.
Answer A is incorrect. Chantix is a partial nicotinic receptor agonist. It binds to nicotine receptors and stimulates a biological response, unlike receptor antagonists. It stimulates the release of dopamine, just to a lesser degree than nicotine itself.
Answer B is incorrect. Chantix like Zyban has been associated with seizures. Chantix should be used cautiously in patients with a history of seizures or other factors that can lower the seizure threshold.
Answer C is correct. It takes about 4 days for steady-state to be achieved. Therefore, it is recommended for patients to start taking Chantix 7 days prior to their quit day to allow the medication to be fully effective before they stop smoking.
Answer D is incorrect. Patients with kidney impairment are able to take Chantix. There are no dose adjustments in patients with CrCl ≥ 30 ml/min, and in patients with CrCl < 30 ml/min, the maximum maintenance dose is reduced to 0.5mg PO BID. If a patient has ESRD and is on hemodialysis, their maximum dose should be 0.5mg PO daily.
Brand/generic: Chantix (varenicline), Edarbyclor (azilsartan/chlorthalidone), Zyban (bupropion SR)
NAPLEX Content Domains Covered:
1.A.1 Pharmacology
1.A.2 Pharmacokinetics and pharmacodynamics
2.A.5 Safety and effectiveness
3.C.2 Appropriateness of therapy
3.E.2 Patient education on medication use
4.B Public health initiatives (eg, tobacco and nicotine cessation)
Dr. Christopher M. Bland is the Albert W. Jowdy Professor in Pharmacy Care at the University of Georgia College of Pharmacy at the Southeast GA campus in Savannah, GA. Dr. Bland has nearly 25 years of academic and clinical experience both in the inpatient and community patient care settings. He is a Fellow of both the Infectious Diseases Society of America as well as the American College of Clinical Pharmacy and has been named Teacher of the Year at the University of Georgia College of Pharmacy. He is co-author of the book "InteGREAT: A Guidebook for Creating Great Healthcare Teams."
He is co-founder of the Southeastern Research Group Endeavor, SERGE-45, with nearly 100 practitioners across 14 states involved. Dr. Bland serves as Associate Editor for the NAPLEX Review Guide 4th edition as well as upcoming 5th edition, as well as the Editor-In-Chief for the Question of the Week. He has provided hundreds of hours in live, interactive NAPLEX reviews for more than 10 Colleges/Schools of Pharmacy over the course of his career.
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