Question of the Week # 271

271 )  A 52 year old man is distressed about his inability to quit smoking despite several office-based counseling and telephone counseling sessions. He has tried alternative therapies such as hypnosis and acupuncture without any benefit. His history is significant for severe depression for which he has been on treatment with Fluoxetine. He was recently diagnosed with coronary artery disease and had a stent placed 4 months ago. He understands that his smoking behavior greatly increases his risk of having a coronary event. He says he feels increasingly depressed about his inability to quit smoking. He denies any suicidal ideation. Which of the following is the most appropriate recommendations for this patient?

A) Nicotine replacement therapy

B) Varenicline

C) Buporopion

D) Rimonabant

E) Group therapy

9 Responses

  1. C) Buporopion

  2. C

  3. B

  4. C

  5. C……Bupropion,is a safe and effective, non-nicotine treatment for smoking which lessens withdrawal symptoms, prevents weight gain and improves mood in most patients

  6. Rimonabant (anorectic antiobesity drug) is not in US market and withdrawn from European market.

  7. ans : bupropion .

    Patient has concomitant depression . Adding another SNRI might help since the vignette mention that he’s been even more depressed with his inability to stop smoking .

    Does bupropion prove superior than nicotine patch ??

    Verenicline would not be the answer : increased suicidal ideation and increased cardiovascular adverse effects . This patient has CAD + stent .

    just my 2cents .

    • Nicotine, bupropion, and verenicline are first line drugs for the smoking cessation. They are not mentioned one is superior to another. Choose according to their side effect.

      • Actually, the order is varenicline > buproprion > nicotine gum/patches in order of effectiveness. However, this patient has a contraindication to varenicline so the next best thing is buproprion.

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