Question of the Week # 272

272 ) A 58 year old man with history of chronic obstructive pulmonary disease and seizure disorder is evaluated in your office during a follow-up visit. He uses tiotropium inhaler on a daily basis and his pulmonary symptoms are adequately controlled. However, he reports inability to comply with smoking cessation recommendations. He has tried counseling sessions and Nicotine replacement therapy in the past without any success. The patient has been counseled again during this visit. Which of the following recommendations is most appropriate for this patient?

A) Nortriptyline

B) Varenicline

C) Bupropion and Telephone Counseling

D) Group therapy

E) Topiramate

8 Responses

  1. B) Varenicline

  2. C) Bupropion and Telephone Counseling

  3. C.bupropion and telephone counselling

  4. B. Bupropion is contraindicated with seizure disorder.

  5. B…….Two systematic reviews and meta-analyses supported by unrestricted funding from Pfizer, one in 2006 and one in 2009, found varenicline more effective than NRT or bupropion

    Group or individual counseling can help people who want to quit. Counseling is effective alone; counseling and medication is more effective than medication alone (and conversely, medication and counseling is more effective than counseling alone); and the number of sessions of counseling with medication correlates with effectiveness

  6. For questions like this..
    1. If seizure disorder…could go for patch or vernicline, as buproprion is contraindicated.
    2. if depression/suicidal patient…could go for patch or buproprion, since vernicline is contraindicated

  7. bbb

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