Smoking

Question 1

A 46-year-old male comes to your office to discuss smoking cessation. You have advised him to quit smoking at past visits, and after several months of contemplation he is now ready to address this problem. He has smoked 1 pack of cigarettes per day for the past 25 years. He is highly motivated and wants to use the most effective regimen.

In addition to behavioral counseling, which one of the following interventions is associated with the most successful outcome? (check one)
“Cold turkey” nicotine withdrawal
Electronic nicotine delivery systems
Hypnotherapy
Clonidine (Catapres)
Varenicline (Chantix)

Answer 1

Varenicline (Chantix)

The U.S. Preventive Services Task Force (USPSTF) recommends that clinicians screen all adults for tobacco use, advise smoking cessation, and provide behavioral therapy and FDA-approved pharmacotherapy if appropriate (A recommendation). Varenicline is an FDA-approved pharmacotherapy that is an effective option for smoking cessation with or without behavioral therapy. Although clonidine has been used for smoking cessation it is considered a second-line agent and is not FDA approved for smoking cessation. The USPSTF concluded that there was not enough evidence on the effect on smoking cessation to recommend an electronic nicotine delivery system (I recommendation). Abrupt and complete (“cold-turkey”) nicotine withdrawal is less effective than pharmacotherapy (nicotine replacement therapy, bupropion hydrochloride, and varenicline). There is a lack of evidence regarding the efficacy of hypnotherapy.

Question 2

A 42-year-old male sees you for help to quit smoking. His sister had excellent results with bupropion (Zyban) and he asks if he could try using it.
When you review his medical history, which one of the following would be a contraindication to bupropion?
(check one)
Diabetes mellitus
Gout
Hypertension
Hyperthyroidism
A seizure disorder

Answer 2

A seizure disorder

Bupropion can lower the seizure threshold and should not be used in patients who have a history of a seizure disorder or who drink heavily. A history of the other medical conditions listed does not contraindicate the use of bupropion.

Question 3

A rural community college has requested your guidance in offering a preventive health program to its students. The most appropriate plan would include which one of the following? (check one)
Mammograms for female students
Lead poisoning screening for all students
Stool occult blood kits for all students
Smoking cessation programs for students who smoke
An annual routine physical examination for all students

Answer 3

Smoking cessation programs for students who smoke

The U.S. Preventive Services Task Force does not recommend routine physical examinations but recommends blood pressure screenings every 3–5 years for adults 18–39 years of age who are at low risk for hypertension. Mammograms are not recommended until age 40. Lead screening is recommended for at-risk individuals between 6 months and 6 years of age. Colorectal cancer screening for average-risk individuals is recommended at age 45. Counseling on tobacco use and other substance abuse is recommended as part of all routine preventive care.

Question 4

Which one of the following is the greatest risk factor for abdominal aortic aneurysm (AAA)? (check one)
Male sex
Female sex
White race
A long duration of smoking
Having a first degree relative with an AAA

Answer 4

A long duration of smoking

The following factors have been found to increase the risk for developing an abdominal aortic aneurysm
(AAA): a history of smoking, advanced age, above-average height, having a first degree relative with an
AAA, a personal history of atherosclerosis, high cholesterol levels, and hypertension. Smokers have a
seven times greater risk of developing an AAA compared with nonsmokers. This single factor outweighs
all of the other risk factors except age. Although women are less likely to develop an AAA, they have a
2–3 times greater chance of an AAA rupturing if it is present.
In addition to significantly increasing the risk for AAA development, current smoking increases the risk
for further AAA expansion and rupture. Epidemiologic studies suggest that the duration of smoking
influences the risk for AAA significantly more than the total number of cigarettes smoked. The U.S.
Preventive Services Task Force currently recommends one-time screening for AAA in males between the
ages of 65 and 75 who have ever smoked (B recommendation). There was not enough evidence to
determine the risk and benefits of screening females with the same risk factors (I recommendation).