Smoking Cessation

Question 1

Nicotine Replacement Therapy (NRT)

Answer 1

Smoking Cessation
MOA
• Nicotine binds to nicotinic receptors
• Leads to release of dopamine and reinforcing effects
ADE
• NRT may affect HR and BP
• Dizziness, headaches
o Skin irritation, trouble sleeping (patch)
o Mouth soreness, taste changed, GI upset (gum, lozenge)
D/I
o Smoking induces CYP 1A2
o Nicotine effects (BP, HR, etc)

Question 2

Varenicline (Chantix®)

Answer 2

Smoking Cessation
MOA
• α4β2 nicotinic acetylcholine receptor partial agonist
ADE
• Nausea, gas, constipation, vomiting
• Sleep changes
• Cardiovascular concerns, hypersensitivity reactions
D/I
o Minimal
o Avoid combining with NRT

Question 3

Bupropion (Zyban®)

Answer 3

Smoking Cessation
MOA
• NE/DA reuptake inhibitor
• Not fully understood, NE effects may decrease withdrawal while DA effects may augment the rewarding feelings
ADE
• Dry mouth, insomnia, NE/DA effects, decreased appetite
• Increased risk seizures
BLACK BOX
- neuropsychiatric symptoms
o Avoid in patients at risk for seizure
D/I
- avoid with MAOIs or other sources of bupropion