Smoking Cessation

Question 1

1/MOA of Varenicline 
2/When to start? 
3/Caution required with: 
4/Dose reduction with renal failure? 
5/Duration?

Answer 1

1/Partial neural nicotinic receptor agonist

• relieves cravings
• stops reward feeling with smokiing

2/7 days before smoking
–> use it with NRT for best results

3/Caution with:
psychological/ psychiatric disease
cardiovascular disease

4/Renal Impairment - reduce

5/ 4 week script and get back, duration = 12 weeks
–> if successful then further 12 weeks available on PBS to reduce relapse

(RACGP smoking cessation, AMH)

Question 2

Bupropion
MOA
Contraindications
Side effects

Answer 2

1/ unclear: possible noradrenaline and dopamine reuptake inhibitor
2/ History of seizures,
concurrent monoamine oxidase inhibitors
contraindicated in bipolar disorder –> antidepressant effect may precipitate mania

3/ pregnancy

other conditions or drugs that can decrease seizure threshold (brain tumour)

contraindicated in bulimia or anorexia nervosa

4/ insomnia, headaches, dry mouth

(RACGP smoking cessation, AMH)

Question 3

Nicotine Replacement Therapy

Duration

Answer 3

Caution in pregnant women and unstable cardiovascular disease

8-12 weeks