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Smoking Cessation: Pharmacotherapy Review

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Avoid patch use due to past medical history

What is the capital of Bulgaria?

1. Which of the following is considered the preferred analgesic for use during pregnancy?

2 mg lozenge every 1-2 hours as needed for cravings

4 mg lozenge every 1-2 hours as needed for cravings

2 mg lozenge every 10-20 minutes as needed for cravings

4 mg lozenge every 10-20 minutes as needed for cravings

2. PH is a 55-year-old patient interested in smoking cessation. He reports wanting to try the nicotine lozenges for his quit attempt, because one of his friends was successful with quitting when using lozenges to assist. He has a history of insomnia and COPD but otherwise reports no other significant past medical history. He smokes two (2) packs of cigarettes per day and has his first cigarette an hour after he wakes up after breakfast. 

According to manufacturer prescribing guidance, which of the following would be the best initial dosing of the nicotine lozenges to recommend?

3. Which of the following smoking cessation pharmacotherapies may be most appropriate to combine with nicotine patches to improve the efficacy for a possible quit attempt barring any contraindications to therapy? 

Select all that apply.


5. Which organism is the most common cause of urinary tract infections?

A possible side effect of varenicline therapy is vivid dreams, which may make it more difficult to sleep at night

There is an increased risk of neuropsychiatric disorders with varenicline therapy in comparison to other treatments, contact your medical provider if you experience any changes in your mood

There is an increased risk of seizures with varenicline therapy in comparison to other treatments, contact your medical provider if you have a history of seizure disorders

All of the above are appropriate counseling points for varenicline therapy

5. Which of the following therapies require dose reduction in a patient with a chronic kidney disease (CrCl <30 ml/min)?

6. Which of the following monotherapy options for tobacco cessation has demonstrated the highest effectiveness in cessation success?

7. ST is a 67 year-old male who comes to a clinic to see his primary care physician with an interest in quitting smoking and finding an appropriate pharmacologic agent to assist his attempt. He reports his depression often prevents him from staying motivated to completely quit smoking. He rates his current depression control as ‘moderately-controlled’ per his PHQ-9 score of 10 (improved from 17 when checked 2 years  ago). His current medications include metformin, atorvastatin, aspirin, sertraline, and fexofenadine. 

Which of the following medications would be most appropriate for JC based on this information?

8. RK is a 72 year-old male who comes to the clinic to see his primary care physician with an interest in quitting smoking and finding an appropriate pharmacologic agent to assist his attempt. He reports his depression often prevents him from staying motivated to completely quit smoking. He rates his current depression control as ‘moderately-controlled’ per his PHQ-9 score of 10. His current medications include metformin, rosuvastatin, diclofenac gel, and duloxetine. He would like to try to use a medication that is most likely to be effective in his quit attempt.  He reports already trying a medication called Zyban about 20 years ago without success. 

Which of the following medications would be most appropriate for JC based on this information?

The 5 Rs (Risks, Rewards, Relevance, Roadblocks, Repetition)

The 5 As (Ask, Advise, Assess, Assist, Arrange)

The 5 Ts (Teach, Train, Tell, Test, Treat)

9. When initially counseling a patient on tobacco cessation, which of the following steps should be used to determine smoking status, a patient's willingness to quit, current understanding of smoking risks/benefits, and therapy considerations?