A 63-year-old man with a history of chronic obstructive pulmonary disease comes to the physician for a follow-up visit. He uses a tiotropium inhaler daily and his pulmonary symptoms are sufficiently controlled. During a previous visit, he was counseled on the benefits of smoking cessation. He reports that despite trying he has been unable to stop smoking due to overwhelming cravings. The physician prescribes a drug that reduces nicotine cravings while decreasing the pleasurable effects of cigarettes and other tobacco products. Which of the following medications was most likely prescribed to the patient?

Question

A 63-year-old man with a history of chronic obstructive pulmonary disease comes to the physician for a follow-up visit.  He uses a tiotropium inhaler daily and his pulmonary symptoms are sufficiently controlled.  During a previous visit, he was counseled on the benefits of smoking cessation.  He reports that despite trying he has been unable to stop smoking due to overwhelming cravings.  The physician prescribes a drug that reduces nicotine cravings while decreasing the pleasurable effects of cigarettes and other tobacco products.  Which of the following medications was most likely prescribed to the patient?

Quizplus · Accepted Answer

11ec160b_3c65_36f9_9249_9d478aa0620f_MD0001_00 The reinforcing effects of nicotine that lead to dependence are thought to be caused by stimulation of the α₄β₂-nicotinic acetylcholine receptor present in the central nervous system. Varenicline is a partial agonist of this receptor that competes with nicotine (a full agonist) and prevents it from binding. Because varenicline is a partial agonist, it helps reduce the symptoms of nicotine withdrawal by mildly stimulating the receptor. Its partial agonist activity only causes limited downstream release of dopamine, resulting in less stimulation of the reward pathways than nicotine (Choice C). Varenicline can thus assist patients with cessation of tobacco use by reducing withdrawal cravings and attenuating the rewarding effects of nicotine. (Choices A and B) Selective serotonin reuptake inhibitors (eg, fluoxetine) and benzodiazepines (eg, clonazepam) have not been shown to be effective for smoking cessation. (Choice D) Topiramate is an anticonvulsant used to treat epilepsy in children and adults. Topiramate is also an effective medication for migraine prophylaxis. However, it is not used for smoking cessation. Educational objective: Varenicline is a partial agonist of nicotinic acetylcholine receptors. It can assist patients with cessation of tobacco use by reducing withdrawal cravings and attenuating the rewarding effects of nicotine.

A 63-Year-Old Man with a History of Chronic Obstructive Pulmonary