Paper I
2019 February (2010 Scheme) · 40 marks · 120 min

Question

Treatment of smoking cessation

Q43 marksShort Notes

Answer

Smoking cessation therapy aims to relieve nicotine withdrawal symptoms and reduce craving.

Nicotine replacement therapy

  • Nicotine gum, patch, lozenge — provide controlled nicotine delivery without the harmful combustion products of tobacco, gradually tapered

Non-nicotine drugs

  • Bupropion: Atypical antidepressant (dopamine/noradrenaline reuptake inhibitor) that reduces craving and withdrawal symptoms
  • Varenicline: Partial agonist at nicotinic acetylcholine receptors (α4β2 subtype) — reduces craving (partial agonist effect) and blocks the rewarding effect of nicotine if the patient resumes smoking (antagonist effect at the receptor when nicotine is present)

Behavioural support

  • Counselling and behavioural therapy combined with pharmacotherapy significantly improve success rates

Adverse effects

  • Bupropion: seizures (lowers seizure threshold), insomnia
  • Varenicline: nausea, vivid dreams, neuropsychiatric effects (monitored)

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