Addiction Medicine Board Review Sample Questions

The correct answer is D. Varenicline should be continued, the patient should continue to call 1 800 QUIT NOW, and nicotine replacement therapy should be added to his regimen.

(D) Varenicline should be continued, the patient should continue to call 1 800 QUIT NOW, and nicotine replacement therapy should be added to his regimen.

Explanation: Smoking cessation is managed with a combination of pharmacotherapy and behavioral modification. The patient has been using the 1-800 QUIT NOW hotline and taking varenicline. Management options in patients who are unable to stop smoking despite optimal first line therapy include adding another first line agent, adding nortriptyline, or discontinuing the current drug and starting nortriptyline. The best answer here is d.1 (A) INCORRECT. Answer choice a is incorrect. The patient is unable to quite despite behavioral intervention and use of varenicline. He should not continue the same management. D is the best choice. 1 (B) INCORRECT. Answer choice b is incorrect. In patients who are unable to stop using tobacco products despite adequate pharmacologic and behavioral intervention, combination therapy is recommended. Thus, the patient should not discontinue varenicline and start bupropion as a monotherapy. 1 Bupropion can be added to varenicline in those with trouble quitting, but this is not an answer choice (C) INCORRECT. Answer choice c is incorrect. This is not the best answer. In those who are unable to stop using tobacco products despite an adequate trial of combination behavioral and pharmacological monotherapy, the addition of another pharmacological agent is recommended. The patient can add nicotine replacement therapy but should continue the varenicline.