Smoking Cessation

Question 1

What are the three first-line pharmacological options for smoking cessation according to NICE (2008)?

Answer 1

Nicotine replacement therapy (NRT), varenicline, and bupropion.

Question 2

How should NRT, varenicline, or bupropion be prescribed in relation to the planned quit date?

Answer 2

As part of a commitment to stop on or before a specific target stop date.

Question 3

How long should the first prescription last?

Answer 3

Until 2 weeks after the target stop date (≈2 weeks for NRT; 3–4 weeks for varenicline/bupropion).

Question 4

When should repeat prescriptions be avoided?

Answer 4

If the quit attempt fails; do not offer a repeat course within 6 months unless special circumstances exist.

Question 5

Can NRT, varenicline, and bupropion be combined together?

Answer 5

No — NICE recommends not combining them.

Question 6

When should combination NRT (patch + short-acting) be offered?

Answer 6

For highly nicotine-dependent smokers or those who failed on single-agent NRT.

Question 7

Common side effects of NRT?

Answer 7

Nausea, vomiting, headaches, flu-like symptoms.

Question 8

Varenicline Mechanism of action?

Answer 8

Nicotinic receptor partial agonist.

Question 9

When should varenicline be started?

Answer 9

1 week before the quit date.

Question 10

Duration of recommended treatment?

Answer 10

12 weeks (continue only if the patient is not smoking).

Question 11

Most common side effect?

Answer 11

Nausea.

Question 12

Other common adverse effects?

Answer 12

Headache, insomnia, abnormal dreams.

Question 13

In which patients should varenicline be used with caution?

Answer 13

Those with a history of depression or self-harm.

Question 14

Is varenicline safe in pregnancy or breastfeeding?

Answer 14

No — contraindicated.

Question 15

Bupropion Mechanism of action?

Answer 15

Norepinephrine–dopamine reuptake inhibitor and nicotinic antagonist.

Question 16

When should bupropion be started?

Answer 16

1–2 weeks before the quit date.

Question 17

Serious adverse effect to remember?

Answer 17

Seizures (risk ≈1 in 1000).

Question 18

Absolute contraindications?

Answer 18

Epilepsy, pregnancy, breastfeeding.

Question 19

Relative contraindication?

Answer 19

Eating disorders.

Question 20

What screening test should all pregnant women undergo?

Answer 20

Carbon monoxide (CO) monitoring.

Question 21

When should women be referred to NHS Stop Smoking Services?

Answer 21

If they smoke, quit within the past 2 weeks, or have CO ≥ 7 ppm.

Question 22

What are the first-line treatments in pregnancy?

Answer 22

CBT, motivational interviewing, structured self-help, NHS Stop Smoking Services.

Question 23

Is NRT allowed in pregnancy?

Answer 23

Yes, if behavioural support fails; safety evidence mixed but acceptable.

Question 24

Important advice for women using NRT patches in pregnancy?

Answer 24

Remove patches at night.

Question 25

Are varenicline and bupropion allowed in pregnancy or breastfeeding?

Answer 25

No — both are contraindicated.