Review Question - QID 105783

Bupropion (Zyban) is an atypical antidepressant medication and smoking cessation aid. As a smoking cessation aid, it is best utilized in conjunction with nicotine replacement and cognitive behavioral therapy.

Smoking is the most important modifiable risk factor for cancer, cardiovascular, and pulmonary disease in the United States. Physicians should screen all patients for tobacco use and discuss smoking cessation options. Common smoking cessation aids include bupropion, varenicline, nicotine replacement, and cognitive behavioral therapy (CBT). Bupropion is thought to aid in smoking cessation by reducing nicotine cravings. It is important to note that bupropion is contraindicated in patients with a history of seizure disorder, eating disorder, or who have recently used monoamine oxidase inhibitor

Larzelere and Williams discuss the process of smoking cessation and the role of the physician in screening and treatment. They promote the use of the five A’s framework in order to encourage smoking cessation. The five A's involves Asking the patient about tobacco use, Advising the patient to quit smoking, Assessing the willingness of the patient to quit, Assisting the patient in quitting (through the use of counseling and therapeutic measurements), and Arranging close follow-up to monitor progression.

Wu et al. review the relative effectiveness of nicotine replacement therapy, bupropion, and varenicline as smoking cessation therapies. They found that each of the three therapies were useful in improving smoking cessation relative to placebo both in the short term and the long term. They suggest that, since the three modalities have different mechanisms of action, it would be possible to use these agents either in combination or as targeted therapies.

Illustration A depicts an artist's rendering of the mechanism of action of bupropion, which is believed to be via the inhibition of dopamine and noradrenalin reuptake.

Incorrect answers:
Answers 1: Quitting 'cold-turkey' has not been found to be as effective as combined therapy with bupropion in conjunction with nicotine replacement and cognitive behavioral therapy.
Answer 3: Although bupropion is an effective smoking cessation aid, combined therapy is more effective than bupropion alone.
Answer 4: Although a support group may be a useful for some patients, cognitive behavioral therapy is recommended as a counseling modality for smoking cessation.
Answer 5: Although nicotine replacement therapy is an effective smoking cessation aid, combined therapy is more effective than nicotine replacement therapy alone.