On anti-smoking treatment

Q: 52 years old male with history of coronary artery disease (CAD), hypertension (HTN) and childhood seizures is admitted to ICU with status epilepticus. Patient was recently started on anti-smoking treatment by his primary care physician. Which of the following is the probable cause? (select one)

A) Nicotine Replacement Therapy (NRT) 

B) Varenicline

C) Bupropion

D) Vaping

Answer: C

Bupropion reduces the seizure threshold. Although it has been used as an anti-smoking treatment it carries the risk of seizure particularly in patient with seizure history.

NRT is also a common method applied against smoking but because of its  adrenergic and vasoconstrictive properties, it is usually avoided in patients with CAD and HTN.

Varenicline is a good choice in patients with multiple comorbidities like CAD, HTN or seizures.

Vaping is considered even worse than cigarette smoking and should be avoided at all cost.

#neurology

#cardiology

#preventive-medicine

#pharmacology

References:

1. Barua RS, Rigotti NA, Benowitz NL, et al. 2018 ACC Expert Consensus Decision Pathway on Tobacco Cessation Treatment: A Report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents. J Am Coll Cardiol 2018; 72:3332.

2. Meine TJ, Patel MR, Washam JB, et al. Safety and effectiveness of transdermal nicotine patch in smokers admitted with acute coronary syndromes. Am J Cardiol 2005; 95:976.

3. Eisenberg MJ, Windle SB, Roy N, et al. Varenicline for Smoking Cessation in Hospitalized Patients With Acute Coronary Syndrome. Circulation 2016; 133:21.

4. Eisenberg MJ, Grandi SM, Gervais A, et al. Bupropion for smoking cessation in patients hospitalized with acute myocardial infarction: a randomized, placebo-controlled trial. J Am Coll Cardiol 2013; 61:524.