A Pharmacological Approach to Tobacco Cessation in a Patient with Cardiovascular Disease

62-year-old male presents for follow-up in clinic.

PMH: coronary artery disease, hypertension, major depressive disorder (stable).

Allergies: no known drug allergies.

SH: Human resources manager. Smokes 2 ppd x 32 years – smokes within 30 minutes of waking. Denies use of illicit drugs, chewing tobacco, or e-cigarette use. Drinks 1 glass of wine weekly.

Aspirin 81 mg PO daily
Atorvastatin 40 mg PO daily
Metoprolol succinate 25 mg PO daily
Lisinopril 5 mg PO daily
Sertraline 100 mg PO daily

Vitals: BP: 110/68 mm Hg, HR: 64 beats per minute, BMI: 22 kg/m2
Labs: all within normal limits

During the clinician-patient discussion at today's visit, you reassess the patient's nicotine dependence and determine him to have high nicotine dependence. Though refusing to quit at previous visits, you discuss the benefits of smoking cessation and the patient states he is amenable to quitting. He is ready to set a quit date and use behavioral support.

According to the American College of Cardiology (ACC) 2018 Expert Consensus Decision Pathway on Tobacco Cessation Treatment, which one of the pharmacological options should be added at this time to the patient's current regimen to aid in smoking cessation for this patient?

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