From the Guidelines
The incorrectly matched statement is "Varenicline (Chantix) improving depressive symptoms precipitated by quitting." Varenicline actually carries a risk of worsening mood and causing depressive symptoms in some patients who are trying to quit smoking, as noted in the guidelines 1. In fact, it has a boxed warning for neuropsychiatric side effects including depression, suicidal ideation, and mood changes. The other statements are correctly matched:
- Nicotine does bind to mesolimbic α4β2 nicotinic receptors (which is key to its addictive properties)
- Smoking does enhance the release of acetylcholine and norepinephrine in the brain
- Nicotine replacement therapy does have a long safety record spanning decades of clinical use, with studies showing its efficacy and safety 1. When prescribing varenicline for smoking cessation, it's essential to monitor patients for mood changes, especially those with pre-existing psychiatric conditions, and to discontinue the medication if concerning neuropsychiatric symptoms develop. Key points to consider when using varenicline include its efficacy in smoking cessation, potential side effects, and the importance of patient monitoring, as outlined in recent guidelines and studies 1.
From the FDA Drug Label
Varenicline binds with high affinity and selectivity at α 4β 2 neuronal nicotinic acetylcholine receptors. The statement that is incorrectly matched is:
- A Nicotine: Binds to the mesolimbic a4ß2 subtype of Nicotinic Receptor (Nn) is correct as the drug label for Varenicline mentions that it binds to α 4β 2 neuronal nicotinic acetylcholine receptors, and nicotine also binds to these receptors.
- B Smoking: Enhances the release of Ach and norepinephrine is correct, but the label does not provide information about this.
- C NRT: Long safety record is correct, but the label does not provide information about this.
- D Varenicline: Improving depressive symptoms precipitated by quitting is not supported by the label, which does not mention improving depressive symptoms. The FDA drug label does not answer the question about NRT and smoking, but it does provide information about Varenicline and nicotine binding to α 4β 2 receptors. The correct answer is D, as the label for Varenicline does not mention improving depressive symptoms precipitated by quitting 2.
From the Research
Incorrectly Matched Statement
The following statements are correctly matched except for one:
- A Nicotine: Binds to the mesolimbic a4ß2 subtype of Nicotinic Receptor (Nn)
- B Smoking: Enhances the release of Ach and norepinephrine
- C NRT: Long safety record
- D Varenicline: Improving depressive symptoms precipitated by quitting
Analysis of Options
- Option A is correct as nicotine does bind to the mesolimbic a4ß2 subtype of Nicotinic Receptor (Nn) 3.
- Option B is correct as smoking does enhance the release of Ach and norepinephrine.
- Option C is correct as NRT has a long safety record 3, 4.
- Option D is incorrect as varenicline has been associated with depressive symptoms and suicidal behavior, rather than improving them 3, 4, 5, 6, 7.
Correct Answer
The correct answer is D Varenicline: Improving depressive symptoms precipitated by quitting, as varenicline has been linked to an increased risk of depression and suicidal behavior, rather than improving depressive symptoms 4. Some studies suggest that varenicline may be well-tolerated and effective for smoking cessation in certain populations, such as those with schizophrenia 5, and may even have cognitive-enhancing effects 7. However, the overall evidence suggests that varenicline is not associated with an improvement in depressive symptoms, but rather an increased risk of depression and suicidal behavior 3, 4, 6.
Key Points
- Nicotine binds to the mesolimbic a4ß2 subtype of Nicotinic Receptor (Nn) 3.
- Smoking enhances the release of Ach and norepinephrine.
- NRT has a long safety record 3, 4.
- Varenicline is associated with an increased risk of depression and suicidal behavior, rather than improving depressive symptoms 3, 4, 5, 6, 7.