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Old 12-02-2011
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ObGyn Asthmatic pregnant for smoking cessation

A 23-year-old woman who is 10 weeks pregnant with her first pregnancy is referred to you for smoking cessation. She has been smoking since the age of 21 and has never tried to quit. However, now that she is pregnant she would really like to quit. She has no symptoms of depression. Her past medical history is significant for asthma. She uses an inhaler occasionally for her asthma and takes no other medications. She has never had surgery and has no known drug allergies. Physical examination is normal for a patient at 10 weeks’ gestation. Which of the following is the most appropriate management for this patient?

A. Address smoking cessation after delivery
B. Prescribe bupropion
C. Prescribe fluoxetine
D. Prescribe the nicotine patch
E. Refer for smoking cessation counseling
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Old 12-02-2011
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reffer for smoking cessation counseling?
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Old 12-02-2011
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E. Refer for smoking cessation counseling
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Old 12-02-2011
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E. counselling seems to be the safest option

but studies have shown safety of Bupropion use in pregnancy. Only problem is when a pregnant woman has previous history of Preeclampsia or eclampsia..avoid using it.
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Old 12-02-2011
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In this case counseling seems better option ,but i will go with B. Prescribe bupropion
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Old 12-02-2011
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i think it should be > B. Prescribe bupropion
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Old 12-03-2011
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bupropion.


counselling would take time and she needs immediate cessation
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Old 12-03-2011
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bupropion is the choice...its in FDA pregnancy category C...
but bupropion is contraindicated in nursing mother.
taking the detail history of patient to rule out any history of seizures esp. n its important to have frequent visits of pt to check for side effects of the drug on her such as suicidal ideation...
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Old 12-04-2011
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The correct answer is E. Smoking during pregnancy is a major problem in the United States. Estimates are that 15 to 30% of women smoke during pregnancy. Those women who do smoke have an increased risk of maternal, fetal, and infant complications. Complications include increased rates of ectopic pregnancy, preterm birth, intrauterine growth restriction (IUGR), placenta previa, and placental abruption. Infants of mothers who smoke have increased rates of sudden infant death syndrome (SIDS), hospitalization, and neurodevelopmental abnormalities. Thus, it is essential to try to decrease the rates of smoking during pregnancy,
Prescribing bupropion (choice B) would be premature at this point. Bupropion has been shown to help increase quit rates in patients who use it to help stop smoking. However, this patient is pregnant, and if she is able to quit through nonpharmacologic methods, then that is the ideal. These nonpharmacologic methods should be tried before initiating drug therapy.
Prescribing fluoxetine (choice C) would be incorrect. Fluoxetine is often used during pregnancy, but this patient is not suffering from depression. Smoking cessation is the desire and goal for her. This is often achieved through counseling.
Prescribing the nicotine patch (choice D) would be premature at this point. Nicotine replacement has been shown to help increase quit rates. However, nicotine replacement will result in a fetal exposure to nicotine. It is preferred that the patient tries to quit with nonpharmacologic means before starting nicotine replacement.
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