A patient who has just found out she is pregnant tells the nurse she wants to quit smoking. She asks about pharmacologic aids to help her quit. The nurse is correct to tell her what?
a. "Nicotine replacement therapy is harmful, but it is safer than smoking, so it can be used."
b. "Psychosocial support is the only recom-mended treatment for smoking cessation during pregnancy."
c. "Varenicline [Chantix] is safe to use dur-ing pregnancy."
d. "You should try to taper off your smoking gradually, because none of the drugs are safe."
A
Because nicotine is a component of nicotine replacement therapy (NRT), NRT is not safe during pregnancy. However, it is safer than smoking, and if it can help the patient stop smoking, it is recommended with caution. Psychosocial support is more effective when combined with a first-line pharmacologic agent. Varenicline has been shown to have harmful effects on fetuses in animal testing, so it should be avoided during pregnancy. Tapering nicotine withdrawal only seems to prolong the withdrawal symptoms; abrupt cessation is better than a taper.
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