331.2 🩺 國考版

331.2.1 高頻考點

331.2.1.1 5A’s

  • Ask
  • Advise
  • Assess
  • Assist
  • Arrange

331.2.1.2 5R’s

  • Relevance
  • Risks
  • Rewards
  • Roadblocks
  • Repetition

331.2.1.3 Stages of Change

  • Precontemplation
  • Contemplation
  • Preparation
  • Action
  • Maintenance
  • Relapse

331.2.1.4 First-Line Pharmacotherapy

  • Varenicline (partial agonist) — most effective
  • NRT (patch + short-acting combination)
  • Bupropion (NDRI)

331.2.1.5 Varenicline

  • α4β2 nicotinic partial agonist
  • 0.5 mg × 3d → 1 mg BID × 12 weeks
  • Side effects: nausea, vivid dreams
  • EAGLES trial: no excess neuropsychiatric risk

331.2.1.6 NRT

  • Patch + gum/lozenge combination most effective
  • Cravings + withdrawal symptoms

331.2.1.7 Bupropion

  • NDRI
  • Avoid if: seizure, eating disorder, alcohol withdrawal
  • 150 mg daily × 3 d → 150 mg BID × 12 weeks

331.2.1.8 Cytisine

  • Plant-derived α4β2 partial agonist
  • Cheaper than varenicline
  • FDA approval pending 2024-2025

331.2.1.9 Combination Therapy

  • Pharmacotherapy + behavioral = best
  • NRT patch + gum/lozenge: more effective than single
  • Varenicline + NRT: synergistic, selected use

331.2.1.10 Behavioral Support

  • CBT
  • Motivational interviewing
  • Telephone quitlines
  • Text messaging
  • Mobile apps

331.2.1.11 E-Cigarettes

  • Harm reduction tool (controversial)
  • Less toxic than combustible
  • EVALI concern (vitamin E acetate)
  • Not first-line cessation
  • Selected for refractory smokers

331.2.1.12 Special Populations

  • Pregnancy: NRT may be considered
  • CV disease: varenicline safe (EAGLES, CATS)
  • Mental health: integrated treatment
  • Adolescents: counseling primarily
  • Cancer survivors: critical

331.2.2 易混淆比范

Agent Mechanism Efficacy Avoid If
Varenicline α4β2 partial agonist High (most effective single) Severe psychiatric
NRT Nicotine replacement High (with combination) Severe MI recent
Bupropion NDRI Moderate Seizure, eating disorder
Cytisine α4β2 partial agonist Comparable to varenicline Future FDA
Combination NRT Two products Higher than single —
Varenicline + NRT Combination Synergistic —

331.2.3 Special Topics

331.2.3.1 EAGLES Trial

  • Varenicline, bupropion, NRT vs placebo
  • Effective vs placebo
  • No excess neuropsychiatric events with varenicline
  • Practice-changing (removed FDA boxed warning 2016)

331.2.3.2 Pre-Op Cessation

  • ≥ 4-8 weeks before surgery
  • Reduces complications
  • NRT acceptable

331.2.3.3 Lung Cancer Cessation

  • Improves treatment response
  • Improves 5-year survival 30-50%
  • All lung cancer patients