Respiratory medicine: varenicline: practice question

A General Medicine question in the style of the NEET PG paper. Answer it first, then read why the right option is right and why each of the others is wrong.

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General Medicine · Respiratory medicine: varenicline

Sample item

A 45-year-old smoker wants to quit. He failed with nicotine patches previously and is prescribed varenicline. How does this drug act?

Original practice item, not a recalled exam question. Nothing here is recorded.

The answer and the reasoning

D. Partial agonist at alpha-4 beta-2 nicotinic receptors

Varenicline is a partial agonist at alpha-4 beta-2 nicotinic receptors. It relieves craving and withdrawal through modest dopamine release while blocking the reward from smoked nicotine. Bupropion works by blocking dopamine and noradrenaline reuptake.

Option by option

  • A. Full agonist at muscarinic M1 receptors

    Muscarinic M1 stimulation is not the basis of smoking cessation therapy.

  • B. Antagonist at cannabinoid CB1 receptors

    CB1 antagonism was the mechanism of rimonabant, which is no longer used.

  • C. Blocks dopamine and noradrenaline reuptake

    Reuptake blockade of dopamine and noradrenaline is the action of bupropion.

  • D. Partial agonist at alpha-4 beta-2 nicotinic receptors (correct)

    Correct. Partial agonism eases craving and blunts the reward from smoking.

Source note: Original NextPrep sample item — pending expert review. This item is original practice material awaiting independent expert review, so confirm important facts in a standard textbook.

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Questions about this General Medicine question

What is the answer to this General Medicine question?

The best answer is D, Partial agonist at alpha-4 beta-2 nicotinic receptors. Varenicline is a partial agonist at alpha-4 beta-2 nicotinic receptors.

Why is "Full agonist at muscarinic M1 receptors" not the answer?

Muscarinic M1 stimulation is not the basis of smoking cessation therapy.

Why is "Antagonist at cannabinoid CB1 receptors" not the answer?

CB1 antagonism was the mechanism of rimonabant, which is no longer used.

Why is "Blocks dopamine and noradrenaline reuptake" not the answer?

Reuptake blockade of dopamine and noradrenaline is the action of bupropion.

What concept does this question test?

It tests Respiratory medicine: varenicline in General Medicine. It relieves craving and withdrawal through modest dopamine release while blocking the reward from smoked nicotine. Bupropion works by blocking dopamine and noradrenaline reuptake.

How hard is this question?

We tag it as an application question: it asks you to use a fact on a patient or a finding. The tag is our own editorial judgement, not an official difficulty rating, so read the reason for every option, not only the answer.

How should I study Respiratory medicine: varenicline?

For each disease know the classic presentation, the best test, and the first-line treatment. Then use the flashcards and the other General Medicine questions on this site to test what stuck.

Is this a real NEET PG question?

No. It is an original practice item (editorial status: sample, version 1). NextPrep does not publish recalled or leaked questions, and independent faculty review of this item has not been completed yet, so confirm important facts in a standard textbook.