Varenicline, despite a warning removed in 2016: for a composite smoker with schizophrenia, the MN665 comparison finds its abstinence advantage outweighs nausea and vivid dreams. Searches like "mn 665 unit 3 assignment example", "mn665 unit 3 sample" and "mn665 unit 3 example" land here.
Varenicline, Bupropion or Combination Nicotine Replacement for a Smoker With Stable Schizophrenia
[Student Name]
Purdue University Global
MN665: PMHNP Diagnosis and Management Across the Lifespan II
Unit 3 Assignment
[Instructor Name]
[Date]
Composite patient written as a model document. Doses are bracketed; nothing here is a prescribing instruction.
The Patient and the Question
A composite 46-year-old man with schizophrenia has been stable for six years on olanzapine at a [composite dose], living in supported housing and working part time at a grocery warehouse. He smokes about 30 cigarettes a day and has since he was 17. Two months ago his older brother, also a heavy smoker, had a heart attack at 51, and he now says he wants to quit "for real this time." He has tried twice before with patches alone and lasted about a week each time. He has no history of seizures, his blood pressure is 128/80, and he had a depressive episode nine years ago that resolved. He had nausea with an earlier medication. His case manager, who has known him for years, remembers that varenicline once carried a boxed warning about psychiatric effects and asked whether it is safe for him.
How the Options Are Weighted
Benefit is weighted first. People with schizophrenia smoke at far higher rates than the general population and die years earlier, largely from cardiovascular and respiratory disease, and each failed attempt to quit adds years of exposure and makes the next attempt harder to begin. For this man, the most important property of a cessation medicine is how likely it is to work.
Neuropsychiatric safety is weighted second, because it is the concern his team raised and because a relapse of psychosis would cost him his job and possibly his housing. Burden and cost are weighted after that. The comparison below is read in that order.
The Comparison, Row by Row
Abstinence evidence. The EAGLES trial randomized 8,144 smokers, about half with a psychiatric disorder, to varenicline, bupropion, nicotine patch or placebo for 12 weeks (Anthenelli et al., 2016). Varenicline produced the highest abstinence rates in both groups, with odds of abstinence about 3.6 times those on placebo and about 1.7 times those on the patch. Bupropion and the patch each did better than placebo and about the same as each other. In a later trial limited to people with schizophrenia or bipolar disorder, those who had quit on varenicline and continued it for a further year were far more likely to remain abstinent at one year than those switched to placebo, 60 percent against 19 percent (Evins et al., 2014).
Neuropsychiatric safety. In the psychiatric group of EAGLES, moderate and severe neuropsychiatric adverse events occurred in 6.5 percent on varenicline, 6.7 percent on bupropion, 5.2 percent on the patch and 4.9 percent on placebo, and the differences from placebo were not statistically significant (Anthenelli et al., 2016). In December 2016 the FDA removed the boxed warnings about serious psychiatric events from both varenicline and bupropion.
Common adverse effects. Varenicline: nausea, which is common and usually eases, abnormal dreams and insomnia. Bupropion: insomnia, dry mouth and a small risk of seizures that rises with dose. Nicotine replacement: skin irritation from the patch and mouth or throat irritation from the short-acting form.
Interactions. None of the three changes olanzapine levels directly. Stopping smoking does, as discussed below.
Practical demands. Varenicline and bupropion both start a week or more before the quit date and continue for 12 weeks. Combination replacement uses a daily patch plus a lozenge or gum for cravings, which asks him to remember several doses a day.
Cost. In this composite case all three are covered by his state Medicaid plan, so cost does not separate them.
Reading the Comparison
Varenicline leads on benefit, which was weighted first. The concern about psychiatric safety is answered by the trial designed to test it, but that answer has a limit that must be stated. EAGLES enrolled people whose psychiatric condition was clinically stable, which left out anyone in an acute episode. The paper therefore argues from his six stable years rather than from the trial alone: the evidence applies to him because he resembles the people it studied. If he had been admitted last year, the argument would be weaker.
Bupropion deserves its due. It may help mood, which matters for a man with a past depressive episode, and it does not cause the nausea he fears. But its abstinence rates were lower than those of varenicline and similar to those of the patch, and its seizure risk, though small, is a consideration in someone taking an antipsychotic that also lowers the seizure threshold. It is not chosen.
Combination replacement is the fallback. If nausea ends the varenicline trial in its first weeks, a patch with a short-acting form offers a reasonable second route, with a better record than the patch alone he tried twice before.
The Choice
Varenicline, started one week before a quit date he chooses, with the dose increased over the first week to reduce nausea, and taken after food with a full glass of water. It is continued for 12 weeks, and, if he has quit, for a further 12 weeks or longer, following the maintenance evidence in people with serious mental illness. Weekly counseling sessions with his case manager accompany it, and his quit date is set for a week when his work schedule is lightest.
What Quitting Does to His Olanzapine Level
This is the part of the plan that his team most needs to understand. Tobacco smoke contains polycyclic aromatic hydrocarbons that induce the liver enzyme CYP1A2, which metabolizes olanzapine, clozapine and several other drugs. Heavy smokers therefore clear olanzapine faster and may need a larger dose for an equal blood level. When a person stops smoking, the enzyme returns toward its normal activity over the following weeks, and levels of drugs that depend on it rise (Kroon, 2007).
It is the smoke, not the nicotine, that causes this effect. Nicotine replacement therefore does not prevent the change: if he quits using patches instead of varenicline, his olanzapine level will still rise.
The plan responds in three ways. His team watches for sedation, dizziness and orthostatic symptoms in the first weeks after he quits. His prescriber considers a planned dose reduction if those appear, rather than waiting for a fall. And if he returns to smoking, the dose is reviewed again, because his level would drop and his risk of relapse would rise.
Monitoring and Follow-Up
Weekly contact with his case manager for the first month: cigarettes smoked, cravings, nausea, sleep and dreams, and any change in mood, suspiciousness or voices. Exhaled carbon monoxide checked at each clinic visit to confirm abstinence. A visit with his prescriber two weeks after his quit date to review sedation and consider an olanzapine adjustment. Weight is recorded monthly, since weight gain after quitting adds to olanzapine's metabolic effects.
References
Anthenelli, R. M., Benowitz, N. L., West, R., St Aubin, L., McRae, T., Lawrence, D., Ascher, J., Russ, C., Krishen, A., & Evins, A. E. (2016). Neuropsychiatric safety and efficacy of varenicline, bupropion, and nicotine patch in smokers with and without psychiatric disorders (EAGLES): A double-blind, randomised, placebo-controlled clinical trial. The Lancet, 387(10037), 2507-2520. https://doi.org/10.1016/S0140-6736(16)30272-0
Evins, A. E., Cather, C., Pratt, S. A., Pachas, G. N., Hoeppner, S. S., Goff, D. C., Achtyes, E. D., Ayer, D., & Schoenfeld, D. A. (2014). Maintenance treatment with varenicline for smoking cessation in patients with schizophrenia and bipolar disorder: A randomized clinical trial. JAMA, 311(2), 145-154. https://doi.org/10.1001/jama.2013.285113
Kroon, L. A. (2007). Drug interactions with smoking. American Journal of Health-System Pharmacy, 64(18), 1917-1921. https://doi.org/10.2146/ajhp060414
How this MN665 Unit 3 example is structured
Likely benefit is weighted first, and the paper says why before any table appears: each failed quit attempt costs this man years of risk. Neuropsychiatric safety is weighted second because it is the concern his team raised. Burden and cost follow. The table is then read in that order. Varenicline leads on benefit, and the safety concern is met by the trial designed to test it, reported with its limits: EAGLES enrolled only people whose psychiatric illness was stable, so the paper argues from his six stable years rather than from the trial alone. Bupropion is credited for possible benefit to mood and rejected on weaker abstinence. Combination replacement is kept as the fallback if nausea ends the varenicline trial. The CYP1A2 paragraph explains that smoke, not nicotine, speeds that enzyme, so replacement does not prevent levels rising when he stops.
Get an MN665 Unit 3 example written to your instructions
Comparative pharmacology prompts differ in how much they fix: some name the agents, others only the patient. Send yours from MN665 Unit 3 with the case and rubric, and within 24-48h a free first custom paper arrives that states its weighting up front, reads every option against it and names a fallback if the first choice fails. The paper above is an original model document written by our desk, not a submitted student paper and not an official Purdue University Global document.
MN665 Unit 3 questions, answered
Should a comparative pharmacology paper include non-drug options?
Yes, briefly, when they change the decision. For smoking cessation, counseling combined with medication tends to outperform either alone, and graders expect it named. Keep the comparison centered on the drugs the prompt asks about, but show that the chosen agent sits inside a fuller plan, including who provides the behavioral support and how often.
How should a paper handle a withdrawn boxed warning?
Report its history with dates: when it was added, what evidence prompted it and what led to its removal. Then say how that history bears on the patient. A paper that cites only the original warning is outdated, and one that ignores why it existed misses a concern the patient or team may still hold.
Do I need exact abstinence rates in the table?
Figures help if you are sure of them and cite the source, but a clear statement of relative effect tends to serve better than numbers copied without context. Say which option produced higher abstinence, in which population and over what period. If you include percentages, check them against the original paper, since secondary sources frequently misreport them.