Question 1

A patient who is receiving medication-assisted treatment for opioid use disorder with naltrexone should start the naltrexone:&#10;A)Two weeks before the quit date&#10;B)Once patient is weaned off all opioids 3.36 hours after the last opioid dose&#10;C)When withdrawal symptoms start&#10;

Accepted Answer

Naltrexone is an opioid antagonist used for medication-assisted treatment of opioid use disorder. It should only be started once a patient is fully detoxified from opioids to avoid precipitating withdrawal symptoms. This typically means waiting until the patient has been opioid-free for a minimum of 7-10 days, not 3.36 hours as mentioned in option B, which is a typo. Starting naltrexone when withdrawal symptoms begin (option C) or before the patient has stopped taking opioids (options A and B as written) would be incorrect and potentially harmful.

Question 2

Patients with chronic alcoholism in severe alcohol withdrawal should be treated with:&#10;A)Thiamine 100 mg orally daily for seven days&#10;B)Thiamine 250 mg parenterally for 3 to 5 days&#10;C)Calcium 500 mg parenterally daily for seven days&#10;D)Calcium 1000 mg orally daily for 3 to 5 days&#10;

Accepted Answer

Thiamine 250 mg parenterally for 3 to 5 days is recommended for patients in severe alcohol withdrawal to prevent Wernicke's encephalopathy, a serious neurological disorder. This high-dose parenteral administration ensures rapid and adequate absorption, which is crucial in this acute setting.

Question 3

A patient who is receiving medication-assisted treatment for opioid use disorder with clonidine should begin treatment by:&#10;A)Applying a clonidine patch three days before quit date&#10;B)Using oral clonidine for three days until the clonidine patch reaches effective dosing&#10;C)Taking clonidine 0.2 mg three times a day if the Clinical Opiate Withdrawal Scale (COWS) score is over 12&#10;D)Maintaining clonidine dose at a steady state for a week then tapering over two weeks&#10;

Accepted Answer

Clonidine is a long-acting alpha-2 adrenergic agonist that is used to treat opioid withdrawal symptoms. It is typically started at a low dose and gradually increased until the desired effect is achieved. The correct answer is B: Using oral clonidine for three days until the clonidine patch reaches effective dosing. This is because the oral form of clonidine has a faster onset of action than the patch, and it can be used to bridge the gap until the patch reaches its full effect.

Question 4

A patient asking for medication to assist with maintaining abstinence from alcohol also takes oxycodone for back pain. Which medication would be appropriate to prescribe?&#10;A)Acamprosate (Campral) 666 mg tid&#10;B)Naltrexone extended-release injection (Vivitrol) 380 mg every four weeks&#10;C)Diazepam 5 mg orally every six hours&#10;D)Naloxone extended-release intramuscular (IM) (Narcan EX) 500 mg every four weeks&#10;

Accepted Answer

Acamprosate is appropriate as it helps maintain abstinence from alcohol and does not interact with opioids like oxycodone. Naltrexone is contraindicated with opioid use.

Question 5

The first-line medication(s) for alcohol withdrawal is/are:&#10;A)Valproates&#10;B)Benzodiazepines&#10;C)Carbamazepine&#10;D)Clonidine&#10;

Accepted Answer

Benzodiazepines are considered the first-line treatment for alcohol withdrawal due to their effectiveness in reducing withdrawal symptoms and preventing complications such as seizures and delirium tremens.

Question 6

Which of the following medications prevents the seizures and delirium tremens associated with alcohol withdrawal?&#10;A)Clonidine&#10;B)Lorazepam&#10;C)Ethanol supplementation&#10;D)Barbiturates&#10;

Accepted Answer

Lorazepam, a benzodiazepine, is commonly used to prevent seizures and delirium tremens in alcohol withdrawal by stabilizing the central nervous system.

Question 7

A patient who is receiving medication-assisted treatment for opioid use disorder with buprenorphine should start the buprenorphine:&#10;A)Two weeks before the quit date&#10;B)Eight hours after the last opioid dose 3.36 hours after the last opioid dose&#10;C)When withdrawal symptoms start&#10;

Accepted Answer

Buprenorphine should be started 8 hours after the last opioid dose to avoid precipitated withdrawal.

Question 8

Monitoring of a patient who is initiating methadone treatment includes monitoring for:&#10;A)Delirium tremens&#10;B)Seizures&#10;C)Prolonged QT&#10;D)Psychosis&#10;

Accepted Answer

Methadone can prolong the QT interval on an electrocardiogram, which can lead to serious heart arrhythmias. Therefore, monitoring for prolonged QT is important when initiating methadone treatment.

Question 9

A 58-year-old patient has been taking temazepam daily for many years for anxiety. The recommended method to discontinue long-term temazepam use is:&#10;A)Discontinue &#34;cold turkey&#34; and monitor for withdrawal symptoms.&#10;B)Wean temazepam dose over three to seven days, then every other day dosing for a week.&#10;C)Switch to long-acting diazepam and then wean over 8 to 12 weeks.&#10;D)Switch to diazepam and wean over three to four weeks.&#10;

Accepted Answer

Switching to a long-acting benzodiazepine like diazepam and then gradually weaning the dose over 8 to 12 weeks is a recommended method for discontinuing long-term use of shorter-acting benzodiazepines like temazepam. This approach helps manage withdrawal symptoms more effectively by providing a more stable blood concentration during the tapering process.

Question 10

Methadone to treat a patient with opioid use disorder is started:&#10;A)Two weeks before the quit date&#10;B)Eight hours after the last opioid dose 3.36 hours after the last opioid dose&#10;C)When withdrawal symptoms start&#10;

Accepted Answer

Methadone treatment for opioid use disorder is typically initiated when a patient starts experiencing withdrawal symptoms. This approach ensures that methadone is used effectively to alleviate withdrawal symptoms and reduce cravings, facilitating a smoother transition away from opioid dependence.

Deck 27: Alcohol and Drug Addiction