Addiction Medicine Pharmacotherapy Flashcards

Which medication is FDA-approved for treating alcohol use disorder by causing an aversive reaction when alcohol is consumed?

Answer: Disulfiram

Disulfiram inhibits aldehyde dehydrogenase, causing accumulation of acetaldehyde and an aversive reaction (flushing, nausea, palpitations) when alcohol is ingested.

What is the primary mechanism by which buprenorphine reduces opioid cravings?

Answer: Partial agonism at mu-opioid receptors with ceiling effect

Buprenorphine is a partial mu-opioid receptor agonist with high receptor affinity and a ceiling effect on respiratory depression, making it safer than full agonists.

A patient on methadone maintenance presents with a QTc of 520 ms on ECG. What is the most appropriate next step?

Answer: Immediately switch to buprenorphine and consult cardiology

A QTc >500 ms on methadone carries significant risk of torsades de pointes; transitioning to buprenorphine (which has minimal QT effect) with cardiology consultation is indicated.

Which of the following statements about naltrexone extended-release injectable (XR-NTX) for opioid use disorder is correct?

Answer: Patients must be opioid-free for at least 7–10 days before initiation

XR-NTX is a full opioid antagonist that will precipitate acute withdrawal if given while the patient is opioid-dependent; a 7–10 day abstinence period is required.

Acamprosate is thought to reduce alcohol cravings primarily by modulating which neurotransmitter system?

Answer: Glutamate (NMDA) and GABA systems to restore balance

Acamprosate restores glutamate–GABA balance disrupted by chronic alcohol use, reducing the hyperexcitability and dysphoria that drive relapse.

A patient with severe renal impairment (CrCl <30 mL/min) is being treated for alcohol use disorder. Which FDA-approved medication should be avoided?

Answer: Acamprosate

Acamprosate is renally excreted and is contraindicated in patients with severe renal impairment (CrCl <30 mL/min) due to risk of drug accumulation.

Which benzodiazepine property makes long-acting agents preferred over short-acting agents for managing alcohol withdrawal in most clinical settings?

Answer: Self-tapering pharmacokinetics reduce rebound and seizure risk

Long-acting benzodiazepines like diazepam and chlordiazepoxide self-taper due to active metabolites, providing smoother withdrawal management and reduced seizure risk.