Addiction Medicine Pharmacotherapy Flashcards

Which medication used off-label for alcohol use disorder has evidence for reducing heavy drinking days and works by blocking sodium channels and enhancing GABA activity?

Answer: Topiramate

Topiramate reduces heavy drinking days through multiple mechanisms including sodium channel blockade and GABA enhancement, though it is not FDA-approved for AUD.

A pregnant patient with opioid use disorder is seeking treatment. Which approach is recommended by ACOG and ASAM?

Answer: Maintenance treatment with methadone or buprenorphine

ACOG and ASAM recommend opioid agonist maintenance therapy (methadone or buprenorphine) during pregnancy because abrupt withdrawal carries high rates of relapse and adverse fetal outcomes.

The Suboxone film formulation combines buprenorphine with naloxone in what ratio to deter injection misuse?

Answer: 4:1

Suboxone contains buprenorphine and naloxone in a 4:1 ratio; sublingual administration minimizes naloxone absorption, but injection would precipitate withdrawal.

Which medication is classified as a GABA-B receptor agonist and has evidence for reducing alcohol cravings and withdrawal symptoms, though not FDA-approved for AUD in the US?

Answer: Baclofen

Baclofen is a GABA-B agonist with evidence for AUD and is approved for this indication in France, but it remains off-label in the US with mixed evidence.

When initiating buprenorphine in the office setting, a patient should ideally be in mild-to-moderate opioid withdrawal (COWS score ≥8-12) to avoid which complication?

Answer: Precipitated withdrawal

Buprenorphine's high mu-receptor affinity displaces full agonists; if given while opioids still occupy receptors, it precipitates acute withdrawal.

Which of the following is a known risk of varenicline (Chantix) that must be discussed during informed consent for smoking cessation?

Answer: Neuropsychiatric symptoms including depression and suicidal ideation

Varenicline carries a black-box warning (later revised) for neuropsychiatric adverse effects including mood changes, depression, and suicidal ideation, particularly in those with psychiatric history.

A patient taking naltrexone for alcohol use disorder requires surgery. Which pain management consideration is most important?

Answer: Opioid analgesics will be ineffective or require higher doses; plan non-opioid alternatives

Naltrexone blocks opioid receptors, making standard opioid analgesics ineffective; the surgical team must plan around this by using regional anesthesia and non-opioid analgesics.