Addiction Medicine Pharmacotherapy Flashcards

Lofexidine (Lucemyra) is FDA-approved for which specific indication related to opioid use disorder?

Answer: Management of acute opioid withdrawal symptoms

Lofexidine is the first non-opioid FDA-approved medication specifically for managing opioid withdrawal symptoms, acting as an alpha-2 adrenergic agonist to reduce autonomic symptoms.

A patient presents with nicotine use disorder and comorbid major depression. Which pharmacotherapy combination has the strongest evidence for this population?

Answer: Bupropion SR combined with NRT

Bupropion SR, which also has antidepressant properties, combined with NRT is particularly beneficial in smokers with comorbid depression; varenicline's neuropsychiatric risks require caution.

Which of the following best describes the pharmacological difference between methadone and buprenorphine in treating opioid use disorder?

Answer: Methadone is a full agonist with long half-life; buprenorphine is a partial agonist with ceiling effect

Methadone is a full mu-opioid agonist with a long, variable half-life (24–36 hrs), while buprenorphine is a partial agonist with a ceiling effect that limits respiratory depression.

What is the rationale for using gabapentin as an adjunct during alcohol withdrawal management?

Answer: It reduces alcohol cravings and manages withdrawal symptoms with less abuse potential than benzodiazepines

Gabapentin modulates voltage-gated calcium channels and has evidence for reducing alcohol craving and withdrawal severity with lower abuse potential than benzodiazepines.

A patient on buprenorphine/naloxone maintenance develops severe pain requiring opioid analgesia. Which statement is most accurate?

Answer: High-affinity full opioid agonists at higher doses can compete with buprenorphine and provide analgesia

Buprenorphine's high receptor affinity can be overcome by high-dose full agonists (e.g., fentanyl, hydromorphone) in monitored settings, or buprenorphine dosing can be adjusted for acute pain.

Which drug-drug interaction is clinically most significant when prescribing methadone for opioid use disorder?

Answer: Methadone + CYP3A4 inducers (e.g., rifampin) causing rapid methadone metabolism and withdrawal

CYP3A4 inducers such as rifampin, carbamazepine, and phenytoin dramatically increase methadone metabolism, potentially precipitating opioid withdrawal in patients on stable doses.

What is the mechanism by which nicotine replacement therapy (NRT) aids smoking cessation?

Answer: It provides low-level nicotine to reduce withdrawal symptoms while behavioral conditioning is broken

NRT delivers controlled, lower levels of nicotine to reduce withdrawal symptoms and cravings, allowing the behavioral and psychological aspects of smoking to be addressed without the harmful combustion products.