Addiction Medicine Pharmacotherapy Flashcards

Which stimulant use disorder currently has an FDA-approved pharmacotherapy?

Answer: Neither cocaine nor methamphetamine use disorder has an FDA-approved pharmacotherapy

As of 2026, no FDA-approved pharmacotherapy exists for cocaine or methamphetamine use disorder; behavioral therapies remain the primary evidence-based treatments.

A patient on buprenorphine/naloxone reports taking it sublingually but urine drug screen is negative for buprenorphine. What is the most likely explanation?

Answer: Buprenorphine is not detectable by standard urine immunoassay panels

Standard urine drug screens do not detect buprenorphine; a specific buprenorphine immunoassay or GC-MS confirmation must be ordered to verify adherence.

Which of the following medications used for opioid use disorder is dispensed exclusively through federally certified Opioid Treatment Programs (OTPs)?

Answer: Methadone for OUD maintenance

Federal law requires methadone for OUD maintenance to be dispensed daily (initially) through DEA-registered OTPs, unlike buprenorphine which can be prescribed from office-based settings.

What is the recommended clinical monitoring parameter for patients on disulfiram therapy for alcohol use disorder?

Answer: Liver function tests due to risk of hepatotoxicity

Disulfiram can cause hepatotoxicity; baseline and periodic liver function tests are recommended, and it is contraindicated in patients with severe hepatic impairment.

In patients with co-occurring opioid use disorder and chronic pain, which buprenorphine formulation offers the advantage of providing both OUD treatment and chronic pain management?

Answer: Buprenorphine transdermal patch (Butrans) or buccal film (Belbuca) at analgesic doses

Low-dose buprenorphine transdermal (Butrans) and buccal (Belbuca) formulations are FDA-approved for chronic pain and may address both conditions, though OUD-level dosing typically requires sublingual forms.

Which of the following is the most significant pharmacokinetic characteristic of methadone that contributes to overdose risk during dose induction?

Answer: Long and variable half-life (24–59 hrs) causing drug accumulation before steady state

Methadone's long and variable half-life means sedation can outlast analgesia, and drug accumulates over 5–7 days before reaching steady state, making early dose increases dangerous.

A patient with opioid use disorder who is stable on buprenorphine/naloxone undergoes an elective cholecystectomy. Which perioperative opioid management strategy is most consistent with current evidence?

Answer: Continue buprenorphine through the perioperative period and use multimodal analgesia

Current evidence and guidelines support continuing buprenorphine perioperatively and supplementing with multimodal non-opioid analgesia, as discontinuation increases relapse risk without clear analgesic benefit.