Pharmacology & Medication Management Flashcards

A patient on methadone maintenance therapy develops QTc prolongation >500ms on ECG. What is the most appropriate next step?

Answer: Reduce or discontinue methadone and consider switching to buprenorphine

QTc >500ms on methadone carries significant risk of torsades de pointes and warrants dose reduction or transition to buprenorphine, which has a much lower cardiac risk profile.

Which benzodiazepine is preferred for alcohol withdrawal management in patients with severe hepatic impairment due to its lack of active metabolites?

Answer: Lorazepam

Lorazepam (along with oxazepam and temazepam) undergoes direct glucuronidation without forming active metabolites, making it safer in hepatic impairment.

A patient taking buprenorphine/naloxone sublingually reports that the naloxone component is causing them distress. Which statement about naloxone in this formulation is correct?

Answer: Naloxone has poor sublingual bioavailability and is primarily a deterrent to injection misuse

Naloxone has very poor sublingual bioavailability (~3%), so it does not meaningfully block buprenorphine's effects when taken as directed; it is included to precipitate withdrawal if the product is injected.

Which medication used in alcohol use disorder works by sensitizing patients to acetaldehyde, causing an aversive reaction when alcohol is consumed?

Answer: Disulfiram

Disulfiram inhibits aldehyde dehydrogenase, causing accumulation of acetaldehyde when alcohol is consumed, resulting in flushing, nausea, vomiting, and palpitations.

Acamprosate is thought to reduce alcohol cravings primarily through which mechanism?

Answer: Modulating glutamate (NMDA) and GABA activity to reduce neuronal hyperexcitability

Acamprosate modulates glutamatergic and GABAergic neurotransmission to reduce the neurological hyperexcitability associated with prolonged abstinence from alcohol.

A patient with opioid use disorder wants to start naltrexone (Vivitrol). They last used heroin 5 days ago. Before initiating, you should:

Answer: Perform a naloxone challenge test or confirm negative urine opioid screen before dosing

A naloxone challenge or confirmed negative urine screen is recommended before naltrexone initiation to prevent precipitating severe opioid withdrawal in a physically dependent patient.

Which of the following is a contraindication to prescribing buprenorphine for opioid use disorder?

Answer: Acute hepatitis with ALT >5x upper limit of normal and rising

Severe or acute hepatic injury (ALT >5x ULN and rising) is a contraindication because buprenorphine is extensively hepatically metabolized and can cause further hepatotoxicity.