Pharmacology & Medication Management Flashcards

Extended-release naltrexone (Vivitrol) for opioid use disorder is administered as:

Answer: A monthly intramuscular injection of 380mg

Vivitrol is administered as a 380mg IM gluteal injection once monthly, which improves adherence by eliminating the need for daily dosing.

A patient on buprenorphine/naloxone reports using fentanyl, and urine drug screening is negative for buprenorphine. The most likely explanation is:

Answer: The patient is not taking the buprenorphine as prescribed (diversion)

Absence of buprenorphine in urine combined with ongoing illicit drug use strongly suggests the patient is not taking (and likely diverting) the prescribed medication.

Which drug-drug interaction is most clinically significant for a patient on methadone maintenance who is started on rifampin for tuberculosis?

Answer: Rifampin induces CYP3A4, significantly decreasing methadone levels and precipitating withdrawal

Rifampin is a potent CYP3A4 inducer that dramatically lowers methadone plasma levels, often precipitating opioid withdrawal and requiring substantial methadone dose increases.

For a pregnant patient with opioid use disorder, which treatment approach is recommended by ACOG and SAMHSA?

Answer: Buprenorphine or methadone maintenance is recommended as the standard of care

ACOG and SAMHSA recommend opioid agonist therapy (buprenorphine or methadone) as the standard of care in pregnancy because it is associated with better outcomes than withdrawal or no treatment.

A patient with alcohol use disorder has a history of alcohol withdrawal seizures. Which medication best prevents recurrence of seizures during withdrawal?

Answer: Benzodiazepines (e.g., chlordiazepoxide or diazepam)

Benzodiazepines are the first-line agents for preventing alcohol withdrawal seizures due to their cross-tolerance with alcohol at GABA-A receptors.

Which statement correctly describes the ceiling effect of buprenorphine?

Answer: Above a certain dose, respiratory depression plateaus, reducing overdose risk compared to full agonists

Buprenorphine's partial agonist activity produces a ceiling on respiratory depression at higher doses, which makes it significantly safer in overdose compared to full opioid agonists.

Varenicline (Chantix) reduces smoking by which primary mechanism?

Answer: Acting as a partial agonist at alpha4beta2 nicotinic receptors, reducing cravings and attenuating reward

Varenicline is a partial agonist at alpha4beta2 nicotinic acetylcholine receptors, providing enough stimulation to reduce withdrawal cravings while blocking nicotine's rewarding effects.