Pharmacology & Medication Management Flashcards

A patient on daily methadone 100mg for OUD is found to be HIV-positive and started on ritonavir-boosted antiretrovirals. You should anticipate:

Answer: Decreased methadone levels due to induction effects of most antiretrovirals, potentially requiring dose increases

Many antiretrovirals (especially NNRTIs like efavirenz and protease inhibitors in combination) induce CYP3A4 and decrease methadone levels, often precipitating withdrawal and requiring dose adjustments.

Which pharmacological property of buprenorphine makes it effective at low doses for managing acute pain in opioid-naive patients but requires higher doses in opioid-dependent patients?

Answer: Its very high affinity for mu-opioid receptors and slow dissociation rate (high receptor avidity)

Buprenorphine's extremely high mu-receptor affinity and slow dissociation mean it displaces other opioids and requires higher doses to achieve adequate receptor occupancy in tolerant patients.

Which of the following statements about naltrexone for alcohol use disorder is accurate?

Answer: Naltrexone reduces heavy drinking days by blocking opioid-mediated reinforcement of alcohol consumption

Naltrexone blocks mu-opioid receptors that mediate alcohol-induced dopamine release in reward pathways, reducing the pleasurable effects of alcohol and decreasing heavy drinking.

A patient presents with suspected opioid overdose but also has suspected benzodiazepine ingestion. After administering naloxone with good response, you should:

Answer: Monitor closely as naloxone does not reverse benzodiazepine effects and re-sedation or respiratory depression may recur

Naloxone has no effect on benzodiazepines, and polysubstance overdoses require prolonged monitoring for re-sedation, especially as naloxone's duration (30-90 min) may be shorter than the opioid.

Which medication for smoking cessation is associated with a black box warning (now removed by FDA in 2016 but still clinically monitored) related to neuropsychiatric adverse events?

Answer: Varenicline (Chantix)

Varenicline carried an FDA black box warning for serious neuropsychiatric events (depression, suicidality, behavioral changes) that was removed in 2016 after the EAGLES trial showed no significant excess risk.

In managing alcohol withdrawal using a symptom-triggered protocol (e.g., CIWA-Ar), benzodiazepines are administered when the CIWA-Ar score exceeds which threshold?

Answer: Greater than 8

Most symptom-triggered protocols initiate benzodiazepine treatment when the CIWA-Ar score exceeds 8, indicating moderate withdrawal symptoms requiring pharmacological intervention.

A patient stabilized on buprenorphine/naloxone 16mg/4mg daily reports persistent opioid cravings. The most appropriate next step is:

Answer: Assess adherence, timing of dosing, and consider dose increase to a maximum of 24mg/day

Persistent cravings on buprenorphine often indicate undertreating; clinical guidelines support doses up to 24mg/day (some evidence for higher), and adherence and dosing schedule should be assessed first.