Addiction Medicine Certification Addiction Medicine Pharmacotherapy 2 — Questions and Answers
Question 1: Which medication is FDA-approved for treating alcohol use disorder by causing an aversive reaction when alcohol is consumed?
- Naltrexone
- Acamprosate
- Disulfiram (Correct answer)
- Topiramate
Correct answer: Disulfiram
Disulfiram inhibits aldehyde dehydrogenase, causing accumulation of acetaldehyde and an aversive reaction (flushing, nausea, palpitations) when alcohol is ingested.
Question 2: What is the primary mechanism by which buprenorphine reduces opioid cravings?
- Full agonism at mu-opioid receptors
- Partial agonism at mu-opioid receptors with ceiling effect (Correct answer)
- Antagonism at kappa-opioid receptors only
- Blockade of NMDA glutamate receptors
Correct answer: Partial agonism at mu-opioid receptors with ceiling effect
Buprenorphine is a partial mu-opioid receptor agonist with high receptor affinity and a ceiling effect on respiratory depression, making it safer than full agonists.
Question 3: A patient on methadone maintenance presents with a QTc of 520 ms on ECG. What is the most appropriate next step?
- Continue methadone at current dose and recheck in 3 months
- Immediately switch to buprenorphine and consult cardiology (Correct answer)
- Add an antiarrhythmic medication and continue methadone
- Increase methadone dose to stabilize the patient
Correct answer: Immediately switch to buprenorphine and consult cardiology
A QTc >500 ms on methadone carries significant risk of torsades de pointes; transitioning to buprenorphine (which has minimal QT effect) with cardiology consultation is indicated.
Question 4: Which of the following statements about naltrexone extended-release injectable (XR-NTX) for opioid use disorder is correct?
- It can be initiated while the patient is still physically dependent on opioids
- Patients must be opioid-free for at least 7–10 days before initiation (Correct answer)
- It requires daily dosing for optimal efficacy
- It has no effect on alcohol cravings
Correct answer: Patients must be opioid-free for at least 7–10 days before initiation
XR-NTX is a full opioid antagonist that will precipitate acute withdrawal if given while the patient is opioid-dependent; a 7–10 day abstinence period is required.
Question 5: Acamprosate is thought to reduce alcohol cravings primarily by modulating which neurotransmitter system?
- Dopaminergic reward pathways
- GABA-A receptor upregulation only
- Glutamate (NMDA) and GABA systems to restore balance (Correct answer)
- Opioid receptor antagonism
Correct answer: Glutamate (NMDA) and GABA systems to restore balance
Acamprosate restores glutamate–GABA balance disrupted by chronic alcohol use, reducing the hyperexcitability and dysphoria that drive relapse.
Question 6: A patient with severe renal impairment (CrCl <30 mL/min) is being treated for alcohol use disorder. Which FDA-approved medication should be avoided?
- Naltrexone oral
- Disulfiram
- Acamprosate (Correct answer)
- Naltrexone extended-release injection
Correct answer: Acamprosate
Acamprosate is renally excreted and is contraindicated in patients with severe renal impairment (CrCl <30 mL/min) due to risk of drug accumulation.
Question 7: Which benzodiazepine property makes long-acting agents preferred over short-acting agents for managing alcohol withdrawal in most clinical settings?
- Greater euphoria reduces patient distress
- Self-tapering pharmacokinetics reduce rebound and seizure risk (Correct answer)
- Less hepatic metabolism prevents accumulation
- Shorter duration limits sedation in outpatient settings
Correct answer: Self-tapering pharmacokinetics reduce rebound and seizure risk
Long-acting benzodiazepines like diazepam and chlordiazepoxide self-taper due to active metabolites, providing smoother withdrawal management and reduced seizure risk.
Addiction Medicine Certification Addiction Medicine Pharmacotherapy 2
Which medication is FDA-approved for treating alcohol use disorder by causing an aversive reaction when alcohol is consumed?