Addiction Medicine Certification Addiction Medicine Pharmacotherapy 2

Question 1

Which medication is FDA-approved for treating alcohol use disorder by causing an aversive reaction when alcohol is consumed?

Accepted Answer

Disulfiram

Answer

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?

Accepted Answer

Partial agonism at mu-opioid receptors with ceiling effect

Answer

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?

Accepted Answer

Immediately switch to buprenorphine and consult cardiology

Answer

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?

Accepted Answer

Patients must be opioid-free for at least 7–10 days before initiation

Answer

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?

Accepted Answer

Glutamate (NMDA) and GABA systems to restore balance

Answer

Acamprosate restores glutamate–GABA balance disrupted by chronic alcohol use, reducing the hyperexcitability and dysphoria that drive relapse.

Addiction Medicine Certification Practice Test

Addiction Medicine Certification Practice Test

Addiction Medicine Certification Addiction Medicine Pharmacotherapy 2