Addiction Medicine Certification Addiction Medicine Pharmacotherapy 3

Question 1

Which medication used off-label for alcohol use disorder has evidence for reducing heavy drinking days and works by blocking sodium channels and enhancing GABA activity?

Accepted Answer

Topiramate

Answer

Topiramate reduces heavy drinking days through multiple mechanisms including sodium channel blockade and GABA enhancement, though it is not FDA-approved for AUD.

Question 2

A pregnant patient with opioid use disorder is seeking treatment. Which approach is recommended by ACOG and ASAM?

Accepted Answer

Maintenance treatment with methadone or buprenorphine

Answer

ACOG and ASAM recommend opioid agonist maintenance therapy (methadone or buprenorphine) during pregnancy because abrupt withdrawal carries high rates of relapse and adverse fetal outcomes.

Question 3

The Suboxone film formulation combines buprenorphine with naloxone in what ratio to deter injection misuse?

Accepted Answer

4:1

Answer

Suboxone contains buprenorphine and naloxone in a 4:1 ratio; sublingual administration minimizes naloxone absorption, but injection would precipitate withdrawal.

Question 4

Which medication is classified as a GABA-B receptor agonist and has evidence for reducing alcohol cravings and withdrawal symptoms, though not FDA-approved for AUD in the US?

Accepted Answer

Baclofen

Answer

Baclofen is a GABA-B agonist with evidence for AUD and is approved for this indication in France, but it remains off-label in the US with mixed evidence.

Question 5

When initiating buprenorphine in the office setting, a patient should ideally be in mild-to-moderate opioid withdrawal (COWS score ≥8-12) to avoid which complication?

Accepted Answer

Precipitated withdrawal

Answer

Buprenorphine's high mu-receptor affinity displaces full agonists; if given while opioids still occupy receptors, it precipitates acute withdrawal.

Addiction Medicine Certification Practice Test

Addiction Medicine Certification Practice Test

Addiction Medicine Certification Addiction Medicine Pharmacotherapy 3