Addiction Medicine Certification Emergency Procedures & Response 2 — Questions and Answers
Question 1: A patient on buprenorphine maintenance presents with severe chest pain, diaphoresis, and an irregular pulse. What is the FIRST priority?
- Administer naloxone immediately
- Call 911 and initiate cardiac emergency protocols (Correct answer)
- Discontinue buprenorphine and monitor
- Increase the buprenorphine dose to relieve pain
Correct answer: Call 911 and initiate cardiac emergency protocols
Chest pain with diaphoresis and irregular pulse suggests a cardiac emergency requiring immediate EMS activation and ACLS protocols.
Question 2: Which benzodiazepine is preferred for IV administration in acute alcohol withdrawal seizure management in an emergency setting?
- Alprazolam
- Diazepam (Correct answer)
- Triazolam
- Clonazepam
Correct answer: Diazepam
Diazepam is preferred for IV use in acute alcohol withdrawal seizures due to its rapid onset and long half-life providing seizure coverage.
Question 3: A patient with known opioid use disorder is found unresponsive with pinpoint pupils and a respiratory rate of 4/min. After administering 0.4 mg naloxone IM, there is no response after 2 minutes. What is the next step?
- Wait an additional 5 minutes before redosing
- Administer a second dose of naloxone and call EMS (Correct answer)
- Begin CPR immediately
- Administer flumazenil
Correct answer: Administer a second dose of naloxone and call EMS
If no response to initial naloxone within 2 minutes, repeat dosing (up to 2 mg total) and activate EMS for high-potency opioid overdose management.
Question 4: During alcohol withdrawal, which finding on CIWA-Ar assessment most urgently indicates the need for immediate pharmacological intervention?
- Mild tremor with score of 4
- Sweating with score of 2
- Score ≥10 with hallucinations and autonomic instability (Correct answer)
- Nausea without vomiting with score of 3
Correct answer: Score ≥10 with hallucinations and autonomic instability
A CIWA-Ar score ≥10 with hallucinations and autonomic instability signals severe withdrawal requiring immediate benzodiazepine intervention to prevent progression to delirium tremens.
Question 5: A patient taking methadone for OUD is brought to the ED with QTc of 560 ms on ECG. What is the MOST appropriate immediate action?
- Continue methadone at the same dose and recheck ECG in 24 hours
- Hold methadone, initiate cardiac monitoring, and consult cardiology (Correct answer)
- Switch immediately to buprenorphine without cardiac evaluation
- Administer magnesium sulfate and discharge
Correct answer: Hold methadone, initiate cardiac monitoring, and consult cardiology
QTc >500 ms on methadone requires immediate dose hold, continuous cardiac monitoring, and cardiology consultation due to Torsades de Pointes risk.
Question 6: In a patient presenting with stimulant (cocaine) toxicity, hyperthermia reaching 41°C, and agitation, which intervention takes highest priority?
- Administer haloperidol to control agitation
- Perform active external cooling and provide benzodiazepines (Correct answer)
- Administer beta-blockers to control tachycardia
- Initiate forced diuresis with IV fluids
Correct answer: Perform active external cooling and provide benzodiazepines
Hyperthermia in stimulant toxicity is life-threatening; active cooling combined with benzodiazepines for sedation is the priority intervention.
Question 7: Which medication is contraindicated in the emergency treatment of cocaine-associated chest pain due to risk of unopposed alpha-adrenergic stimulation?
- Nitroglycerin
- Aspirin
- Propranolol (Correct answer)
- Lorazepam
Correct answer: Propranolol
Non-selective beta-blockers like propranolol are contraindicated in cocaine toxicity because they block beta-2 vasodilation while leaving alpha-1 vasoconstriction unopposed, worsening coronary spasm.
Addiction Medicine Certification Emergency Procedures & Response 2
A patient on buprenorphine maintenance presents with severe chest pain, diaphoresis, and an irregular pulse.
What is the FIRST priority?