Mixed Deck — All ADM Topics Flashcards

A clinician wants to prescribe buprenorphine/naloxone in an office-based setting. Under the 2023 Mainstreaming Addiction Treatment (MAT) Act, what is required?

Answer: No additional DEA registration beyond a standard DEA controlled substance license for Schedule III medications

The 2023 MAT Act eliminated the X-waiver requirement; any DEA-licensed practitioner authorized to prescribe Schedule III substances can now prescribe buprenorphine for OUD.

Which of the following best describes the ethical concept of 'therapeutic privilege'?

Answer: Withholding information from a patient when disclosure would harm them, justifying paternalistic non-disclosure

Therapeutic privilege refers to withholding information from a patient on the grounds that disclosure would cause harm, though it is widely criticized as undermining autonomy.

Understanding human anatomy is essential in this field primarily because it:

Answer: Informs proper technique application and prevents injury

Anatomical knowledge directly informs proper technique application, helping practitioners work safely and effectively while preventing injury to clients.

What documentation is required when equipment is replaced or upgraded?

Answer: Asset tracking records, disposal documentation, and updated operating procedures

Proper documentation of replacements includes asset tracking, disposal records, and updated procedures to maintain compliance and ensure staff are trained on new equipment.

When assessing a dual diagnosis patient, which factor is most important before diagnosing a primary psychiatric disorder?

Answer: A period of sobriety to clarify substance-free psychiatric status

A period of sobriety is needed to determine whether psychiatric symptoms are substance-induced or represent an independent primary disorder, as many symptoms resolve with abstinence.

What is the best practice for documenting assessment findings?

Answer: Record findings objectively using measurable criteria immediately after assessment

Documenting findings objectively with measurable criteria immediately after assessment ensures accuracy, provides legal protection, and creates reliable baseline data for tracking progress.

What is the legal definition of addiction?

Answer: Addiction is a chronic, relapsing disorder involving substance dependency

The legal definition of addiction recognizes it as a chronic, relapsing disorder involving substance dependency. It is characterized by compulsive drug seeking and use despite harmful consequences, stemming from changes in brain circuits related to reward, motivation, and memory. This understanding guides comprehensive treatment approaches that address both the biological and behavioral aspects of the disease.

Berridge and Robinson's 'incentive salience theory' distinguishes between 'wanting' and 'liking' in addiction, proposing that compulsive drug-seeking is driven by:

Answer: Sensitized 'wanting' (motivation) even as 'liking' decreases

Incentive salience theory holds that dopamine sensitization amplifies 'wanting' (motivation circuits) independently of 'liking' (hedonic circuits), explaining compulsive use despite reduced pleasure.

According to ASAM criteria, which level of care is appropriate for a patient with alcohol use disorder who has mild withdrawal symptoms, stable vital signs, and strong social support at home?

Answer: Level 1: Outpatient treatment

Mild withdrawal with stable vitals and strong support qualifies for outpatient treatment (ASAM Level 1) with close monitoring.

Under the Drug-Free Workplace Act of 1988, federal contractors and grantees are required to do which of the following?

Answer: Establish a drug-free workplace policy and provide employee education about substance use

The Drug-Free Workplace Act requires covered employers to establish a written drug-free workplace policy and provide drug-awareness education, but does not mandate drug testing.

When a clinic dispenses take-home methadone doses in individual bottles, which labeling element is required by federal OTP regulations?

Answer: The patient's name, the dispensing date, and the dose amount

Federal OTP regulations (42 CFR Part 8) require take-home bottles to be labeled with the patient's name, dispensing date, and dose to prevent misuse or diversion.

A patient with benzodiazepine use disorder wants to discontinue alprazolam 4 mg/day. Which conversion and taper strategy is most appropriate?

Answer: Convert to an equivalent dose of a long-acting benzodiazepine such as diazepam, then taper by 5–10% every 1–2 weeks

Converting to a long-acting benzodiazepine like diazepam and tapering slowly (5–10%/1–2 weeks) minimizes seizure risk and withdrawal severity.

A physician learns that a patient in a buprenorphine program is driving while impaired. After counseling the patient, the behavior continues. What is the next most appropriate step?

Answer: Consult state law regarding duty-to-warn obligations and consider notification of authorities if required

Physicians must balance confidentiality with duty-to-protect obligations defined by state law when a patient poses a danger to others.

A patient on methadone maintenance develops acute bacterial endocarditis. The infectious disease team proposes adding fluconazole. The primary pharmacokinetic concern is:

Answer: Fluconazole inhibits CYP3A4 and CYP2C19, increasing methadone plasma levels and QTc risk

Fluconazole inhibits CYP3A4 and CYP2C19, reducing methadone clearance and raising plasma levels, which can prolong the QTc interval.

A patient with alcohol use disorder and a contraindication to benzodiazepines needs alcohol withdrawal management. Which agent is the best alternative for seizure prophylaxis?

Answer: Phenobarbital

Phenobarbital, a GABA-A agonist acting at a different receptor site than benzodiazepines, is a validated alternative for alcohol withdrawal management including seizure prophylaxis.

How should a professional handle a situation where they lack competence?

Answer: Refer the client to a qualified professional or seek additional training

Referring to qualified professionals or obtaining additional training when facing competence limitations protects clients and upholds professional standards.

According to DSM-5, which of the following is classified as a Non-Substance-Related Disorder in the Substance-Related and Addictive Disorders chapter?

Answer: Gambling disorder

Gambling disorder is the only non-substance behavioral addiction included in DSM-5's Substance-Related and Addictive Disorders chapter.

Naltrexone extended-release injectable (XR-NTX) is contraindicated within how many days of last opioid use to avoid precipitated withdrawal?

Answer: 7–10 days

A minimum 7–10 day opioid-free period is required before initiating XR-NTX to avoid precipitated withdrawal from opioid receptor blockade.

Under Joint Commission standards, which of the following is required regarding pain assessment in accredited healthcare organizations?

Answer: Patients must be screened for pain at every clinical contact, with reassessment after treatment

The Joint Commission requires organizations to screen patients for pain at each encounter and reassess pain after treatment interventions, though the specific scale used is not mandated.

What does the ethical concept of 'non-abandonment' require of an addiction medicine physician?

Answer: The physician must not abruptly terminate care without providing reasonable notice and referral options

Non-abandonment prohibits abrupt termination of care; physicians must give adequate notice and assist with transfer of care.