Pharmacotherapy & Medication-Assisted Treatment Flashcards

A patient with OUD on buprenorphine/naloxone reports they are selling part of their medication. Which formulation change addresses diversion most directly?

Answer: Transition to extended-release injectable buprenorphine (Sublocade)

Sublocade is a subcutaneous depot formulation that eliminates diversion potential because the medication is injected by a healthcare provider and cannot be removed or transferred.

Which QTc threshold on ECG is the standard trigger for clinical concern when a patient on methadone maintenance is being monitored?

Answer: QTc > 500 ms

A QTc exceeding 500 ms is considered a threshold requiring dose reduction, medication review, or cardiology consultation due to increased risk of torsades de pointes.

Varenicline's superior efficacy over nicotine replacement therapy in smoking cessation is primarily due to its action as a:

Answer: Partial agonist at alpha4beta2 nicotinic receptors, reducing craving while blunting smoking reward

Varenicline's partial agonism provides enough dopamine stimulation to reduce withdrawal and craving while competitively blocking nicotine from producing the full rewarding effect.

Low-dose naltrexone (LDN, ~1.5–4.5 mg/day) is being studied for conditions such as fibromyalgia. Its proposed mechanism at these doses differs from standard dosing by:

Answer: Transiently blocking opioid receptors, triggering a rebound upregulation of endogenous opioids

At low doses, naltrexone briefly occupies opioid receptors, causing a compensatory upregulation of endogenous opioids and endorphins upon receptor release.

Which laboratory finding would prompt immediate dose reduction of naltrexone in a patient on extended-release injectable naltrexone?

Answer: ALT/AST greater than 3–5 times the upper limit of normal

Naltrexone carries a black box warning for hepatotoxicity; elevations of liver enzymes 3–5 times the upper limit of normal warrant dose reduction or discontinuation.

A patient with severe alcohol use disorder and concurrent major depression is being considered for pharmacotherapy. Which agent addresses both conditions with the strongest evidence?

Answer: Naltrexone, which reduces alcohol craving and has antidepressant properties in some trials

Naltrexone reduces heavy drinking days and has shown mood-stabilizing properties in some studies, making it a reasonable choice in comorbid AUD and depression.

The Suboxone film formulation contains buprenorphine and naloxone in which ratio?

Answer: 4:1

Suboxone contains buprenorphine and naloxone in a 4:1 ratio (e.g., 8 mg buprenorphine / 2 mg naloxone) designed to deter injection misuse.