Pharmacotherapy & Medication-Assisted Treatment Flashcards

A patient on buprenorphine/naloxone takes alprazolam prescribed by another provider. The primary concern with this combination is:

Answer: Synergistic CNS and respiratory depression, increasing overdose risk

Concurrent use of buprenorphine and benzodiazepines carries a black box warning due to additive CNS depression and increased risk of fatal respiratory depression.

Extended-release naltrexone (Vivitrol) 380 mg IM is administered monthly. If a patient uses opioids during this period, what is the expected outcome?

Answer: Attenuation or blockade of opioid euphoria without precipitated withdrawal

XR-NTX blocks mu-opioid receptors, blunting the rewarding effects of opioid use; precipitated withdrawal occurs only if opioid-dependent patients receive the injection prematurely.

Buprenorphine/naloxone is prescribed for a patient with OUD who also tests positive for fentanyl on urine drug screen. Which clinical consideration is most important when inducing?

Answer: Fentanyl and its metabolites have prolonged tissue binding, increasing precipitated withdrawal risk with early induction

Fentanyl's high lipophilicity and tissue redistribution can prolong the risk window for precipitated withdrawal beyond what standard COWS scores reflect.

Which pharmacotherapy for alcohol use disorder is most appropriate for a patient with severe renal impairment (CrCl < 30 mL/min)?

Answer: Naltrexone, because it is primarily hepatically metabolized and not renally cleared

Naltrexone is hepatically metabolized; acamprosate is contraindicated in severe renal impairment due to renal excretion, making naltrexone the preferred AUD medication.

A patient stabilized on methadone 80 mg/day at an OTP is hospitalized and the hospital team refuses to continue methadone. What is the correct response?

Answer: The OTP can verify the dose and the hospital must provide methadone to prevent withdrawal per federal regulations

Federal regulations require hospitals to continue a patient's documented methadone maintenance dose; the OTP verifies the dose and the hospital is obligated to administer it.

Which smoking cessation medication is contraindicated in a patient with a current or recent history of anorexia nervosa?

Answer: Bupropion SR

Bupropion lowers the seizure threshold and is contraindicated in eating disorders such as anorexia nervosa and bulimia due to the associated risk of electrolyte abnormalities and seizures.

A physician practicing addiction medicine uses 'low-dose induction' (also called micro-dosing) with buprenorphine. This technique is primarily designed to:

Answer: Allow buprenorphine initiation in patients on full agonist opioids without precipitating withdrawal

Micro-dosing (Bernese method) involves gradually escalating sub-precipitating doses of buprenorphine while the patient continues full agonist opioids, avoiding the need for a withdrawal period.