Treatment Protocols & Procedures Flashcards

A patient on methadone maintenance therapy for OUD is hospitalized for surgery. What is the best approach to methadone dosing perioperatively?

Answer: Continue the established methadone dose throughout hospitalization and add short-acting opioids for pain as needed

Methadone should be continued at the maintenance dose perioperatively, as discontinuation risks withdrawal and relapse; additional opioids for pain are titrated separately.

The CIWA-Ar scale is used to assess severity of which type of withdrawal?

Answer: Alcohol withdrawal

The Clinical Institute Withdrawal Assessment for Alcohol Revised (CIWA-Ar) is the standard tool for monitoring alcohol withdrawal severity and guiding benzodiazepine dosing.

A 45-year-old patient with severe alcohol use disorder is treated with diazepam using a symptom-triggered protocol. What is the primary advantage of symptom-triggered over fixed-schedule dosing?

Answer: Reduces total benzodiazepine dose administered and shortens detox duration

Symptom-triggered dosing administers benzodiazepines only when CIWA-Ar scores indicate need, resulting in lower total doses and faster treatment.

Acamprosate is thought to reduce alcohol cravings primarily by which mechanism?

Answer: Modulating glutamate (NMDA) and GABA-B receptor activity to restore neurological balance

Acamprosate restores the glutamate/GABA balance disrupted by chronic alcohol use, reducing the dysphoric state that drives craving.

Which opioid use disorder treatment protocol is sometimes called 'low-dose' or 'Bernese' buprenorphine induction and is used for patients currently taking fentanyl?

Answer: Microdosing induction, where buprenorphine is initiated in small doses without requiring full withdrawal first

The Bernese method uses incremental microdoses of buprenorphine while the patient continues their opioid, gradually transitioning without precipitated withdrawal.

A pregnant patient with opioid use disorder presents at 14 weeks gestation. Which treatment approach is recommended per ACOG and ASAM guidelines?

Answer: Methadone or buprenorphine maintenance; medically supervised withdrawal is not recommended due to high relapse risk

MOUD with methadone or buprenorphine is the standard of care in pregnancy; withdrawal/detox is associated with high relapse rates and fetal harm.

Varenicline (Chantix) for tobacco use disorder works primarily by which mechanism?

Answer: Partial agonism at alpha-4 beta-2 nicotinic acetylcholine receptors, reducing withdrawal and blocking nicotine reward

Varenicline is a partial agonist at α4β2 receptors, providing enough stimulation to ease withdrawal while blocking nicotine's additional reinforcement.