ADM Pharmacotherapy & Medication-Assisted Treatment 3

Question 1

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

Accepted Answer

Transition to extended-release injectable buprenorphine (Sublocade)

Answer

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.

Question 2

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

Accepted Answer

QTc > 500 ms

Answer

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.

Question 3

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

Accepted Answer

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

Answer

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

Question 4

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:

Accepted Answer

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

Answer

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

Question 5

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

Accepted Answer

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

Answer

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.

(ADM) Board Certified Addiction Medicine Specialist Practice Test

(ADM) Board Certified Addiction Medicine Specialist Practice Test

ADM Pharmacotherapy & Medication-Assisted Treatment 3