ADM Treatment Protocols & Procedures 2 — Questions and Answers
Question 1: A patient with opioid use disorder is starting buprenorphine. Which condition must be met before administering the first dose to avoid precipitated withdrawal?
- The patient must be in mild-to-moderate opioid withdrawal (COWS ≥8) (Correct answer)
- The patient must have abstained from all opioids for at least 72 hours
- The patient must have a negative urine drug screen for all opioids
- The patient must have completed a medically supervised detox program
Correct answer: The patient must be in mild-to-moderate opioid withdrawal (COWS ≥8)
Buprenorphine induction requires the patient to be in at least mild withdrawal (COWS ≥8) to prevent precipitated withdrawal from its partial agonist/antagonist properties.
Question 2: Which naltrexone formulation is preferred for opioid use disorder in patients with adherence concerns and no hepatic impairment?
- Extended-release injectable naltrexone (Vivitrol) monthly (Correct answer)
- Oral naltrexone 50 mg daily
- Naltrexone 25 mg daily with titration
- Sublingual naltrexone film twice daily
Correct answer: Extended-release injectable naltrexone (Vivitrol) monthly
Extended-release injectable naltrexone (Vivitrol) eliminates the daily adherence issue and maintains consistent plasma levels for the full month.
Question 3: A patient on methadone maintenance presents with QTc of 510 ms on ECG. What is the most appropriate next step?
- Reduce the methadone dose and consider switching to buprenorphine (Correct answer)
- Continue the current dose and repeat ECG in 3 months
- Immediately discontinue methadone and start buprenorphine today
- Add a QTc-prolonging antibiotic for a concurrent infection without dose adjustment
Correct answer: Reduce the methadone dose and consider switching to buprenorphine
QTc >500 ms is a serious concern with methadone; dose reduction or transition to buprenorphine is indicated to reduce arrhythmia risk.
Question 4: 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?
- Level 1: Outpatient treatment (Correct answer)
- Level 3.7: Medically managed intensive inpatient
- Level 3.2: Clinically managed residential
- Level 2.1: Intensive outpatient program
Correct answer: Level 1: Outpatient treatment
Mild withdrawal with stable vitals and strong support qualifies for outpatient treatment (ASAM Level 1) with close monitoring.
Question 5: Which medication is FDA-approved specifically for the treatment of alcohol use disorder and works by blocking opioid receptors to reduce craving?
- Naltrexone (Correct answer)
- Acamprosate
- Disulfiram
- Topiramate
Correct answer: Naltrexone
Naltrexone blocks opioid receptors involved in alcohol-induced reward, reducing craving and the pleasurable effects of drinking.
Question 6: A patient with stimulant use disorder is seeking pharmacotherapy. Which of the following has the strongest evidence base as a treatment option?
- There is currently no FDA-approved medication for stimulant use disorder (Correct answer)
- Bupropion 150 mg twice daily is FDA-approved for methamphetamine use disorder
- Modafinil is FDA-approved for cocaine use disorder
- Naltrexone is first-line for all stimulant use disorders
Correct answer: There is currently no FDA-approved medication for stimulant use disorder
No medication is currently FDA-approved for stimulant use disorder, though several show promise in clinical trials (e.g., bupropion + naltrexone for methamphetamine).
Question 7: Which withdrawal syndrome poses the greatest immediate risk of mortality if untreated?
- Alcohol withdrawal (Correct answer)
- Opioid withdrawal
- Cocaine withdrawal
- Cannabis withdrawal
Correct answer: Alcohol withdrawal
Alcohol withdrawal can progress to delirium tremens with seizures and cardiovascular collapse, carrying significant mortality risk without treatment.
ADM Treatment Protocols & Procedures 2
A patient with opioid use disorder is starting buprenorphine.
Which condition must be met before administering the first dose to avoid precipitated withdrawal?