Mental Health in Primary Care Flashcards

A 52-year-old patient presents with alcohol use disorder. Which FDA-approved medication is first-line for maintaining abstinence in alcohol use disorder?

Answer: Naltrexone (ReVia/Vivitrol) or acamprosate (Campral)

Naltrexone (opioid receptor antagonist) and acamprosate (GABA/glutamate modulator) are FDA-approved first-line agents for alcohol use disorder maintenance. Naltrexone reduces relapse to heavy drinking; acamprosate is preferred when abstinence is established.

A patient presents requesting benzodiazepines for chronic anxiety. The primary care NP counsels that the main risk of long-term benzodiazepine use is:

Answer: Physical dependence, tolerance, cognitive impairment, fall risk especially in elderly, and withdrawal seizures on abrupt discontinuation

Long-term benzodiazepine use causes physical dependence, tolerance requiring escalating doses, cognitive impairment, increased fall risk, and life-threatening withdrawal including seizures if abruptly discontinued.

A 16-year-old presents with depression. The FDA has a black box warning for all antidepressants regarding which risk in patients under age 25?

Answer: Increased risk of suicidal thinking and behavior, particularly in the first weeks of treatment

FDA black box warning: antidepressants increase the risk of suicidal thinking and behavior in children, adolescents, and young adults 24 and younger during the first 1-2 months of treatment, requiring close monitoring.

A patient is started on lithium for bipolar I disorder. Which monitoring parameters are essential during lithium therapy?

Answer: Renal function (serum creatinine, eGFR), thyroid function (TSH), serum lithium levels, and electrolytes (sodium)

Lithium has a narrow therapeutic index and requires regular monitoring of renal function (lithium is renally eliminated), thyroid function (lithium causes hypothyroidism in up to 40%), serum lithium levels, and electrolytes.

A patient with opioid use disorder is being evaluated for medication-assisted treatment in primary care. Which medication can be prescribed by any DEA-licensed provider in an office-based setting for OUD treatment as of 2023?

Answer: Buprenorphine including buprenorphine/naloxone (Suboxone) after completing required training, without the former DATA 2000 waiver requirement since 2023

The 2023 Mainstreaming Addiction Treatment Act eliminated the X-waiver requirement. Any DEA-licensed provider can now prescribe buprenorphine for OUD after completing 8 hours of training.

A 44-year-old patient with panic disorder has taken alprazolam 2mg three times daily for 2 years and wants to stop. The safest approach for discontinuation is:

Answer: Gradually taper alprazolam by approximately 10% per week or slower while transitioning to an SSRI plus CBT for long-term panic disorder management

Abrupt benzodiazepine discontinuation after 2 years of daily high-dose use can cause life-threatening withdrawal including seizures. A slow taper with long-term transition to SSRI plus CBT is the safest evidence-based approach.