BCACP Mental Health and Substance Use Disorders 2 — Questions and Answers
Question 1: Which medication is first-line for generalized anxiety disorder (GAD) pharmacotherapy in ambulatory care?
- Lorazepam
- Buspirone or an SSRI/SNRI (Correct answer)
- Hydroxyzine
- Alprazolam
Correct answer: Buspirone or an SSRI/SNRI
SSRIs, SNRIs, and buspirone are first-line for GAD due to efficacy without the dependence risk of benzodiazepines.
Question 2: What is the primary mechanism of action of naltrexone when used for alcohol use disorder?
- GABA-A receptor potentiation
- Opioid receptor blockade reducing reward from alcohol (Correct answer)
- Aversion to alcohol via acetaldehyde accumulation
- Serotonin reuptake inhibition
Correct answer: Opioid receptor blockade reducing reward from alcohol
Naltrexone blocks opioid receptors, reducing the rewarding effects of alcohol and decreasing craving.
Question 3: A patient starting on an SSRI for depression asks when they will begin to feel better. What is the most accurate response?
- Within 24–48 hours
- Within 1 week
- 2–4 weeks for mood improvement, up to 6–8 weeks for full effect (Correct answer)
- Immediately upon achieving therapeutic levels
Correct answer: 2–4 weeks for mood improvement, up to 6–8 weeks for full effect
SSRIs typically produce initial mood improvement at 2–4 weeks with full therapeutic effect taking 6–8 weeks.
Question 4: Which atypical antipsychotic requires mandatory enrollment in a REMS program due to risk of agranulocytosis?
- Quetiapine
- Risperidone
- Clozapine (Correct answer)
- Aripiprazole
Correct answer: Clozapine
Clozapine has a REMS program (CLOZAPINE REMS) requiring ANC monitoring due to its risk of life-threatening agranulocytosis.
Question 5: What is the role of motivational interviewing (MI) in managing substance use disorders in ambulatory care?
- To confront and challenge the patient's denial directly
- To use empathy and elicit the patient's own motivation for change (Correct answer)
- To prescribe pharmacotherapy without counseling
- To document refusal of treatment
Correct answer: To use empathy and elicit the patient's own motivation for change
Motivational interviewing uses reflective listening and empathy to help patients explore ambivalence and strengthen their own motivation to change.
Question 6: Which benzodiazepine property makes lorazepam preferred over diazepam in patients with liver impairment?
- Longer half-life
- Active metabolites
- No hepatic oxidation; undergoes glucuronidation only (Correct answer)
- Stronger anxiolytic effect
Correct answer: No hepatic oxidation; undergoes glucuronidation only
Lorazepam undergoes direct glucuronidation without hepatic oxidative metabolism, making it safer in liver disease.
BCACP Mental Health and Substance Use Disorders 2
Which medication is first-line for generalized anxiety disorder (GAD) pharmacotherapy in ambulatory care?