BCACP Mental Health and Substance Use Disorders 4

Question 1

A patient with bipolar I disorder is stable on lithium 900 mg/day. She reports she is 8 weeks pregnant. What is the most appropriate next step regarding her lithium therapy?

Accepted Answer

Continue lithium with close monitoring and folic acid supplementation, discussing risks and benefits

Answer

Lithium carries teratogenic risk (Ebstein's anomaly) but abrupt discontinuation risks severe relapse; a shared decision-making approach with continued therapy and enhanced monitoring is generally preferred.

Question 2

Which opioid use disorder (OUD) medication is the ONLY one approved by the FDA that can be prescribed in an office-based setting without a special waiver historically required under the DATA 2000 Act?

Accepted Answer

Extended-release naltrexone (Vivitrol)

Answer

Extended-release naltrexone (injectable) has no special prescribing restrictions and can be prescribed by any licensed provider, unlike methadone for OUD (OTP only) or buprenorphine (which historically required a waiver).

Question 3

A 55-year-old patient with schizophrenia is non-adherent to oral antipsychotics. Which long-acting injectable (LAI) antipsychotic requires an oral overlap period of at least 3 weeks before the first injection to ensure adequate plasma levels?

Accepted Answer

Risperidone microspheres (Risperdal Consta)

Answer

Risperidone microspheres (Risperdal Consta) has a 3-week lag before therapeutic drug release, requiring oral antipsychotic overlap for the first 3 weeks after initiation.

Question 4

A patient on clozapine develops an ANC of 1,200 cells/mm³. According to REMS monitoring requirements, what is the correct action?

Accepted Answer

Interrupt clozapine and resume only when ANC ≥ 1,500

Answer

An ANC of 1,000–1,499 (moderate neutropenia) requires interruption of clozapine; therapy may resume when ANC returns to ≥ 1,500 cells/mm³ with more frequent monitoring.

Question 5

A pharmacist is counseling a patient starting disulfiram for alcohol use disorder. Which of the following interactions is MOST clinically significant to warn the patient about?

Accepted Answer

Metronidazole (Flagyl)

Answer

Metronidazole combined with disulfiram can cause acute psychosis and confusion; this combination is contraindicated.

BCACP - Board Certified Ambulatory Care Pharmacist Exam Practice Test

BCACP - Board Certified Ambulatory Care Pharmacist Exam Practice Test

BCACP Mental Health and Substance Use Disorders 4