CAADC Pharmacology and MAT 2 — Questions and Answers
Question 1: What is buprenorphine's mechanism of action in treating opioid use disorder?
- Full opioid agonist producing the same effects as heroin
- Partial opioid agonist that reduces cravings and withdrawal without full euphoria (Correct answer)
- Blocks all brain receptors completely
- Accelerates opioid metabolism
Correct answer: Partial opioid agonist that reduces cravings and withdrawal without full euphoria
Buprenorphine activates mu-opioid receptors enough to suppress withdrawal and cravings but has a ceiling effect limiting euphoria.
The ceiling effect limits respiratory depression risk. High binding affinity means it can displace other opioids, which is why induction timing matters to avoid precipitated withdrawal.
Question 2: Which alcohol use disorder medication blocks opioid receptors to reduce alcohol's rewarding effects?
- Disulfiram
- Naltrexone (Correct answer)
- Acamprosate
- Benzodiazepines
Correct answer: Naltrexone
Naltrexone blocks the endorphin-mediated rewarding effects of alcohol.
Available in oral and injectable (Vivitrol) formulations, naltrexone should not be initiated until the patient is opioid-free (7-10 days). Monthly injection improves adherence.
Question 3: What is the CAADC counselor's role in a MAT team?
- No role since MAT is purely medical
- Provides psychosocial support, monitors adherence, educates about medications, and collaborates with prescribers (Correct answer)
- Prescribes medications
- Only conducts drug testing
Correct answer: Provides psychosocial support, monitors adherence, educates about medications, and collaborates with prescribers
Counselors provide the essential psychosocial component, monitor response, and serve as liaison between client and prescriber.
The counselor's contributions include psychoeducation, adherence support, behavioral treatment, monitoring effects, addressing ambivalence about medication, and building the life skills medication alone cannot provide.
Question 4: What is buprenorphine's 'ceiling effect' and why is it clinically significant?
- It means it cannot be taken with other medications
- Beyond a certain dose, effects plateau, significantly reducing respiratory depression risk (Correct answer)
- It refers to the maximum patient count per provider
- It means it works for a limited time
Correct answer: Beyond a certain dose, effects plateau, significantly reducing respiratory depression risk
The ceiling effect makes buprenorphine significantly safer in overdose than full agonists like methadone.
The dose-response curve flattens at moderate doses, meaning increasing beyond 16-32mg does not produce additional effects. This is why buprenorphine can be prescribed in office-based settings.
Question 5: Which medication maintains alcohol abstinence by restoring excitatory/inhibitory neurotransmitter balance?
- Methadone
- Acamprosate (Campral) (Correct answer)
- Buprenorphine
- Clonidine
Correct answer: Acamprosate (Campral)
Acamprosate modulates glutamate and GABA systems disrupted by chronic alcohol use.
Chronic alcohol upregulates glutamate and downregulates GABA. Acamprosate normalizes this imbalance, reducing protracted withdrawal symptoms. Requires three-times-daily dosing and is most effective for maintaining abstinence.
Question 6: What should a CAADC counselor understand about MAT stigma?
- There is no stigma
- Many communities stigmatize MAT, and counselors must actively counteract this while supporting treatment decisions (Correct answer)
- Stigma only affects methadone
- Counselors should discourage MAT
Correct answer: Many communities stigmatize MAT, and counselors must actively counteract this while supporting treatment decisions
MAT stigma is a significant barrier, and counselors have a responsibility to provide accurate information.
Research demonstrates that MAT reduces mortality, overdose, and criminal activity. Counselors should educate about evidence, challenge stigmatizing attitudes, and help clients find medication-friendly supports.
CAADC Pharmacology and MAT 2
What is buprenorphine's mechanism of action in treating opioid use disorder?