CARN - Certified Addictions Registered Nurse Pharmacology of Addictive Substances Questions and Answers — Questions and Answers
Question 1: A client with alcohol use disorder is prescribed acamprosate. The nurse should explain that the primary mechanism of action for this medication is to:
- Create an unpleasant reaction if alcohol is consumed.
- Block the euphoric effects of alcohol by binding to opioid receptors.
- Restore the balance between GABA and glutamate neurotransmission. (Correct answer)
- Substitute for alcohol by providing a similar sedating effect.
Correct answer: Restore the balance between GABA and glutamate neurotransmission.
Acamprosate is believed to work by restoring the natural balance of chemical signaling in the brain that is disrupted by chronic alcohol use, specifically involving the GABA and glutamate neurotransmitter systems. It is not an aversive agent like disulfiram, nor does it block opioid receptors like naltrexone.
Question 2: A nurse is caring for a patient experiencing withdrawal from a short-acting opioid like heroin. Which of the following symptoms would the nurse expect to see peak within 1 to 3 days after the last use?
- Constipation and urinary retention
- Euphoria and sense of calm
- Respiratory depression and constricted pupils
- Rhinorrhea, muscle aches, and gastrointestinal distress (Correct answer)
Correct answer: Rhinorrhea, muscle aches, and gastrointestinal distress
The peak of withdrawal from short-acting opioids such as heroin typically occurs between 24 and 72 hours. Symptoms are often flu-like and include runny nose (rhinorrhea), lacrimation, muscle and bone pain, diarrhea, nausea, and vomiting. The other options are symptoms of opioid intoxication, not withdrawal.
Question 3: A patient is being initiated on naltrexone for the treatment of opioid use disorder. Which statement by the patient indicates a need for further education?
- "This medication will help reduce my cravings for opioids."
- "I must stop using all opioids for 7-10 days before I start this pill."
- "If I use opioids while taking this, I won't feel the euphoric effects."
- "This medication is a partial opioid agonist that will prevent withdrawal." (Correct answer)
Correct answer: "This medication is a partial opioid agonist that will prevent withdrawal."
Naltrexone is a pure opioid antagonist, not a partial agonist. It works by blocking the mu-opioid receptors, which prevents the euphoric and sedative effects of opioids and helps reduce cravings. It does not activate the receptors and therefore does not prevent withdrawal; in fact, taking it while physically dependent on opioids will precipitate acute withdrawal. Buprenorphine is an example of a partial opioid agonist.
Question 4: A nurse is providing education to a client who has been prescribed disulfiram. The nurse should warn the client to avoid which of the following products?
- Foods high in tyramine, such as aged cheeses
- Grapefruit juice
- Mouthwash containing alcohol (Correct answer)
- Nicotine replacement therapy
Correct answer: Mouthwash containing alcohol
Disulfiram works by inhibiting the enzyme aldehyde dehydrogenase, leading to an accumulation of acetaldehyde if alcohol is consumed. This causes a severe, unpleasant reaction. Many common products, including mouthwash, cough syrups, and some topical preparations, contain alcohol and can trigger this reaction.
Question 5: A patient who has been on long-term, high-dose benzodiazepine therapy abruptly stops taking the medication. The nurse should be most concerned about the patient developing:
- Hypertensive crisis
- Serotonin syndrome
- Grand mal seizures (Correct answer)
- Neuroleptic malignant syndrome
Correct answer: Grand mal seizures
Abrupt cessation of benzodiazepines, which are GABA-A receptor agonists, can lead to a severe and potentially life-threatening withdrawal syndrome. This is characterized by central nervous system hyperexcitability, which can manifest as anxiety, insomnia, tremors, and in severe cases, seizures and delirium.
Question 6: When comparing the pharmacology of nicotine delivery via electronic cigarettes (vaping) versus traditional combustible cigarettes, which of the following is most accurate?
- Vaping delivers nicotine to the brain more rapidly than smoking.
- Traditional cigarettes deliver carbon monoxide, while e-cigarettes do not. (Correct answer)
- Both methods deliver identical amounts of nicotine per puff.
- E-cigarettes are a non-addictive alternative to smoking.
Correct answer: Traditional cigarettes deliver carbon monoxide, while e-cigarettes do not.
The combustion of tobacco in traditional cigarettes produces thousands of chemicals, including carbon monoxide and tar, which are largely absent in the aerosol from e-cigarettes. While both deliver the addictive substance nicotine, the byproducts of combustion are the primary source of smoking-related harm. Nicotine delivery from vaping can be slower and less efficient than from smoking, especially in new users, and it is still an addictive substance.
CARN - Certified Addictions Registered Nurse Pharmacology of Addictive Substances Questions and Answers
A client with alcohol use disorder is prescribed acamprosate.
The nurse should explain that the primary mechanism of action for this medication is to: