CARN Pharmacology in Addictions Nursing 4 — Questions and Answers
Question 1: Which of the following correctly describes the pharmacokinetic advantage of methadone in treating opioid use disorder?
- Short half-life allows flexible dosing schedules
- Long half-life (24–36 hours) enables once-daily dosing and prevents withdrawal between doses (Correct answer)
- Rapid onset makes it effective for acute overdose reversal
- Low protein binding reduces drug interaction risk
Correct answer: Long half-life (24–36 hours) enables once-daily dosing and prevents withdrawal between doses
Methadone's long half-life of 24–36 hours allows once-daily dosing, maintains stable blood levels, and prevents the peaks and troughs that drive craving.
Question 2: A patient with opioid use disorder is starting naltrexone. The nurse knows the patient must be opioid-free for at least how long before initiation to prevent precipitated withdrawal?
- 12 hours for short-acting opioids; 24 hours for long-acting opioids
- 7–10 days for short-acting opioids; 10–14 days for methadone (Correct answer)
- 24 hours for all opioids regardless of type
- 3 days for short-acting; 7 days for long-acting opioids
Correct answer: 7–10 days for short-acting opioids; 10–14 days for methadone
Naltrexone should not be initiated until the patient is opioid-free for 7–10 days (short-acting) or 10–14 days (methadone) to avoid precipitating severe withdrawal.
Question 3: Nicotine replacement therapy (NRT) reduces withdrawal symptoms primarily by:
- Blocking nicotine receptors to prevent tobacco from binding
- Providing controlled nicotine delivery to reduce withdrawal without behavioral reinforcement of smoking (Correct answer)
- Increasing dopamine release beyond what tobacco provides
- Inhibiting acetylcholinesterase to enhance cholinergic tone
Correct answer: Providing controlled nicotine delivery to reduce withdrawal without behavioral reinforcement of smoking
NRT delivers nicotine in controlled doses to reduce withdrawal symptoms and cravings while eliminating tobacco combustion products and the behavioral ritual of smoking.
Question 4: A patient on methadone maintenance is prescribed erythromycin for an infection. The nurse's priority concern is:
- Reduced methadone efficacy due to enzyme induction
- QTc interval prolongation increasing risk of torsades de pointes (Correct answer)
- Increased methadone sedation from CNS synergy
- Serotonin syndrome from combined serotonergic activity
Correct answer: QTc interval prolongation increasing risk of torsades de pointes
Both methadone and erythromycin can prolong the QTc interval, and their combination significantly increases risk of life-threatening torsades de pointes.
Question 5: Which statement about buprenorphine's ceiling effect is clinically most significant?
- Buprenorphine cannot produce analgesia above certain doses
- At higher doses, increasing buprenorphine does not proportionally increase respiratory depression, reducing overdose risk (Correct answer)
- Buprenorphine's ceiling effect means it always requires combination with naloxone
- The ceiling effect prevents buprenorphine from being effective in high-tolerance patients
Correct answer: At higher doses, increasing buprenorphine does not proportionally increase respiratory depression, reducing overdose risk
As a partial agonist, buprenorphine's respiratory depression effect plateaus at higher doses, making overdose from buprenorphine alone far less likely than with full opioid agonists.
Question 6: A patient with alcohol use disorder has been abstinent for 6 months and wants to stop taking acamprosate. The nurse should advise:
- Discontinue immediately since alcohol cravings typically resolve after 6 months
- Taper slowly over 4 weeks to prevent rebound seizures
- Continue for at least 12 months total as relapse risk remains elevated, then discuss with provider (Correct answer)
- Switch to naltrexone before stopping acamprosate
Correct answer: Continue for at least 12 months total as relapse risk remains elevated, then discuss with provider
Guidelines recommend acamprosate for at least 12 months to address prolonged post-acute withdrawal; stopping early increases relapse risk since neurochemical dysregulation can persist.
Question 7: Which pharmacological property of fentanyl makes it particularly dangerous compared to heroin in the context of overdose?
- Longer duration of action requiring multiple naloxone doses in overdose reversal
- Extreme potency (50–100x morphine) leading to rapid, unpredictable respiratory depression at minute quantities (Correct answer)
- Higher affinity for kappa opioid receptors causing greater respiratory depression
- Slower onset preventing users from self-titrating dose
Correct answer: Extreme potency (50–100x morphine) leading to rapid, unpredictable respiratory depression at minute quantities
Fentanyl's extreme potency means that microgram quantities can cause fatal respiratory depression, and illicit supply inconsistency makes every dose potentially lethal.
CARN Pharmacology in Addictions Nursing 4
Which of the following correctly describes the pharmacokinetic advantage of methadone in treating opioid use disorder?