CARN Pharmacology in Addictions Nursing 5 — Questions and Answers
Question 1: A nurse is preparing to administer naloxone to a patient with suspected opioid overdose who is also opioid-dependent. The anticipated risk after naloxone administration is:
- Respiratory stimulation causing hyperventilation
- Precipitated withdrawal with agitation, vomiting, and potential violence (Correct answer)
- Prolonged sedation from naloxone's CNS depressant effects
- Seizures from sudden GABA receptor activation
Correct answer: Precipitated withdrawal with agitation, vomiting, and potential violence
Naloxone rapidly reverses opioid effects in dependent patients, precipitating acute withdrawal characterized by agitation, vomiting, diaphoresis, and combativeness.
Question 2: Bupropion (Wellbutrin/Zyban) aids smoking cessation through which primary mechanism?
- Partial agonism at nicotinic receptors reducing withdrawal
- Inhibition of dopamine and norepinephrine reuptake, reducing nicotine cravings and withdrawal symptoms (Correct answer)
- Serotonin reuptake inhibition improving mood during abstinence
- GABA-B agonism reducing reward from nicotine
Correct answer: Inhibition of dopamine and norepinephrine reuptake, reducing nicotine cravings and withdrawal symptoms
Bupropion inhibits dopamine and norepinephrine reuptake, partially compensating for the dopaminergic deficit during nicotine cessation and reducing cravings.
Question 3: A patient with severe alcohol use disorder develops delirium tremens 72 hours after last drink. Which pharmacological intervention is the first-line treatment?
- Haloperidol to control agitation and hallucinations
- High-dose benzodiazepines titrated to symptom control using CIWA-Ar (Correct answer)
- Phenobarbital as first-line because it is safer than benzodiazepines
- Clonidine to manage autonomic hyperactivity
Correct answer: High-dose benzodiazepines titrated to symptom control using CIWA-Ar
Benzodiazepines are first-line for delirium tremens; they enhance GABA-A activity to suppress CNS hyperexcitability and are titrated using symptom-triggered protocols like CIWA-Ar.
Question 4: Which cytochrome P450 enzyme is most responsible for methadone metabolism, and why does this matter clinically?
- CYP2D6; inhibitors cause methadone toxicity while inducers cause withdrawal
- CYP3A4; inducers like rifampin can precipitate opioid withdrawal by accelerating methadone breakdown (Correct answer)
- CYP1A2; smoking cessation can raise methadone levels dangerously
- CYP2C19; proton pump inhibitors significantly alter methadone levels
Correct answer: CYP3A4; inducers like rifampin can precipitate opioid withdrawal by accelerating methadone breakdown
CYP3A4 is the primary methadone metabolizer; inducers like rifampin, carbamazepine, and phenytoin dramatically accelerate metabolism and can precipitate withdrawal.
Question 5: A CARN nurse reviews the pharmacology of lofexidine (Lucemyra) for opioid withdrawal management. Which statement best describes its advantage over clonidine?
- Lofexidine treats all opioid withdrawal symptoms including pain and insomnia unlike clonidine
- Lofexidine is an FDA-approved non-opioid with less hypotensive effect than clonidine, improving tolerability (Correct answer)
- Lofexidine can be used during buprenorphine induction to prevent precipitated withdrawal
- Lofexidine blocks mu-opioid receptors to prevent relapse unlike clonidine
Correct answer: Lofexidine is an FDA-approved non-opioid with less hypotensive effect than clonidine, improving tolerability
Lofexidine is the first FDA-approved non-opioid for opioid withdrawal management and causes less hypotension than clonidine due to greater selectivity for peripheral alpha-2 receptors.
Question 6: A patient is taking methadone for OUD and reports using benzodiazepines obtained on the street. The nurse's primary concern is:
- Antagonism reducing methadone efficacy and causing withdrawal
- Synergistic CNS and respiratory depression significantly increasing overdose risk (Correct answer)
- Hepatotoxicity from combined metabolism via CYP3A4
- Serotonin syndrome from combined serotonergic activity
Correct answer: Synergistic CNS and respiratory depression significantly increasing overdose risk
Methadone and benzodiazepines both cause CNS and respiratory depression; combined use dramatically increases the risk of fatal overdose through synergistic effects.
Question 7: In a patient with co-occurring opioid use disorder and chronic pain, which pharmacological consideration is most important when prescribing buprenorphine?
- Buprenorphine must be discontinued before any surgical procedure due to analgesia blockade
- Buprenorphine provides partial analgesia and can treat both conditions; dose splitting (TID/QID) may optimize pain control (Correct answer)
- Buprenorphine is contraindicated in chronic pain as it will worsen hyperalgesia
- Full opioid agonists must be prescribed alongside buprenorphine for adequate pain management
Correct answer: Buprenorphine provides partial analgesia and can treat both conditions; dose splitting (TID/QID) may optimize pain control
Buprenorphine has analgesic properties at standard doses, and dividing the daily dose into multiple administrations can improve pain coverage while maintaining OUD treatment.
CARN Pharmacology in Addictions Nursing 5
A nurse is preparing to administer naloxone to a patient with suspected opioid overdose who is also opioid-dependent.
The anticipated risk after naloxone administration is: