CARN Pharmacology & Substance Use Disorders 4

Question 1

A patient using methamphetamine presents with severe hyperthermia and agitation. In addition to cooling measures, which medication class is most appropriate for immediate management?

Accepted Answer

Benzodiazepines

Answer

Benzodiazepines are first-line for methamphetamine-induced agitation and hyperthermia because they reduce CNS excitation without the risks associated with antipsychotics in stimulant toxicity.

Question 2

Which of the following best describes the pharmacokinetic advantage of the buprenorphine transdermal patch compared to sublingual formulations?

Accepted Answer

Avoidance of first-pass metabolism and steady plasma levels

Answer

Transdermal buprenorphine bypasses first-pass hepatic metabolism and provides consistent plasma concentrations over days, improving adherence and reducing peak-trough fluctuations.

Question 3

A nurse notes that a patient's urine drug screen is positive for fentanyl but the patient denies using fentanyl and only admits to heroin use. The most appropriate interpretation is:

Accepted Answer

Illicitly obtained heroin is often adulterated with fentanyl, so the result is consistent with the patient's report

Answer

Illicit drug supplies, including heroin, are frequently contaminated with fentanyl; a fentanyl-positive screen in a self-reported heroin user is commonly explained by adulteration.

Question 4

The CARN nurse is reviewing medications for a patient with co-occurring opioid use disorder and major depressive disorder on buprenorphine. Which antidepressant combination requires the most caution due to CYP3A4 interactions?

Accepted Answer

Fluoxetine and fluvoxamine

Answer

Fluoxetine and fluvoxamine significantly inhibit CYP3A4 and CYP2D6, potentially increasing buprenorphine plasma levels and requiring dose monitoring.

Question 5

Neonatal opioid withdrawal syndrome (NOWS) is most reliably assessed using which tool?

Accepted Answer

Finnegan Neonatal Abstinence Scoring Tool

Answer

The Finnegan Neonatal Abstinence Scoring Tool is the standard validated instrument for assessing severity of NOWS and guiding pharmacological treatment decisions.

(CARN) Certified Addictions Registered Nurse Practice Test

(CARN) Certified Addictions Registered Nurse Practice Test

CARN Pharmacology & Substance Use Disorders 4