Pharmacology and Medication-Assisted Treatment Flashcards

A client taking disulfiram (Antabuse) for alcohol use disorder consumes a mouthwash containing ethanol. What reaction is most likely to occur?

Answer: A disulfiram-ethanol reaction due to acetaldehyde accumulation

Even small amounts of ethanol, including in mouthwash, can trigger a disulfiram-ethanol reaction characterized by flushing, tachycardia, nausea, and vomiting due to acetaldehyde buildup.

Which of the following best describes the pharmacological mechanism of naltrexone in treating alcohol use disorder?

Answer: It antagonizes opioid receptors, reducing the rewarding effects of alcohol

Naltrexone blocks mu-opioid receptors, dampening the endorphin-mediated euphoric reward from alcohol and reducing the reinforcing 'high' that drives continued drinking.

A client with opioid use disorder is interested in extended-release injectable naltrexone (Vivitrol). Which condition must be met before the first injection?

Answer: Client must be opioid-free for 7–10 days to avoid precipitated withdrawal

Extended-release naltrexone must not be initiated until the client is opioid-free for at least 7–10 days; administration to an opioid-dependent person causes severe precipitated withdrawal.

Varenicline (Chantix) assists smoking cessation by acting as a partial agonist at which receptor?

Answer: Alpha-4 beta-2 nicotinic acetylcholine receptors

Varenicline partially activates alpha-4 beta-2 nicotinic acetylcholine receptors, reducing cravings while blocking nicotine from producing its full rewarding effect.

A pregnant client with opioid use disorder is being evaluated for MAT. According to clinical guidelines, which approach is recommended over medically supervised withdrawal during pregnancy?

Answer: Maintenance therapy with methadone or buprenorphine

SAMHSA and ACOG guidelines recommend methadone or buprenorphine maintenance during pregnancy because withdrawal significantly increases risk of fetal distress, preterm labor, and miscarriage.

Which side effect is most associated with buprenorphine therapy that clients should be counseled about before starting treatment?

Answer: Constipation, headache, and insomnia

Common side effects of buprenorphine include constipation (opioid receptor-mediated), headache, and insomnia, which clients should be prepared to manage.

A counselor learns that a client stable on methadone maintenance for two years wants to discontinue MAT. What is the evidence-based counseling response?

Answer: Advise a very gradual taper and discuss the significantly increased overdose risk after stopping

Evidence shows relapse and overdose mortality increase substantially after MAT discontinuation; counselors should support a very gradual taper and ensure the client understands the risks.