CASAC Pharmacology and Co-Occurring Disorders 3 — Questions and Answers
Question 1: A client on buprenorphine/naloxone (Suboxone) reports taking a benzodiazepine prescribed by another doctor. What is the primary concern?
- Reduced efficacy of buprenorphine
- Increased risk of fatal respiratory depression (Correct answer)
- Accelerated buprenorphine metabolism
- Naloxone blocking benzodiazepine effects
Correct answer: Increased risk of fatal respiratory depression
Combining buprenorphine with benzodiazepines carries a significant risk of respiratory depression and death, which is why the FDA issued a black box warning.
Question 2: Which neurotransmitter system is primarily targeted by SSRIs used to treat co-occurring depression in clients with alcohol use disorder?
- Dopamine
- GABA
- Serotonin (Correct answer)
- Norepinephrine
Correct answer: Serotonin
SSRIs (selective serotonin reuptake inhibitors) work by blocking the reuptake of serotonin, increasing its availability in the synapse.
Question 3: A client with opioid use disorder and PTSD is being treated with naltrexone. Which statement about this combination is most accurate?
- Naltrexone is contraindicated in clients with PTSD
- Naltrexone may also help reduce PTSD-related alcohol cravings (Correct answer)
- Naltrexone worsens PTSD hyperarousal symptoms
- Naltrexone has no interaction with PTSD treatment
Correct answer: Naltrexone may also help reduce PTSD-related alcohol cravings
Research suggests naltrexone can reduce cravings for alcohol in clients with PTSD, making it useful in treating co-occurring PTSD and alcohol use disorder.
Question 4: What is the mechanism of action of disulfiram (Antabuse) in treating alcohol use disorder?
- Blocks opioid receptors to reduce alcohol cravings
- Inhibits aldehyde dehydrogenase causing toxic acetaldehyde buildup (Correct answer)
- Enhances GABA activity to reduce withdrawal symptoms
- Stimulates dopamine release to satisfy cravings
Correct answer: Inhibits aldehyde dehydrogenase causing toxic acetaldehyde buildup
Disulfiram inhibits aldehyde dehydrogenase, causing acetaldehyde to accumulate when alcohol is consumed, producing an aversive reaction.
Question 5: A client with schizophrenia and cannabis use disorder is prescribed an antipsychotic. Cannabis use is most likely to do which of the following?
- Enhance antipsychotic efficacy through synergistic effects
- Reduce antipsychotic blood levels by inducing metabolism
- Worsen psychotic symptoms and undermine medication adherence (Correct answer)
- Have no significant impact on psychiatric symptoms
Correct answer: Worsen psychotic symptoms and undermine medication adherence
Cannabis use can exacerbate psychotic symptoms, trigger relapse, and reduce medication adherence in clients with schizophrenia.
Question 6: Which of the following is the most appropriate pharmacological treatment for alcohol withdrawal seizures?
- Naltrexone
- Disulfiram
- Benzodiazepines (Correct answer)
- Buprenorphine
Correct answer: Benzodiazepines
Benzodiazepines are the first-line treatment for alcohol withdrawal seizures because they enhance GABA activity to stabilize the nervous system.
Question 7: A client with bipolar disorder and alcohol use disorder is being considered for mood-stabilizing medication. Which mood stabilizer also has evidence for reducing alcohol cravings?
- Lithium
- Lamotrigine
- Valproate (Correct answer)
- Carbamazepine
Correct answer: Valproate
Valproate (valproic acid) has shown efficacy as a mood stabilizer and has evidence supporting reduced alcohol cravings and consumption in clients with bipolar disorder.
CASAC Pharmacology and Co-Occurring Disorders 3
A client on buprenorphine/naloxone (Suboxone) reports taking a benzodiazepine prescribed by another doctor.
What is the primary concern?