CASAC Pharmacology and Co-Occurring Disorders 4 — Questions and Answers
Question 1: What is the primary pharmacological difference between methadone and buprenorphine in treating opioid use disorder?
- Methadone is a partial agonist; buprenorphine is a full agonist
- Methadone is a full agonist; buprenorphine is a partial agonist with a ceiling effect (Correct answer)
- Both are full agonists but differ in half-life only
- Buprenorphine requires daily clinic visits; methadone does not
Correct answer: Methadone is a full agonist; buprenorphine is a partial agonist with a ceiling effect
Methadone is a full opioid agonist while buprenorphine is a partial agonist, meaning buprenorphine has a ceiling effect that limits respiratory depression risk.
Question 2: A counselor is working with a client who has both ADHD and stimulant use disorder. Which approach is generally recommended?
- Withhold all ADHD treatment until 1 year of sobriety is achieved
- Use non-stimulant medications like atomoxetine and integrate with SUD treatment (Correct answer)
- Immediately prescribe amphetamine-based medications to address ADHD
- Treat the SUD only; ADHD symptoms typically resolve with sobriety
Correct answer: Use non-stimulant medications like atomoxetine and integrate with SUD treatment
Non-stimulant medications such as atomoxetine are preferred for clients with co-occurring ADHD and stimulant use disorder to avoid reinforcing stimulant use.
Question 3: Which drug class is most commonly associated with 'kindling' in the context of repeated withdrawal episodes?
- Opioids
- Stimulants
- Alcohol/benzodiazepines (Correct answer)
- Cannabis
Correct answer: Alcohol/benzodiazepines
Kindling refers to the neurological phenomenon where repeated alcohol or benzodiazepine withdrawals result in progressively more severe and dangerous withdrawal episodes.
Question 4: A client taking MAOIs for depression wants to know if they can use certain street drugs. Which combination is potentially fatal?
- MAOIs and cannabis
- MAOIs and MDMA (ecstasy) (Correct answer)
- MAOIs and hallucinogens
- MAOIs and inhalants
Correct answer: MAOIs and MDMA (ecstasy)
Combining MAOIs with MDMA can cause serotonin syndrome, a potentially life-threatening condition characterized by agitation, hyperthermia, and cardiovascular instability.
Question 5: Acamprosate (Campral) is thought to support alcohol abstinence primarily by which mechanism?
- Blocking opioid receptors to reduce reward
- Inhibiting alcohol metabolism to create aversion
- Restoring glutamate/GABA balance disrupted by chronic alcohol use (Correct answer)
- Stimulating serotonin release to improve mood
Correct answer: Restoring glutamate/GABA balance disrupted by chronic alcohol use
Acamprosate is believed to restore the balance between glutamate (excitatory) and GABA (inhibitory) neurotransmission disrupted by chronic alcohol dependence.
Question 6: A client with opioid use disorder is precipitated into withdrawal after receiving naloxone. This occurs because naloxone:
- Is a partial agonist that displaces full agonists from receptors
- Is a pure antagonist that rapidly displaces opioids from receptors (Correct answer)
- Inhibits opioid metabolism causing rapid drug clearance
- Cross-reacts with GABA receptors causing rebound excitation
Correct answer: Is a pure antagonist that rapidly displaces opioids from receptors
Naloxone is a pure opioid antagonist with high receptor affinity that rapidly displaces opioids from mu receptors, precipitating acute withdrawal in dependent individuals.
Question 7: In treating a client with co-occurring major depressive disorder and opioid use disorder on buprenorphine, which class of antidepressant has the most evidence for safety and efficacy?
- Tricyclic antidepressants (TCAs)
- MAO inhibitors
- SSRIs and SNRIs (Correct answer)
- Antipsychotics used off-label
Correct answer: SSRIs and SNRIs
SSRIs and SNRIs are considered first-line antidepressants for clients on buprenorphine due to their favorable safety profile and evidence base for treating co-occurring depression.
CASAC Pharmacology and Co-Occurring Disorders 4
What is the primary pharmacological difference between methadone and buprenorphine in treating opioid use disorder?