CASAC Pharmacology and Medication-Assisted Treatment 4 — Questions and Answers
Question 1: A client on buprenorphine/naloxone reports severe precipitated withdrawal 30 minutes after taking the first dose. What is the most likely explanation?
- The naloxone component was absorbed sublingually
- The client used opioids too recently before dosing (Correct answer)
- Buprenorphine caused a paradoxical hyperalgesia response
- The dose prescribed was too high for the client's tolerance
Correct answer: The client used opioids too recently before dosing
Precipitated withdrawal occurs when buprenorphine displaces full opioid agonists from receptors before the client is in sufficient withdrawal, typically if opioids were used too recently.
Question 2: Which medication used in MAT is classified as a Schedule III controlled substance by the DEA?
- Methadone
- Naltrexone
- Buprenorphine (Correct answer)
- Disulfiram
Correct answer: Buprenorphine
Buprenorphine is classified as a Schedule III controlled substance due to its partial agonist properties and lower abuse potential compared to full opioid agonists.
Question 3: Acamprosate (Campral) is thought to reduce alcohol cravings primarily by modulating which neurotransmitter system?
- Dopamine and serotonin pathways
- Glutamate and GABA systems (Correct answer)
- Norepinephrine and acetylcholine receptors
- Opioid mu and kappa receptors
Correct answer: Glutamate and GABA systems
Acamprosate is believed to restore balance between glutamate (excitatory) and GABA (inhibitory) neurotransmission disrupted by chronic alcohol use.
Question 4: A client with opioid use disorder has severe liver disease. Which MAT option requires the most careful evaluation due to hepatic metabolism concerns?
- Extended-release naltrexone (Vivitrol)
- Naloxone intranasal spray
- Methadone (Correct answer)
- Buprenorphine monoproduct
Correct answer: Methadone
Methadone is extensively metabolized by the liver (CYP3A4/CYP2D6), and hepatic impairment can significantly alter its plasma levels and increase toxicity risk.
Question 5: When a client receives naloxone (Narcan) for an opioid overdose reversal and then regains consciousness, what is a primary concern for the counselor to communicate?
- Naloxone permanently reduces opioid tolerance
- The client may re-enter overdose as naloxone wears off faster than many opioids (Correct answer)
- Naloxone causes permanent opioid receptor damage
- The client can safely resume opioid use at a reduced dose after 24 hours
Correct answer: The client may re-enter overdose as naloxone wears off faster than many opioids
Naloxone has a shorter half-life (30–90 minutes) than most opioids, meaning the client can slip back into overdose when naloxone wears off — requiring medical observation.
Question 6: A CASAC counselor notices a client on methadone maintenance is also prescribed erythromycin by their primary care physician. What pharmacological concern should be raised?
- Erythromycin blocks methadone absorption in the gut
- Erythromycin inhibits CYP3A4, potentially increasing methadone plasma levels and QTc risk (Correct answer)
- Methadone neutralizes the antibiotic effect of erythromycin
- Erythromycin accelerates methadone metabolism, reducing its effectiveness
Correct answer: Erythromycin inhibits CYP3A4, potentially increasing methadone plasma levels and QTc risk
Erythromycin is a CYP3A4 inhibitor that can elevate methadone blood levels and prolong the QTc interval, increasing risk of life-threatening arrhythmia.
Question 7: Under current SAMHSA regulations, which of the following professionals is NOT authorized to prescribe buprenorphine for opioid use disorder in an office-based setting?
- Licensed clinical social workers with specialized training (Correct answer)
- Nurse practitioners with appropriate waivers
- Physician assistants with buprenorphine certification
- General practice physicians with DATA 2000 waiver
Correct answer: Licensed clinical social workers with specialized training
Licensed clinical social workers are not authorized to prescribe medications; only licensed prescribers (MDs, DOs, NPs, PAs, CNMs, CRNAs) with appropriate waivers may prescribe buprenorphine.
CASAC Pharmacology and Medication-Assisted Treatment 4
A client on buprenorphine/naloxone reports severe precipitated withdrawal 30 minutes after taking the first dose.
What is the most likely explanation?