CASAC Pharmacology & Co-Occurring Disorders 2 — Questions and Answers
Question 1: A client on buprenorphine/naloxone (Suboxone) reports that the medication 'doesn't work' when injected. What property of naloxone explains this?
- Naloxone is inactive when taken sublingually
- Naloxone precipitates withdrawal only via injection due to its parenteral bioavailability (Correct answer)
- Naloxone is metabolized before reaching the brain when taken sublingually
- Naloxone blocks mu receptors only in peripheral tissue
Correct answer: Naloxone precipitates withdrawal only via injection due to its parenteral bioavailability
Naloxone has poor sublingual bioavailability but becomes active parenterally, precipitating withdrawal if Suboxone is injected, thereby deterring misuse.
Question 2: Which psychiatric disorder is MOST commonly co-occurring with alcohol use disorder in clinical populations?
- Schizophrenia
- Major depressive disorder (Correct answer)
- Obsessive-compulsive disorder
- Autism spectrum disorder
Correct answer: Major depressive disorder
Major depressive disorder is the most prevalent co-occurring psychiatric condition among individuals with alcohol use disorder.
Question 3: A client with opioid use disorder is also prescribed clonidine. What is the PRIMARY clinical use of clonidine in this context?
- To replace methadone as a maintenance agent
- To manage autonomic symptoms of opioid withdrawal (Correct answer)
- To treat co-occurring ADHD
- To reduce cravings for opioids long-term
Correct answer: To manage autonomic symptoms of opioid withdrawal
Clonidine, an alpha-2 agonist, reduces noradrenergic hyperactivity and manages autonomic withdrawal symptoms such as sweating, anxiety, and elevated blood pressure.
Question 4: Disulfiram (Antabuse) works by inhibiting which enzyme?
- Alcohol dehydrogenase
- Aldehyde dehydrogenase (Correct answer)
- CYP2E1
- Monoamine oxidase
Correct answer: Aldehyde dehydrogenase
Disulfiram inhibits aldehyde dehydrogenase, causing acetaldehyde accumulation when alcohol is consumed, producing an aversive flushing reaction.
Question 5: A client with bipolar disorder and stimulant use disorder reports their mood stabilizer 'stopped working.' Which phenomenon should the counselor consider?
- Tolerance to lithium at the cellular level
- Stimulant use interfering with sleep and mood regulation, mimicking medication failure (Correct answer)
- Cross-tolerance between stimulants and mood stabilizers
- The stimulant reversing the pharmacological effects of lithium
Correct answer: Stimulant use interfering with sleep and mood regulation, mimicking medication failure
Stimulant use causes sleep disruption and neurochemical dysregulation that can destabilize mood, making mood stabilizers appear ineffective.
Question 6: Which of the following is a benzodiazepine with a long half-life often used for alcohol detoxification due to self-tapering properties?
- Lorazepam (Ativan)
- Oxazepam (Serax)
- Chlordiazepoxide (Librium) (Correct answer)
- Alprazolam (Xanax)
Correct answer: Chlordiazepoxide (Librium)
Chlordiazepoxide has a long half-life and active metabolites, providing a gradual self-taper that reduces the risk of breakthrough withdrawal seizures.
Question 7: Post-acute withdrawal syndrome (PAWS) from alcohol commonly includes which symptom cluster that can persist for months?
- Hypertension, tachycardia, and diaphoresis
- Anxiety, sleep disturbance, and cognitive difficulties (Correct answer)
- Hallucinations, delusions, and tremors
- Nausea, vomiting, and diarrhea
Correct answer: Anxiety, sleep disturbance, and cognitive difficulties
PAWS after alcohol cessation is characterized by protracted anxiety, sleep dysregulation, and cognitive impairment that may persist 6–24 months.
CASAC Pharmacology & Co-Occurring Disorders 2
A client on buprenorphine/naloxone (Suboxone) reports that the medication 'doesn't work' when injected.
What property of naloxone explains this?