Detox Detox Medications and Pharmacology 2 — Questions and Answers
Question 1: What is the primary concern when administering high-dose benzodiazepines during alcohol detox?
- Risk of drug-seeking behavior
- Respiratory depression, especially in patients with pulmonary disease (Correct answer)
- Permanent memory impairment
- Development of a new addiction to benzodiazepines
Correct answer: Respiratory depression, especially in patients with pulmonary disease
High-dose benzodiazepines carry risk of respiratory depression, requiring careful monitoring particularly in patients with chronic obstructive pulmonary disease.
Question 2: Methadone is effective in opioid withdrawal management due to its pharmacokinetic property of:
- Short half-life allowing rapid dose titration
- Long half-life providing stable opioid receptor occupancy and preventing withdrawal (Correct answer)
- Rapid onset for immediate symptom relief
- Inability to cross the blood-brain barrier
Correct answer: Long half-life providing stable opioid receptor occupancy and preventing withdrawal
Methadone's long half-life provides steady-state opioid receptor activation that prevents withdrawal peaks and troughs associated with short-acting opioids.
Question 3: Which medication is specifically contraindicated in patients currently using opioids due to risk of precipitated withdrawal?
- Clonidine
- Buprenorphine given too early (before sufficient withdrawal onset) (Correct answer)
- Methadone
- Naltrexone given after confirmed abstinence
Correct answer: Buprenorphine given too early (before sufficient withdrawal onset)
Buprenorphine given before sufficient withdrawal onset displaces full agonists from receptors with partial agonism, precipitating acute withdrawal.
Question 4: For a patient in severe alcohol withdrawal with a CIWA-Ar of 20, which route of benzodiazepine administration is preferred?
- Oral route for ease of administration
- Intramuscular for convenience
- Intravenous for rapid onset and reliable absorption (Correct answer)
- Subcutaneous for slower release
Correct answer: Intravenous for rapid onset and reliable absorption
Intravenous administration ensures rapid and reliable drug delivery in severe withdrawal, which is critical when oral absorption may be unreliable.
Question 5: What is phenobarbital's role in alcohol detox when benzodiazepines are inadequate?
- It replaces benzodiazepines completely
- It acts as a second-line CNS depressant to control refractory withdrawal seizures (Correct answer)
- It treats withdrawal-related depression
- It reverses benzodiazepine overdose
Correct answer: It acts as a second-line CNS depressant to control refractory withdrawal seizures
Phenobarbital is used as a second-line agent for severe or refractory alcohol withdrawal when benzodiazepines fail to control symptoms adequately.
Question 6: Which vitamin supplementation is essential during alcohol detox in addition to thiamine?
- Vitamin C only
- Folic acid and multivitamins (Correct answer)
- Vitamin D and calcium
- Vitamin A and zinc
Correct answer: Folic acid and multivitamins
Folic acid and a multivitamin are routinely given during alcohol detox because alcoholics are commonly deficient in multiple B vitamins and folate.
Detox Detox Medications and Pharmacology 2
What is the primary concern when administering high-dose benzodiazepines during alcohol detox?