MCAP Pharmacology and Medication-Assisted Treatment 1 — Questions and Answers
Question 1: Which medication for opioid use disorder acts as a full mu-opioid agonist and must be dispensed through federally certified opioid treatment programs (OTPs)?
- Buprenorphine
- Naltrexone
- Methadone (Correct answer)
- Naloxone
Correct answer: Methadone
Methadone is a full mu-opioid agonist that, when used for OUD treatment, can only legally be dispensed through federally certified opioid treatment programs.
Question 2: Buprenorphine exhibits a 'ceiling effect' on respiratory depression primarily because it is a:
- Full agonist at mu-opioid receptors
- Partial agonist at mu-opioid receptors (Correct answer)
- Full antagonist at all opioid receptors
- Selective kappa-opioid receptor blocker
Correct answer: Partial agonist at mu-opioid receptors
Buprenorphine's partial agonist activity at mu-opioid receptors means its respiratory depressant effects plateau, providing a safer margin than full agonists.
Question 3: Sublingual buprenorphine/naloxone (Suboxone) contains naloxone primarily to:
- Enhance the analgesic potency of buprenorphine
- Prevent diversion and deter injection misuse (Correct answer)
- Increase buprenorphine's oral bioavailability
- Treat concurrent alcohol use disorder
Correct answer: Prevent diversion and deter injection misuse
Naloxone is added to deter injection misuse; when injected by an opioid-dependent individual, the bioavailable naloxone precipitates acute withdrawal.
Question 4: A patient receiving naltrexone for opioid use disorder requires emergency surgery. The surgical team should be informed that:
- Naltrexone enhances opioid analgesic efficacy during surgery
- Higher-than-usual opioid doses may be needed for adequate pain control (Correct answer)
- Naltrexone becomes fully ineffective within 6 hours of the last dose
- Regional anesthesia is absolutely contraindicated with naltrexone
Correct answer: Higher-than-usual opioid doses may be needed for adequate pain control
Naltrexone blocks opioid receptors, so patients may require significantly higher opioid doses to achieve adequate analgesia during surgical procedures.
Question 5: Which of the following represents a contraindication to initiating buprenorphine treatment for opioid use disorder?
- Active daily tobacco smoking
- History of benzodiazepine use disorder currently in remission
- Full opioid agonist use within the past 12-24 hours without signs of withdrawal (Correct answer)
- Co-occurring depression managed with an SSRI
Correct answer: Full opioid agonist use within the past 12-24 hours without signs of withdrawal
Initiating buprenorphine before adequate withdrawal from full opioid agonists risks precipitating acute withdrawal, because buprenorphine's high receptor affinity and partial agonism displace the full agonist.
Question 6: Extended-release injectable naltrexone (Vivitrol) offers which primary clinical advantage over oral naltrexone for OUD patients?
- Provides mild opioid agonist effects to prevent withdrawal symptoms
- Eliminates the need for liver function monitoring
- Removes the daily adherence requirement, significantly improving medication compliance (Correct answer)
- Can be initiated without requiring a period of opioid abstinence
Correct answer: Removes the daily adherence requirement, significantly improving medication compliance
Monthly injection eliminates the need for daily pill adherence, which is a major barrier to effective oral naltrexone treatment in real-world settings.
Question 7: According to evidence-based research, medications for opioid use disorder (MOUD) compared to behavioral therapy alone demonstrate:
- Similar outcomes when patient motivation is sufficiently high
- Superior outcomes in reducing illicit opioid use and overdose mortality (Correct answer)
- Better results only for patients with severe, long-term OUD
- Equivalent effectiveness but higher patient satisfaction ratings
Correct answer: Superior outcomes in reducing illicit opioid use and overdose mortality
Research consistently shows MOUD significantly reduces illicit opioid use, overdose mortality, criminal activity, and infectious disease transmission compared to behavioral therapy alone.
MCAP Pharmacology and Medication-Assisted Treatment 1
Which medication for opioid use disorder acts as a full mu-opioid agonist and must be dispensed through federally certified opioid treatment programs (OTPs)?