NAECB Medication Management 2 — Questions and Answers
Question 1: A patient on naltrexone for alcohol use disorder reports taking opioid pain medication after a dental procedure. What is the most critical concern?
- Naltrexone will be ineffective
- The opioid will cause severe respiratory depression
- The opioid analgesic effect will be blocked by naltrexone (Correct answer)
- Naltrexone blood levels will increase dangerously
Correct answer: The opioid analgesic effect will be blocked by naltrexone
Naltrexone is an opioid antagonist that blocks opioid receptors, rendering opioid pain medications ineffective for analgesia.
Question 2: Which of the following is a contraindication for buprenorphine/naloxone (Suboxone) induction?
- Patient is in mild opioid withdrawal
- Patient last used heroin 24 hours ago
- Patient is in acute opioid intoxication (Correct answer)
- Patient has a history of opioid overdose
Correct answer: Patient is in acute opioid intoxication
Buprenorphine induction during acute opioid intoxication is contraindicated because it can precipitate severe withdrawal by displacing full agonists from receptors.
Question 3: A patient prescribed disulfiram (Antabuse) asks if they can use mouthwash. What is the most appropriate response?
- Mouthwash is safe because it is not swallowed
- Avoid alcohol-containing mouthwash to prevent a disulfiram reaction (Correct answer)
- Only use mouthwash if alcohol content is below 10%
- Disulfiram only reacts with beverages, not topical products
Correct answer: Avoid alcohol-containing mouthwash to prevent a disulfiram reaction
Alcohol-containing mouthwash can be absorbed through oral mucosa and trigger a disulfiram-ethanol reaction even when not swallowed.
Question 4: What is the maximum recommended daily dose of buprenorphine/naloxone for opioid use disorder maintenance in most adults?
- 8 mg/2 mg
- 16 mg/4 mg
- 24 mg/6 mg (Correct answer)
- 32 mg/8 mg
Correct answer: 24 mg/6 mg
The FDA-approved maximum recommended dose of buprenorphine/naloxone for maintenance treatment is 24 mg/6 mg per day.
Question 5: Which medication used in addiction treatment requires a special DEA waiver (X-waiver) for office-based prescribing, as of regulations prior to 2023?
- Naltrexone
- Disulfiram
- Methadone for pain
- Buprenorphine (Correct answer)
Correct answer: Buprenorphine
Prior to the Mainstreaming Addiction Treatment (MAT) Act of 2023, buprenorphine required a DEA X-waiver for office-based opioid treatment prescribing.
Question 6: A patient on methadone maintenance reports that a new medication causes QTc prolongation. Which additional medication would pose the highest cardiac risk when combined with methadone?
- Amoxicillin
- Fluoxetine
- Azithromycin (Correct answer)
- Lisinopril
Correct answer: Azithromycin
Azithromycin prolongs the QTc interval, and combining it with methadone (which also prolongs QTc) significantly increases the risk of potentially fatal arrhythmias like torsades de pointes.
Question 7: When educating a patient starting acamprosate (Campral) for alcohol use disorder, which statement is most accurate?
- It will cause severe nausea if alcohol is consumed
- It reduces cravings by modulating glutamate activity (Correct answer)
- It must be taken only when cravings occur
- It is ineffective if the patient relapses
Correct answer: It reduces cravings by modulating glutamate activity
Acamprosate reduces alcohol cravings by restoring balance to the glutamate system dysregulated by chronic alcohol use, and should be continued even after relapse.
NAECB Medication Management 2
A patient on naltrexone for alcohol use disorder reports taking opioid pain medication after a dental procedure.
What is the most critical concern?