NAECB Medication Management 4 — Questions and Answers
Question 1: A patient prescribed methadone for OUD reports taking it for 3 days but experiences increasing drowsiness and confusion on day 3. What phenomenon explains this?
- Tachyphylaxis to opioid side effects
- Methadone accumulation due to its long half-life (Correct answer)
- Development of opioid tolerance
- Cross-tolerance from prior heroin use wearing off
Correct answer: Methadone accumulation due to its long half-life
Methadone has a very long and variable half-life (24-60 hours), which can cause drug accumulation and delayed sedation or respiratory depression with repeated dosing.
Question 2: Which of the following is a SAMHSA-recognized best practice for take-home methadone doses in stable OTP patients?
- Take-homes are prohibited by federal law regardless of stability
- Stable patients may receive up to 30 days of take-home doses (Correct answer)
- Take-homes require monthly urine drug screens only
- Federal regulations allow unlimited take-homes after 6 months
Correct answer: Stable patients may receive up to 30 days of take-home doses
Federal regulations allow stable OTP patients (generally compliant for 2+ years) to receive up to 30 days of take-home methadone doses based on assessed stability criteria.
Question 3: Which assessment tool is specifically used to evaluate the severity of alcohol withdrawal symptoms?
- AUDIT-C
- CAGE questionnaire
- CIWA-Ar scale (Correct answer)
- PHQ-9
Correct answer: CIWA-Ar scale
The Clinical Institute Withdrawal Assessment for Alcohol-Revised (CIWA-Ar) is the standardized tool used to assess severity of alcohol withdrawal and guide treatment decisions.
Question 4: A patient on disulfiram inadvertently consumes alcohol. Which set of symptoms is consistent with a disulfiram-ethanol reaction?
- Constipation, bradycardia, and sedation
- Flushing, tachycardia, diaphoresis, and nausea/vomiting (Correct answer)
- Miosis, respiratory depression, and coma
- Hypertension, seizures, and hallucinations
Correct answer: Flushing, tachycardia, diaphoresis, and nausea/vomiting
The disulfiram-ethanol reaction is caused by acetaldehyde accumulation and manifests as flushing, tachycardia, diaphoresis, nausea, vomiting, and hypotension.
Question 5: For which substance use disorder has varenicline (Chantix) received FDA approval as a pharmacotherapy?
- Alcohol use disorder
- Opioid use disorder
- Tobacco use disorder (Correct answer)
- Cannabis use disorder
Correct answer: Tobacco use disorder
Varenicline is FDA-approved specifically for smoking cessation (tobacco use disorder) by acting as a partial agonist at nicotinic acetylcholine receptors.
Question 6: What is the recommended monitoring parameter for patients receiving long-term naltrexone therapy?
- Electrocardiogram every 3 months
- Liver function tests due to hepatotoxicity risk at high doses (Correct answer)
- Complete blood count for bone marrow suppression
- Thyroid function tests for hypothyroidism risk
Correct answer: Liver function tests due to hepatotoxicity risk at high doses
Naltrexone carries a black box warning for hepatotoxicity when used at doses exceeding recommended levels, so liver function tests should be monitored periodically.
Question 7: A patient with co-occurring opioid use disorder and major depressive disorder is being considered for buprenorphine. What effect may buprenorphine have on depression?
- Buprenorphine worsens depression and is contraindicated with antidepressants
- Buprenorphine may have antidepressant properties and improve depressive symptoms (Correct answer)
- Buprenorphine has no effect on mood disorders
- Buprenorphine must be discontinued before antidepressants can be initiated
Correct answer: Buprenorphine may have antidepressant properties and improve depressive symptoms
Emerging evidence suggests buprenorphine may have antidepressant properties through kappa opioid receptor antagonism, and stabilization on MOUD often improves depressive symptoms.
NAECB Medication Management 4
A patient prescribed methadone for OUD reports taking it for 3 days but experiences increasing drowsiness and confusion on day 3.
What phenomenon explains this?