Psychopharmacology and Co-occurring Disorders Flashcards

A client with treatment-resistant depression is being considered for ketamine infusions. Which co-occurring condition would be the GREATEST contraindication?

Answer: Active psychosis or schizophrenia spectrum disorder

Ketamine's dissociative and psychotomimetic properties can significantly exacerbate psychotic symptoms, making active psychosis a primary contraindication.

A pregnant client in her first trimester has severe bipolar disorder. Which medication carries the GREATEST risk of congenital malformations, particularly Ebstein's anomaly?

Answer: Lithium

Lithium is associated with Ebstein's anomaly (a cardiac malformation) when used in the first trimester, though the absolute risk is small and risk-benefit must be weighed.

Which of the following BEST describes the mechanism by which buprenorphine reduces opioid cravings without causing euphoria at therapeutic doses?

Answer: It is a partial agonist at mu-opioid receptors with a ceiling effect

Buprenorphine's partial agonism at mu-opioid receptors means it activates those receptors sufficiently to reduce withdrawal and cravings but has a ceiling effect that limits euphoria.

A counselor's client with co-occurring ADHD and methamphetamine use disorder achieves sobriety and asks about ADHD treatment. Bupropion is being considered. What should the counselor know?

Answer: Bupropion has shown some evidence for reducing both ADHD symptoms and methamphetamine cravings

Bupropion (Wellbutrin) has emerging evidence for reducing methamphetamine use and can address ADHD symptoms through dopamine/norepinephrine reuptake inhibition without significant abuse potential.

Which of the following best describes 'pharmacodynamic tolerance' in the context of substance use?

Answer: The brain's receptors become less sensitive to a drug's effects with repeated exposure

Pharmacodynamic tolerance occurs when target receptors decrease in number or sensitivity (downregulation) in response to repeated drug stimulation.

A client with bipolar II disorder and alcohol use disorder is prescribed valproic acid. What laboratory monitoring is MOST essential given heavy alcohol use?

Answer: Liver function tests (LFTs) due to hepatotoxicity risk from both alcohol and valproate

Both chronic alcohol use and valproic acid are independently hepatotoxic; their combination significantly elevates risk of liver damage, making LFT monitoring essential.

In integrated dual diagnosis treatment (IDDT), which of the following is a core principle that distinguishes it from sequential treatment models?

Answer: Mental health and substance use disorders are addressed simultaneously by the same treatment team

IDDT integrates mental health and substance use treatment within the same clinical team simultaneously, rather than treating one condition first and the other second.