CARN Pharmacology in Addictions Nursing 2 — Questions and Answers
Question 1: A patient on methadone maintenance therapy reports severe constipation. Which mechanism best explains this side effect?
- Increased GI motility due to opioid receptor stimulation
- Decreased GI motility due to mu-opioid receptor activation in the gut (Correct answer)
- Serotonin antagonism causing bowel spasm
- Dopamine blockade reducing peristalsis
Correct answer: Decreased GI motility due to mu-opioid receptor activation in the gut
Methadone activates mu-opioid receptors in the enteric nervous system, reducing gut motility and causing constipation.
Question 2: Which medication used in alcohol use disorder works by blocking the reinforcing effects of alcohol through opioid receptor antagonism?
- Disulfiram
- Acamprosate
- Naltrexone (Correct answer)
- Topiramate
Correct answer: Naltrexone
Naltrexone is an opioid antagonist that blocks the euphoric and rewarding effects of alcohol by antagonizing mu-opioid receptors.
Question 3: A nurse is educating a patient starting buprenorphine/naloxone (Suboxone). Which instruction is most critical to prevent precipitated withdrawal?
- Take the first dose immediately after using opioids
- Wait until experiencing moderate withdrawal symptoms (COWS score ≥8-12) before taking the first dose (Correct answer)
- Take with food to improve absorption
- Swallow the film whole for best effect
Correct answer: Wait until experiencing moderate withdrawal symptoms (COWS score ≥8-12) before taking the first dose
Buprenorphine must not be given until moderate withdrawal is present; its high receptor affinity can displace full agonists and precipitate acute withdrawal.
Question 4: Which benzodiazepine property makes long-acting agents preferred for managing alcohol withdrawal syndrome?
- Higher abuse potential requiring closer monitoring
- Self-tapering effect due to long half-life reducing seizure risk (Correct answer)
- Faster onset providing quicker symptom relief
- Increased potency requiring lower doses
Correct answer: Self-tapering effect due to long half-life reducing seizure risk
Long-acting benzodiazepines like diazepam or chlordiazepoxide provide a self-tapering effect, smoothing withdrawal and reducing seizure and delirium risk.
Question 5: Varenicline (Chantix) aids smoking cessation primarily through which mechanism?
- Full agonism at nicotinic acetylcholine receptors
- Partial agonism at alpha-4 beta-2 nicotinic receptors, reducing cravings and blocking nicotine reward (Correct answer)
- Inhibition of dopamine reuptake in the nucleus accumbens
- Antagonism of NMDA glutamate receptors
Correct answer: Partial agonism at alpha-4 beta-2 nicotinic receptors, reducing cravings and blocking nicotine reward
Varenicline acts as a partial agonist at alpha-4 beta-2 nicotinic receptors, providing low-level stimulation to reduce cravings while blocking nicotine's full rewarding effect.
Question 6: A patient taking disulfiram consumes a small amount of alcohol hidden in a sauce. Which symptom cluster is most expected?
- Sedation, respiratory depression, and miosis
- Flushing, tachycardia, nausea, vomiting, and hypotension (Correct answer)
- Hypertension, diaphoresis, and hyperthermia
- Bradycardia, bronchospasm, and lacrimation
Correct answer: Flushing, tachycardia, nausea, vomiting, and hypotension
Disulfiram inhibits aldehyde dehydrogenase, causing acetaldehyde accumulation and producing the classic disulfiram-ethanol reaction of flushing, tachycardia, nausea, and hypotension.
Question 7: Which statement correctly describes acamprosate's mechanism in treating alcohol use disorder?
- It causes an aversive reaction when alcohol is consumed
- It modulates glutamate and GABA activity to reduce post-acute withdrawal symptoms (Correct answer)
- It blocks opioid receptors to reduce alcohol cravings
- It inhibits alcohol metabolism to maintain sobriety
Correct answer: It modulates glutamate and GABA activity to reduce post-acute withdrawal symptoms
Acamprosate restores balance between glutamate (excitatory) and GABA (inhibitory) neurotransmission, alleviating protracted abstinence symptoms like anxiety and dysphoria.
CARN Pharmacology in Addictions Nursing 2
A patient on methadone maintenance therapy reports severe constipation.
Which mechanism best explains this side effect?