CARN Pharmacology & Substance Use Disorders 2 — Questions and Answers
Question 1: A patient on methadone maintenance therapy reports QTc prolongation on ECG. What is the most appropriate nursing action?
- Discontinue methadone immediately
- Notify the prescriber and monitor for arrhythmias (Correct answer)
- Administer a beta-blocker
- Increase the methadone dose gradually
Correct answer: Notify the prescriber and monitor for arrhythmias
Methadone can prolong the QTc interval, increasing risk of torsades de pointes, so the prescriber must be notified and cardiac monitoring initiated.
Question 2: Which benzodiazepine is preferred for alcohol withdrawal management in patients with severe liver disease?
- Diazepam
- Chlordiazepoxide
- Lorazepam (Correct answer)
- Alprazolam
Correct answer: Lorazepam
Lorazepam (along with oxazepam and temazepam) undergoes direct glucuronidation and is preferred in hepatic impairment because it avoids extensive liver metabolism.
Question 3: Naltrexone is contraindicated in a patient who:
- Has a history of alcohol use disorder
- Is currently taking opioids for pain management (Correct answer)
- Has mild renal impairment
- Is enrolled in a smoking cessation program
Correct answer: Is currently taking opioids for pain management
Naltrexone blocks opioid receptors and will precipitate acute withdrawal in patients physically dependent on opioids.
Question 4: A patient taking disulfiram consumes a small amount of alcohol in a mouthwash. Which reaction is most likely?
- No reaction due to the small amount
- Mild flushing and tachycardia (Correct answer)
- Severe hypotension and respiratory depression
- Seizures and coma
Correct answer: Mild flushing and tachycardia
Even small amounts of alcohol can trigger a disulfiram-ethanol reaction characterized by flushing, nausea, tachycardia, and hypotension due to acetaldehyde accumulation.
Question 5: Buprenorphine's 'ceiling effect' on respiratory depression is primarily due to its action as a:
- Full opioid agonist at mu receptors
- Partial agonist at mu receptors (Correct answer)
- Full antagonist at kappa receptors
- Pure antagonist at all opioid receptors
Correct answer: Partial agonist at mu receptors
Buprenorphine's partial agonist activity at mu-opioid receptors creates a ceiling effect, reducing the risk of fatal respiratory depression compared to full agonists.
Question 6: Which medication used in opioid use disorder treatment also has FDA approval for alcohol use disorder?
- Methadone
- Buprenorphine
- Naltrexone (Correct answer)
- Clonidine
Correct answer: Naltrexone
Naltrexone is FDA-approved for both opioid use disorder and alcohol use disorder, reducing cravings and the rewarding effects of alcohol.
Question 7: A nurse is educating a patient about acamprosate for alcohol use disorder. Which statement is most accurate?
- Acamprosate works best when started before the patient stops drinking
- Acamprosate causes a severe reaction if alcohol is consumed
- Acamprosate helps reduce cravings by modulating glutamate activity (Correct answer)
- Acamprosate is metabolized extensively by the liver
Correct answer: Acamprosate helps reduce cravings by modulating glutamate activity
Acamprosate modulates glutamatergic neurotransmission to reduce protracted withdrawal symptoms and alcohol cravings after abstinence is established.
CARN Pharmacology & Substance Use Disorders 2
A patient on methadone maintenance therapy reports QTc prolongation on ECG.
What is the most appropriate nursing action?