CARN Pharmacology & Substance Use Disorders 3 — Questions and Answers
Question 1: A patient in opioid withdrawal is prescribed clonidine. The nurse understands this medication primarily addresses which symptom cluster?
- Pain and euphoria
- Autonomic symptoms such as diaphoresis, tachycardia, and hypertension (Correct answer)
- Seizure risk and hallucinations
- Insomnia and psychosis
Correct answer: Autonomic symptoms such as diaphoresis, tachycardia, and hypertension
Clonidine is an alpha-2 adrenergic agonist that suppresses the noradrenergic hyperactivity driving autonomic symptoms of opioid withdrawal.
Question 2: Which of the following is a first-line pharmacological treatment for nicotine use disorder that works by partially stimulating nicotinic acetylcholine receptors?
- Bupropion
- Nortriptyline
- Varenicline (Correct answer)
- Clonidine
Correct answer: Varenicline
Varenicline (Chantix) is a partial agonist at alpha-4 beta-2 nicotinic acetylcholine receptors, reducing cravings and blocking the rewarding effects of nicotine.
Question 3: A patient receiving extended-release naltrexone (Vivitrol) for opioid use disorder requires surgery. The CARN nurse should advise the surgical team that:
- Standard opioid doses will be effective for pain control
- Higher-than-usual opioid doses may be needed and sedation risk is increased
- Non-opioid analgesia must be used and opioids will be ineffective at standard doses (Correct answer)
- The injection must be reversed before any procedure
Correct answer: Non-opioid analgesia must be used and opioids will be ineffective at standard doses
Naltrexone blocks opioid receptors, so standard opioid analgesics will be ineffective; non-opioid pain management strategies are preferred and the surgical team must be informed.
Question 4: Which statement best describes the role of GABA in sedative-hypnotic substance use disorders?
- Alcohol and benzodiazepines inhibit GABA-A receptors, causing CNS stimulation
- Chronic alcohol use upregulates GABA receptors, explaining tolerance
- Alcohol and benzodiazepines enhance GABA-A activity, and chronic use leads to receptor downregulation and tolerance (Correct answer)
- GABA plays no significant role in sedative-hypnotic dependence
Correct answer: Alcohol and benzodiazepines enhance GABA-A activity, and chronic use leads to receptor downregulation and tolerance
Alcohol and benzodiazepines potentiate GABA-A inhibitory activity; with chronic use, receptors downregulate causing tolerance, and abrupt cessation causes CNS excitability and withdrawal.
Question 5: A patient on buprenorphine/naloxone (Suboxone) sublingual film reports nausea and headache after switching to the generic. What is the most likely cause?
- Naloxone toxicity from the new formulation
- Differences in bioavailability between brand and generic formulations (Correct answer)
- Opioid withdrawal from reduced buprenorphine dose
- Serotonin syndrome from a drug interaction
Correct answer: Differences in bioavailability between brand and generic formulations
Minor differences in formulation between brand and generic sublingual films can affect bioavailability, potentially causing mild symptoms until the patient adjusts.
Question 6: For a pregnant patient with opioid use disorder, which treatment is considered the standard of care?
- Abrupt opioid detoxification in the second trimester
- Methadone or buprenorphine maintenance therapy (Correct answer)
- Naltrexone extended-release injection monthly
- Clonidine-assisted withdrawal in the third trimester
Correct answer: Methadone or buprenorphine maintenance therapy
Methadone and buprenorphine maintenance are the evidence-based standards of care for pregnant patients with OUD, reducing fetal risk associated with repeated withdrawal cycles.
Question 7: Cocaine's primary mechanism of action that produces euphoria involves:
- Activation of mu-opioid receptors in the VTA
- Blocking reuptake of dopamine, serotonin, and norepinephrine (Correct answer)
- Stimulating GABA-B receptors in the nucleus accumbens
- Directly releasing acetylcholine at nicotinic receptors
Correct answer: Blocking reuptake of dopamine, serotonin, and norepinephrine
Cocaine blocks dopamine, norepinephrine, and serotonin transporters, increasing their synaptic concentration, with dopamine elevation in the nucleus accumbens driving euphoria.
CARN Pharmacology & Substance Use Disorders 3
A patient in opioid withdrawal is prescribed clonidine.
The nurse understands this medication primarily addresses which symptom cluster?