NCMHCE Psychopharmacology and Co-occurring Disorders 2 — Questions and Answers
Question 1: A client with bipolar disorder and alcohol use disorder is stabilized on lithium. Which concern is MOST clinically significant when the client begins drinking heavily again?
- Alcohol increases lithium excretion, causing subtherapeutic levels
- Alcohol causes lithium toxicity by reducing renal clearance (Correct answer)
- Alcohol has no pharmacokinetic interaction with lithium
- Alcohol blocks lithium absorption in the GI tract
Correct answer: Alcohol causes lithium toxicity by reducing renal clearance
Heavy alcohol use causes dehydration, which reduces renal clearance of lithium and can precipitate toxicity.
Question 2: A client diagnosed with PTSD and opioid use disorder is being considered for medication-assisted treatment. Which medication is MOST appropriate given both conditions?
- Methadone only
- Buprenorphine/naloxone (Suboxone)
- Naltrexone extended-release injection (Correct answer)
- Clonidine monotherapy
Correct answer: Naltrexone extended-release injection
Extended-release naltrexone (Vivitrol) is preferred for clients with PTSD and OUD because it blocks opioid receptors without abuse potential and does not require daily dosing.
Question 3: Which of the following SSRIs is FDA-approved for BOTH major depressive disorder and obsessive-compulsive disorder in adults?
- Citalopram
- Escitalopram
- Fluoxetine (Correct answer)
- Fluvoxamine
Correct answer: Fluoxetine
Fluoxetine (Prozac) has FDA approval for MDD, OCD, panic disorder, bulimia nervosa, and bipolar depression (in combination).
Question 4: A client with schizophrenia and cannabis use disorder reports that smoking marijuana reduces their anxiety. What is the counselor's BEST clinical response?
- Support cannabis use if it reduces psychotic symptoms
- Validate their experience while educating on cannabis-induced psychosis risk (Correct answer)
- Immediately refer for antipsychotic adjustment without discussing cannabis
- Discharge the client for non-compliance
Correct answer: Validate their experience while educating on cannabis-induced psychosis risk
Motivational and psychoeducational approaches validate the client's experience while addressing the evidence that cannabis significantly worsens psychotic symptoms long-term.
Question 5: Disulfiram (Antabuse) works by inhibiting which enzyme, causing acetaldehyde buildup when alcohol is consumed?
- Alcohol dehydrogenase
- Aldehyde dehydrogenase (Correct answer)
- Cytochrome P450 2E1
- Monoamine oxidase
Correct answer: Aldehyde dehydrogenase
Disulfiram inhibits aldehyde dehydrogenase (ALDH), preventing the conversion of acetaldehyde to acetate and producing the aversive disulfiram-alcohol reaction.
Question 6: A client taking an MAOI for treatment-resistant depression reports beginning to use cocaine on weekends. Which risk must be addressed IMMEDIATELY?
- Cocaine reduces MAOI efficacy over time
- The combination can cause hypertensive crisis or serotonin syndrome (Correct answer)
- MAOIs block cocaine's euphoric effects
- Cocaine accelerates MAOI metabolism causing underdosing
Correct answer: The combination can cause hypertensive crisis or serotonin syndrome
MAOIs combined with stimulants like cocaine can precipitate life-threatening hypertensive crisis or serotonin syndrome requiring emergency intervention.
Question 7: In treating a client with co-occurring generalized anxiety disorder and alcohol use disorder, which approach reflects best practice for sequencing treatment?
- Treat alcohol use disorder first; anxiety typically resolves with sobriety
- Treat GAD first with benzodiazepines before addressing alcohol
- Treat both simultaneously using an integrated treatment model (Correct answer)
- Wait 6 months of sobriety before diagnosing or treating anxiety
Correct answer: Treat both simultaneously using an integrated treatment model
Integrated dual diagnosis treatment addressing both disorders simultaneously is the evidence-based best practice for co-occurring anxiety and alcohol use disorder.
NCMHCE Psychopharmacology and Co-occurring Disorders 2
A client with bipolar disorder and alcohol use disorder is stabilized on lithium.
Which concern is MOST clinically significant when the client begins drinking heavily again?