NCMHCE Psychopharmacology and Co-occurring Disorders 5 — Questions and Answers
Question 1: A client with treatment-resistant depression is being considered for ketamine infusions. Which co-occurring condition would be the GREATEST contraindication?
- Generalized anxiety disorder
- Active psychosis or schizophrenia spectrum disorder (Correct answer)
- Mild cannabis use disorder in remission
- History of a single manic episode 10 years ago
Correct answer: Active psychosis or schizophrenia spectrum disorder
Ketamine's dissociative and psychotomimetic properties can significantly exacerbate psychotic symptoms, making active psychosis a primary contraindication.
Question 2: A pregnant client in her first trimester has severe bipolar disorder. Which medication carries the GREATEST risk of congenital malformations, particularly Ebstein's anomaly?
- Quetiapine
- Lithium (Correct answer)
- Lamotrigine
- Aripiprazole
Correct 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.
Question 3: Which of the following BEST describes the mechanism by which buprenorphine reduces opioid cravings without causing euphoria at therapeutic doses?
- It is a full agonist at kappa receptors, blocking mu receptors competitively
- It is a partial agonist at mu-opioid receptors with a ceiling effect (Correct answer)
- It is an opioid antagonist that blocks all opioid receptors
- It increases endogenous endorphin production
Correct 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.
Question 4: 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?
- Bupropion is a Schedule II controlled substance contraindicated in SUD
- Bupropion has shown some evidence for reducing both ADHD symptoms and methamphetamine cravings (Correct answer)
- Bupropion is only FDA-approved for smoking cessation and cannot treat ADHD
- Bupropion's stimulant-like properties make it too risky for any SUD history
Correct 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.
Question 5: Which of the following best describes 'pharmacodynamic tolerance' in the context of substance use?
- The body metabolizes a drug faster over time, requiring higher doses
- The brain's receptors become less sensitive to a drug's effects with repeated exposure (Correct answer)
- The drug is absorbed less efficiently in the GI tract after prolonged use
- The liver produces more enzymes to break down the substance
Correct 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.
Question 6: A client with bipolar II disorder and alcohol use disorder is prescribed valproic acid. What laboratory monitoring is MOST essential given heavy alcohol use?
- Monthly CBC and serum iron levels
- Liver function tests (LFTs) due to hepatotoxicity risk from both alcohol and valproate (Correct answer)
- Quarterly thyroid panel
- Weekly serum creatinine levels
Correct 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.
Question 7: In integrated dual diagnosis treatment (IDDT), which of the following is a core principle that distinguishes it from sequential treatment models?
- Substance use disorders must be fully addressed before any psychiatric medication is prescribed
- Mental health and substance use disorders are addressed simultaneously by the same treatment team (Correct answer)
- Clients must be completely abstinent before entering mental health treatment
- Psychiatric diagnosis is withheld until the client has achieved 6 months of sobriety
Correct 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.
NCMHCE Psychopharmacology and Co-occurring Disorders 5
A client with treatment-resistant depression is being considered for ketamine infusions.
Which co-occurring condition would be the GREATEST contraindication?