Pharmacotherapy of SUD

Question 1

There is serious concern for which adverse effect with methadone?

Answer 1

QTc prolongation

Question 2

Which drugs used for the treatment of SUD should you monitor LFTs? (3)

Answer 2

Naltrexone
Buprenorphine
Disulfiram

Question 3

Onset to stage 1 of alcohol withdrawal

Answer 3

6-8 hours

Question 4

Onset to stage 2 of alcohol withdrawal

Answer 4

24 hours

Question 5

Onset to stage 3 of alcohol withdrawal

Answer 5

1-2 days

Question 6

Onset to stage 4 on alcohol withdrawal

Answer 6

3-5 days

Question 7

What can occur in stage 4 alcohol withdrawal that happens in about 5% of patients?

Answer 7

Delirium tremens

Question 8

What are 5 risk factors for delirium tremens?

Answer 8

1. Prior history of DTs (#1 predictor)
2. Number of detoxifications
3. Consuming the equivalent of 1 pint of whiskey for 10-14 days prior to admission
4. Early symptoms of withdrawal
5. Hepatic dysfunction

Question 9

What benzodiazepines may be used for alcohol withdrawal if there is NO liver dysfunction?

Answer 9

Diazepam
Chlordiazepoxide
(can also use lorazepam and oxazepam)

Question 10

What benzodiazepines may be used for alcohol withdrawal if there IS liver dysfunction?

Answer 10

Lorazepam
Oxazepam

Question 11

What anticonvulsant medication is NOT effective in treating withdrawal seizures?

Answer 11

Phenytoin

Question 12

What supplement should be recommended if any suspicion of alcohol use?

Answer 12

Thiamine - 100mg daily

Question 13

Wernicke’s encephalopathy is a result of what?

Answer 13

Thiamine deficiency

Question 14

Acamprosate has a warning for what?

Answer 14

suicidality

Question 15

Acamprosate should be avoided in severe ______ impairment

Answer 15

renal

Question 16

A patient can have a disulfiram reaction for up to ___ days after discontinuation of Antabuse

Answer 16

14

Question 17

T/F: incarcerated people should NOT be required to switch medications if entering incarceration on medication

Answer 17

TRUE

Question 18

For which drug is risk of respiratory depression in overdose much less than with other opioids due to its partial agonist effect?

Answer 18

Buprenorphine

Question 19

Buprenorphine ER injection brand names

Answer 19

Sublocade
Brixadi

Question 20

If taking buprenorphine, monitor for use with ___________ drugs due to risk of what?

Answer 20

serotonergic drugs
risk of serotonin syndrome

Question 21

T/F: naltrexone is given in the same dose for OUD as that used for alcohol use disorder

Answer 21

TRUE

Question 22

There is a high risk for what if a patient stops taking naltrexone and “relapses”?

Answer 22

OVERDOSE