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Opioid Addiction Treatment: Pharmacology of Medications Used

Pharmacology of Medications Used To Treat Opioid Addiction

1. Which opioid addiction treatment medication is associated with cardiac arrhythmia?

A. Methadone

B. Levo-alpha acetyl methadol

C. Buprenorphine

D. Naltrexone

2. Methadone cannot be administered daily because its duration of action would lead to accumulation of toxic levels in the body and could result in death.

A. True

B. False

3. Methadone should not be given _____ in an OTP.

A. Parenterally

B. Intramuscularly

C. Orally

D. Methadone may be given by any of the above methods in an OTP

4. Researchers have found that trough SMLs of _____ are necessary to suppress drug cravings.

A. 50 - 200 ng/mL

B. 100 - 400 ng/mL

C. 150 - 600 ng/mL

D. 200 - 1,000 ng/mL

5. Which of the following has clinically significant mu receptor agonist activity?

A. (R)-methadone

B. (S)-methadone

C. Both (A) and (B)

D. None of the above

6. During initiation of methadone maintenance, methadone can increase CYP3A4 activity, thereby accelerating its own metabolism in some individuals.

A. True

B. False

7. Larger doses of buprenorphine:

A. Increase its agonist activity

B. Lengthen its duration of action

C. Both (A) and (B)

D. None of the above

8. Naltrexone displaces which of the following from receptors and blocks its effects?

A. Heroin

B. Morphine

C. Methadone

D. All of the above

9. Which of the following may precipitate withdrawal?

A. Combination therapy tablets containing buprenorphine and naloxone.

B. If too much or too little buprenorphine is given.

C. If buprenorphine is administered while the opioid receptors are highly occupied by an opioid agonist.

D. Withdrawal may be precipitated from any of the above.

10. Methadone, like heroin and morphine, interfere with the normal activity of the immune system through stress hormones such as cortisol.

A. True

B. False

11. Severe liver impairment might result in toxic serum levels of an opioid medication.  Symptoms of toxic levels include all of the following, except for:

A. Poor concentration

B. Dizziness when standing

C. Headaches

D. Drowsiness

12. Of all the SSRIs, _____ likely has the most potential to cause excessive SMLs while patients are receiving it and decreased SMLs after patients discontinue it.

A. Escitalopram

B. Fluvoxamine

C. Sertraline

D. Citalopram

13. When potentially interactive medications are coadministered, the agonist or partial agonist dosage should be adjusted based on:

A. Patient response

B. Expected interaction

C. Both (A) and (B)

D. None of the above

Clinical Pharmacotherapy

14. If a clear history of opioid abuse or addiction exists but a person currently is not addicted, regulations allow admission to an OTP for all of the following cases in which a person might relapse without treatment, except for:

A. Pregnancy

B. Release from incarceration

C. Alcohol or sedative dependence

D. Regulations allow admission to an OTP for all of the above

15. In order to prevent potentially severe withdrawal symptoms, patients should be abstinent from all short-acting opioids for at least _____ days before beginning naltrexone.

A. 3

B. 7

C. 10

D. 14

16. The consensus panel recommends that patients be observed for several hours after the first dose of any opioid treatment medication.

A. True

B. False

17. Dosage adjustments in the first week of treatment should be based on how long the effects of a medication last.

A. True

B. False

18. Approximately four to five half-life times are needed to establish a steady state for most drugs.

A. True

B. False

19. During induction, patients should be instructed to judge their doses by how they feel during the:

A. Peak period

B. Trough period

C. Both (A) and (B)

D. None of the above

20. Which medication must never be given on 2 consecutive days because its extended duration of action can result in toxic blood levels leading to fatal overdose?

A. Methadone

B. Buprenorphine

C. Naltrexone

D. Levo-alpha acetyl methadol

21. Awaiting signs of withdrawal before administering the first dose is especially important for _____ induction due to its ability to precipitate withdrawal.

A. Naltrexone

B. Methadone

C. Buprenorphine

D. Levo-alpha acetyl methadol

22. It can be concluded that a particular methadone dosage causes a specific serum methadone level.

A. True

B. False

23. Emesis of medication 15 to 30 minutes after dosing can be handled by replacing half the dose.

A. True

B. False

24. Which of the following OTP patients may receive a single take-home dose for a day when the OTP is close for business, including Sundays and State and Federal holidays?

A. Only patients with stable home environments and social relationships

B. Only patients with an acceptable length of time in comprehensive maintenance treatment

C. Only patients with safe storage of take-home medication

D. All OTP patients

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