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1. Which of the following can block the effects of exogenously administered opioids?
A. Mu-opioid receptor full agonists
B. Mu-opioid receptor partial agonists
C. Mu-opioid receptor antagonists
D. The effects of exogenously administered opioids can be blocked by mu-opioid receptor full agonists, partial agonists, and antagonists
2. Which of the following is typically used for patients with OUD who have abstained from short-acting opioids for at least 7 to 10 days and long-acting opioids for at least 10 to 14 days?
A. Extended-Release Injectable Naltrexone
B. Methadone
C. Buprenorphine
D. Patients do not need to have a period of abstinence for any of the above medications
3. Naltrexone consideration should be given to its use in situations where adherence can be ensured, such as with observed daily dosing.
A. True
B. False
4. Buprenorphine is more likely than methadone to cause respiratory depression in an accidental overdose due to it not having a ceiling effect on opioid activity.
A. True
B. False
5. Which of the following is recommended for OUD treatment during pregnancy?
A. Methadone only
B. Methadone or buprenorphine
C. Buprenorphine or Extended-Release Injectable Naltrexone
D. Buprenorphine only
6. A review of clinical trials found that, when provided at flexible doses on an outpatient basis, buprenorphine retained patients in treatment longer than methadone.
A. True
B. False
7. Stable patients can continue on their selected OUD medication indefinitely as long as it is beneficial.
A. True
B. False
8. Medically supervised withdrawal using buprenorphine or methadone is appropriate when patients:
A. Prefer it to treatment without medications, after they have been told the risks and benefits of this approach compared with treatment with medication.
B. Wish to start XR-NTX, which is also FDA approved for the treatment of alcohol dependence.
C. Are entering a controlled environment or workplace that disallows opioid agonists.
D. Medially supervised withdrawal using buprenorphine or methadone is appropriate if patients prefer it to treatment without medications, if patients wish to start XR-NTX, or if patients are entering a controlled environment or workplace that disallows opioid agonists.
9. All of the following apply to methadone, except for:
A. It is a short-acting mu-opioid receptor full agonist.
B. It is a schedule II controlled medication.
C. It is highly plasma-protein bound and binds to proteins within tissues throughout the body.
D. At adequate doses, it reduces opioid craving and withdrawal and blunts or blocks the effects of illicit opioids.
10. The average half-life of methadone is:
A. 8 hours
B. 24 hours
C. 36 hours
D. 59 hours
11. At the start of methadone treatment, methadone can increase CYP3A4 activity and accelerate its own metabolism in some individuals.
A. True
B. False
12. The goal of methadone dosing in the first weeks of treatment is to relieve withdrawal but avoid oversedation and respiratory depression.
A. True
B. False
13. Because of methadone’s half-life, patients will not feel the full effect of the initial dose for _____ or more days even if the daily dose is the same.
A. 2
B. 3
C. 4
D. 5
14. Engage in outpatient medically supervised withdrawal only with patients who:
A. Are physically dependent on benzodiazepines.
B. Inject benzodiazepines.
C. Binge on benzodiazepines.
D. Outpatient medically supervised withdrawal should not be performed for patients on benzodiazepines.
15. The treatment with which of the following has been associated with QTc prolongation?
A. Extended-Release Injectable Naltrexone
B. Methadone
C. Buprenorphine
D. All OUD treatment medications have been associated with QTc prolongation
16. Methadone has fewer clinically significant drug-drug interactions than buprenorphine.
A. True
B. False
17. All of the following may cause a reduction in serum methadone levels, except for:
A. Efavirenz
B. Abacavir
C. Rifampin
D. Ketoconazole
18. Side effects of methadone include all of the following, except for:
A. Constipation
B. Sexual dysfunction or decreased libido
C. Drowsiness
D. Weight loss
19. An alcohol breathalyzer should be used to estimate the patient’s blood alcohol content and methadone should not be provided until the alcohol reading is considerably below the legal level of alcohol intoxication.
A. True
B. False
20. Patients should be warned of the increased risk of overdose during the first _____ of methadone treatment.
A. 24 hours
B. 72 hours
C. 2 weeks
D. Month
21. For patients addicted to prescription opioids, opioid conversion tables should be relied on to determine methadone dosage.
A. True
B. False
22. For patients with opioid tolerance, after the first dose, patients should remain for observation for ____ if possible to see whether the dose is sedating or relieves withdrawal signs.
A. 1 to 2 hours
B. 2 to 4 hours
C. 4 to 6 hours
D. 8 to 12 hours
23. Patients who miss more than ____ dose(s) of methadone treatment must be reassessed, and their next methadone dose should be decreased substantially and built back up gradually.
A. 1
B. 2
C. 3
D. 4
24. What should be done for those in the third trimester of pregnancy, when after being on a stable methadone dose, they report feeling drowsy 2 to 4 hours after dose administration but develop craving or withdrawal symptoms before the next dose is due to be administered?
A. Their dosage should be doubled.
B. Their dosage should be halved.
C. Their dosage should be divided into twice-daily dosing.
D. Their dosage should not be adjusted.
25. Peak:trough ratios above 4:1 may indicate rapid methadone metabolism.
A. True
B. False
26. People with OUD who are not in treatment more frequently use illicit methadone to achieve euphoria than to self-medicate withdrawal symptoms.
A. True
B. False
27. Interim methadone maintenance has been shown to be more effective than a waiting list to facilitate entry into comprehensive methadone treatment and to reduce illicit opioid use.
A. True
B. False
28. Oral naltrexone is not widely used to treat opioid use disorder for all of the following reasons, except for:
A. It has special regulatory requirements.
B. Low rates of patient acceptance.
C. Difficulty in achieving abstinence for the necessary time before initiation of treatment.
D. High rates of medication nonadherence.
29. A Cochrane review concluded that oral naltrexone is superior to placebo and to no medication in treatment retention or illicit opioid use reduction.
A. True
B. False
30. Naltrexone does which of the following?
A. Activates the mu-opioid receptor.
B. Competitively binds to the mu-opioid receptor with strong receptor affinity.
C. Exerts an opioid effect.
D. Alleviates withdrawal symptoms.
31. All of the following are contraindications to receiving XR-NTX, except for:
A. Current pain treatment with opioid analgesics
B. Current acute opioid withdrawal
C. Severe hepatic impairment
D. Renal impairment
32. A negative naloxone challenge guarantees that the patient will not experience precipitated opioid withdrawal upon naltrexone administration.
A. True
B. False
33. Naltrexone use has been occasionally associated with dysphoria, although it is unclear whether this is a side effect of the medication or a manifestation of underlying depression or depressed mood related to OUD.
A. True
B. False
34. Naltrexone is not recommended for OUD treatment in pregnancy.
A. True
B. False
35. A naltrexone medication guide should be dispensed to patients with each injection.
A. True
B. False
36. All of the following are signs that a patient may be ready to discontinue medication, except for:
A. Switching to a new job that requires drug testing.
B. Sustaining illicit drug abstinence over time.
C. Having substantially reduced cravings.
D. Attending counseling or mutual-help groups.
37. When patients stop using naltrexone, they will have no tolerance for opioids, and their risk of overdose is very high if they use again.
A. True
B. False
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