Davis Edge PHARM 3 Opioid practice test questions

Which medication is an injectable and can be used for patients with moderate to severe alcohol use disorder? 1. Naltrexone (Vivitrol) 380 mg intramuscular (IM) every 4 weeks 2. Paliperidone (Invega) 117 mg IM monthly 3. Haloperidol (Haldol Decanoate) 50 mg IM once weekly 4. Promethazine (Phenergan) 25 mg IM PRN

ANS 1 Option 1: Naltrexone extended-release injection (Vivitrol) can be used for patients with alcohol use disorder and is dosed at 380 mg every 4 weeks. Option 2: Paliperidone (Invega) is a second generation antipsychotic and is not indicated for alcohol use disorder. Option 3: Haldol is an antipsychotic and is not indicated for alcohol use disorder. Option 4: Phenergan is an antihistamine and is not indicated for alcohol use disorder.

A patient presents to the clinician's clinical setting today and states that she wants to stop the benzodiazepine that she has taken for several years. You should educate the patient regarding which of the following? 1. "You should not discontinue a benzodiazepine abruptly because it can cause serious complications including seizures and death." 2. "You can stop the medication today." 3. "You must continue taking the medication since you have taken it long-term." 4. "You must taper over 3 days to avoid withdrawal symptoms from occurring before you stop the medication."

ANS 1 Option 1: Withdrawing abruptly from benzodiazepines can cause not only discomfort and anxiety, but also confusion, psychosis, seizures, and death. It is recommended that gradual tapering should be instituted for long-term users. Option 2: Withdrawing abruptly from benzodiazepines can cause serious occurrences such as confusion, psychosis, seizures, and even death. Gradual tapering should be instituted. Option 3: Long-term use is not generally recommended. However, gradual tapering should be instituted. Option 4: Withdrawing abruptly from benzodiazepines can cause not only discomfort and anxiety, but also confusion, psychosis, seizures, and death. It is recommended that gradual tapering should be instituted for long-term users.

Which physiological biomarker is a metabolite of ethyl alcohol that can be detected in urine and hair samples and can be used to assess individuals with known or suspected alcohol use disorder? 1. Ethyl glucuronide (EtG) 2. Mean corpuscular volume (MCV) 3. Lipase and amylase 4. Testosterone

ANS 1 Option 1: EtG is a metabolite of ethyl alcohol and can be detected in urine and hair samples. Option 2: This is considered an indirect biomarker. EtG is a metabolite of ethyl alcohol and can be detected in urine and hair samples. Option 3: Lipase and amylase are not used as a screening tool for alcohol use. Option 4: Testosterone is not used as a screening tool for alcohol use.

According to the National Survey on Drug Use and Health conducted by Substance Abuse and Mental Health Services Administration (SAMHSA), 10.6% (28.6 million people) of the U.S. population over which age had used some illicit drug in the past month? 1. Age 12 2. Age 18 3. Age 30 4. Age 50

ANS 1 Option 1: It is important to identify the age span for illicit drug use. According to the National Survey on Drug Use and Health conducted by SAMHSA, 10.6% (28.6 million people) of the U.S. population over the age of 12 had used some illicit drug in the past month. Option 2: According to the National Survey on Drug Use and Health conducted by SAMHSA, 10.6% (28.6 million people) of the U.S. population over the age of 12 had used some illicit drug in the past month. Option 3: According to the National Survey on Drug Use and Health conducted by SAMHSA, 10.6% (28.6 million people) of the U.S. population over the age of 12 had used some illicit drug in the past month. Option 4: According to the National Survey on Drug Use and Health conducted by SAMHSA, 10.6% (28.6 million people) of the U.S. population over the age of 12 had used some illicit drug in the past month.

Long-term use of benzodiazepines is not associated with which of the following? 1. Improvement of memory 2. Cognitive impairment 3. Falls 4. Motor vehicle accidents

ANS 1 Option 1: Long-term use of benzodiazepines is associated with cognitive impairment, falls, and motor vehicle accidents. Option 2: Long-term use of benzodiazepines is associated with cognitive impairment, falls, and motor vehicle accidents. Option 3: Long-term use of benzodiazepines is associated with cognitive impairment, falls, and motor vehicle accidents. Option 4: Long-term use of benzodiazepines is associated with cognitive impairment, falls, and motor vehicle accidents.

You are planning to prescribe a benzodiazepine as a treatment for alcohol withdrawal in a patient. Special consideration should be given for which of the following patients? 1. A patient with severe liver disease 2. A middle-aged adult 3. A patient with hypertension 4. A patient with frequent urinary tract infections

ANS 1 Option 1: Longer acting choices such as diazepam and chlordiazepoxide are preferable for their smoother withdrawal course and lesser potential for rebound symptoms, but these choices, with their longer half-life and active metabolites, may build up in the system of those with poor hepatic clearance from liver disease. Option 2: Consideration should be provided for older adult patients. Option 3: Although hypertension can be considered a comorbidity, this diagnosis does not pose a contraindication or change the treatment plan. Option 4: Frequent urinary tract infections do not impact treatment with benzodiazepines.

A patient with a history of chronic alcohol consumption presents with confusion, ataxia, and ophthalmoplegia. Which condition should you suspect? 1. Wernicke's encephalopathy 2. Alcoholic fatty liver disease 3. Psychotic disorder 4. Epilepsy

ANS 1 Option 1: Thiamine deficiency may result in confusion, ataxia, and ophthalmoplegia, a classic triad known as Wernicke's encephalopathy. Option 2: Although alcoholic fatty liver disease can be associated with chronic alcohol consumption, the symptoms that the patient in this scenario exhibits are associated with Wernicke's encephalopathy. Option 3: Although certain psychotic states can be seen with alcohol consumption, these symptoms are associated with Wernicke's encephalopathy. Option 4: Although alcohol consumption can be linked as a component cause of epilepsy, these symptoms are not characteristic of epilepsy and are instead characteristic of Wernicke's encephalopathy.

Which drug is approved for medication-assisted treatment for opioid use disorder in an office-based setting and can be prescribed by qualified physicians, physician's assistants, and nurse practitioners who have additional training and have a waiver under the Drug Addiction and Treatment Act of 2000? 1. Buprenorphine (Belbuca, Buprenex, Subutex, Probuphine) 2. Methadone (Dolophine, Metadol) 3. Naltrexone (Revia, Depade, Vivitrol) 4. Alpha-2 adrenergic agonist lofexidine (Lucemyra)

ANS 1 Option 1: To prescribe this drug, the advanced practice nurse must attain additional training and obtain a waiver. Option 2: Methadone treatment may be provided only by opioid treatment programs (OTPs) that are certified by Substance Abuse and Mental Health Services Administration (SAMHSA) and registered with the Drug Enforcement Agency (DEA). Option 3: There is not a requirement for additional training or attainment of a waiver to prescribe this drug if within the advanced practice nurse's scope of practice. Option 4: There is not a requirement for additional training or attainment of a waiver to prescribe this drug if within the advanced practice nurse's scope of practice.

Which of the following benzodiazepines has the shortest duration of action? 1. Triazolam (Halcion) 2. Diazepam (Valium) 3. Clonazepam (Klonopin) 4. Chlordiazepoxide (Librium)

ANS 1 Option 1: Triazolam (Halcion) has a very short duration of action. Option 2: Valium has a long duration of action. Option 3: Klonopin has a long duration of action. Option 4: Librium has a long duration of action.

Which of the following symptoms is associated with protracted or postacute opioid withdrawal? 1. Anxiety 2. Confusion 3. Sleepiness 4. Anger

ANS 1 Option 1: Protracted or postacute withdrawal may last months. Though not as severe as acute withdrawal, patients suffer with anxiety, insomnia, dysphoria, and anhedonia. Option 2: Protracted or postacute withdrawal may last months. Though not as severe as acute withdrawal, patients suffer with anxiety, insomnia, dysphoria, and anhedonia. Option 3: Protracted or postacute withdrawal may last months. Though not as severe as acute withdrawal, patients suffer with anxiety, insomnia, dysphoria, and anhedonia. Option 4: Protracted or postacute withdrawal may last months. Though not as severe as acute withdrawal, patients suffer with anxiety, insomnia, dysphoria, and anhedonia

Which of the following patients should not be prescribed buprenorphine with naloxone (Suboxone)? 1. Pregnant women 2. A patient who has a history of diversion 3. A male who has a history of injectable drug use 4. A patient with a history of opioid addiction

ANS 1 Option 1: The addition of naloxone acts as a deterrent to diversion and injection of medication and is generally preferable. One exception is with pregnant women, with whom the risk of precipitated withdrawal could be detrimental if the combination is injected. Option 2: The addition of naloxone acts as a deterrent to diversion and injection of medication and is generally preferable. Option 3: The addition of naloxone acts as a deterrent to diversion and injection of medication and is generally preferable. Option 4: Buprenorphine with naloxone is used as part of a medication-assisted treatment for opioid addiction.

Question 4. Which receptor is thought to be responsible for the reward effect of opioids? 1. Mu 2. Delta 3. Kappa 4. Phi

ANS 1 Option 1: The mu receptor is thought to be responsible for the reward effects of opioids. Option 2: The mu receptor is thought to be responsible for the reward effects of opioids. Option 3: The mu receptor is thought to be responsible for the reward effects of opioids. Option 4: The mu receptor is thought to be responsible for the reward effects of opioids.

Which medication is indicated for emergency treatment of known or suspected opioid overdose, is carried by first responders, and is prescribed to known opioid users? 1. Naloxone nasal spray 2. Flumazenil (Romazicon) 3. Citalopram (Celexa) 4. lofexidine (Lucemyra)

ANS 1 Option 1: Naloxone nasal spray is indicated for emergency treatment of known or suspected opioid overdose, is carried by first responders, and is prescribed to known opioid users. A single spray of naloxone nasal spray is administered to adult or pediatric patients intranasally in one nostril. Additional doses of naloxone nasal spray may be given every 2 to 3 minutes until emergency medical assistance arrives. Option 2: Naloxone nasal spray is indicated for emergency treatment of known or suspected opioid overdose. Option 3: Naloxone nasal spray is indicated for emergency treatment of known or suspected opioid overdose. Celexa is a selective serotonin reuptake inhibitor (SSRI). Option 4: Naloxone nasal spray is indicated for emergency treatment of known or suspected opioid overdose.

A 59-year-old male presents with severe alcohol withdrawal, a history of poor diet, and overt signs of malnutrition. Which of the following should be ordered? 1. Thiamine 250 mg for 3 to 5 days parentally 2. Multivitamin supplement parentally 3. Thiamine 100 mg every day by mouth 4. Magnesium 250 mg every day by mouth

ANS 1 Option 1: Patients with severe alcohol withdrawal and those with poor diet and overt signs of malnutrition should be treated with parenterally administered thiamine 250 mg for 3 to 5 days. Option 2: Patients with severe alcohol withdrawal and those with poor diet and overt signs of malnutrition should be treated with parenterally administered thiamine 250 mg for 3 to 5 days. In this patient, a multivitamin would be adjunctive treatment and the decision for its administration would be based on what nutritional deficiencies exist. Option 3: Patients with severe alcohol withdrawal and those with poor diet and overt signs of malnutrition should be treated with parenterally administered thiamine 250 mg for 3 to 5 days. Option 4: Patients with severe alcohol withdrawal and those with poor diet and overt signs of malnutrition should be treated with parenterally administered thiamine 250 mg for 3 to 5 days.

Which of the following can occur with abrupt discontinuation of benzodiazepines? 1. Seizure activity 2. Arrhythmias 3. Migraine headache 4. Visual loss

ANS 1 Option 1: Benzodiazepine withdrawal can result in seizure activity, which may include absence seizures manifested as clouded sensorium, confusion, altered level of consciousness, and poor performance on the Mini-Mental Status Exam (MMSE), all of which may be exhibited during benzodiazepine intoxication as well. Option 2: Benzodiazepine withdrawal can result in seizure activity. Option 3: Benzodiazepine withdrawal can result in seizure activity. Option 4: Benzodiazepine withdrawal can result in seizure activity.

You have prescribed a clonidine transdermal patch. Which of the following actions should be performed? 1. Start the patient on oral clonidine for the first 3 days. 2. Instruct the patient to monitor for irregular heart rate while taking the medication. 3. Discontinue methadone or buprenorphine once clonidine transdermal is initiated. 4. Begin tapering at day 7

ANS 1 Option 1: Clonidine can be given orally or administered via transdermal patch, although the patch requires 3 days to reach effective dosing; therefore, the patient should be started on oral clonidine for the first 3 days. Option 2: Blood pressure and pulse should be monitored while on therapy. Option 3: The alpha-2 agonists are usually used as adjuncts to treatment with methadone or buprenorphine. Option 4: Tapering is started day 5.

When possible, the clinician should avoid prescribing what drug for a patient who is taking an opioid pain medication? 1. Anticonvulsants 2. Benzodiazepines 3. Anticholinergics 4. Corticosteroids

ANS 2 Option 1: Clinicians should avoid prescribing opioid pain medication and benzodiazepines concurrently whenever possible. Option 2: Clinicians should avoid prescribing opioid pain medication and benzodiazepines concurrently whenever possible. Option 3: Clinicians should avoid prescribing opioid pain medication and benzodiazepines concurrently whenever possible. Option 4: Clinicians should avoid prescribing opioid pain medication and benzodiazepines concurrently whenever possible.

How often should the clinician evaluate benefits and harms with patients when starting opioid therapy for chronic pain or at dose escalation? 1. Within 3 days 2. Within 1 to 4 weeks 3. After 6 weeks 4. Within 9 weeks

ANS 2 Option 1: Clinicians should evaluate benefits and harms with patients within 1 to 4 weeks. Option 2: Clinicians should evaluate benefits and harms with patients within 1 to 4 weeks of starting opioid therapy for chronic pain or at dose escalation. Option 3: Clinicians should evaluate benefits and harms with patients within 1 to 4 weeks of starting opioid therapy for chronic pain or at dose escalation. Clinicians should evaluate benefits and harms of continued therapy with patients every 3 months or more frequently. Option 4: Clinicians should evaluate benefits and harms with patients within 1 to 4 weeks of starting opioid therapy for chronic pain or at dose escalation. Clinicians should evaluate benefits and harms of continued therapy with patients every 3 months or more frequently.

Which of the following is an important prescribing consideration when treating a patient with methadone? 1. Methadone treatment should be started when the patient is exhibiting signs of sedation or intoxication. 2. Increasing methadone dose too quickly can lead to respiratory depression and death. 3. The dosage should be increased quickly to prevent withdrawal symptoms and relapse. 4. Due to the long half-life, methadone can be tapered rapidly.

ANS 2 Option 1: Methadone treatment is started when there are no signs of sedation or intoxication, and the patient is demonstrating signs of withdrawal. Option 2: Increasing methadone dose too quickly can lead to respiratory depression and death. This requires careful titration of the dose and knowledge of the variable half-life of methadone. Option 3: Dosage is gradually increased to suppress cravings, to a dose of 60 to 120 mg per day. Increasing the dose too quickly can place the patient at risk for respiratory depression and death. Option 4: Weaning from methadone should be done slowly. Tapering should be medically supervised with dosage reductions of less than 10% every 10 to 14 days. Patients should be monitored closely during tapering for relapse.

Which medication is the standard treatment for an opioid overdose? 1. Benzodiazepine 2. Naloxone 3. Alpha-2 adrenergic agonist 4. Methadone

ANS 2 Option 1: Naloxone is the standard treatment for opioid overdose. Option 2: Naloxone is the standard treatment for opioid overdose. Option 3: Naloxone is the standard treatment for opioid overdose. Option 4: Naloxone is the standard treatment for opioid overdose.

Which of the following acts on the gamma-aminobutyric acid (GABA) pathway as an agonist and has been shown to be helpful in the treatment of alcohol withdrawal syndrome (AWS), with reduction of cravings? 1. Ramelteon (Rozerem) 2. Baclofen 3. Memantine (Namenda) 4. Lisdexamfetamine (Vyvanse)

ANS 2 Option 1: Ramelteon (Rozerem) binds to melatonin MT1 and MT2 receptors and is used for sleep. Baclofen is the correct answer. It acts on the GABA pathway as an agonist and has been shown to be helpful in the treatment of AWS, with reduction of cravings. Option 2: Baclofen acts on the GABA pathway as an agonist and has been shown to be helpful in the treatment of AWS, with reduction of cravings and decreased Clinical Institute for Withdrawal Assessment - Alcohol, revised (CIWA-Ar) scores comparable to diazepam. Option 3: There has not been an association between the use of Namenda and alcohol withdrawal. Baclofen is the correct answer. It acts on the GABA pathway as an agonist and has been shown to be helpful in the treatment of AWS, with reduction of cravings. Option 4: Baclofen is the correct answer. It acts on the GABA pathway as an agonist and has been shown to be helpful in the treatment of AWS, with reduction of cravings

Which of the following drugs can be used as a fixed-schedule dosing to detoxify patients with acute withdrawal syndrome? 1. Chlordiazepoxide (Librium) is dosed at 12.5 mg every 12 hours for 1 day, then 5 mg daily for eight doses. 2. Diazepam (Valium) is dosed at 10 mg every 6 hours for four doses, then 5 mg every 6 hours for eight doses. 3. Lorazepam (Ativan) is dosed at 0.5 mg every 12 hours for four days. 4. Hydroxyzine (Vistaril) is prescribed.

ANS 2 Option 1: A fixed-schedule dosing of benzodiazepines (BDZs) can be used to detoxify patients with acute withdrawal syndrome (Ricks et al, 2010). Chlordiazepoxide is dosed at 50 mg every 6 hours for four doses, then 25 mg every 6 hours for eight doses. Option 2: A fixed-schedule dosing of benzodiazepines (BDZs) can be used to detoxify patients with acute withdrawal syndrome (Ricks et al, 2010). Diazepam is dosed 10 mg every 6 hours for four doses, then 5 mg every 6 hours for eight doses. Option 3: Short-acting benzodiazepines (BDZs) may also be used, with lorazepam dosed at 2 mg every 6 hours for four doses, followed by 1 mg every 6 hours for eight doses. This particular answer is not correct due to the lower dose and shortened duration. Option 4: Vistaril, an antihistamine used commonly for anxiety, is not appropriate for acute withdrawal syndrome.

The United States Preventive Services Task Force (USPSTF) recommends screening for alcohol misuse in primary care settings for what age group? 1. 12 and older 2. 18 and older 3. 30 and younger 4. 65 and younger

ANS 2 Option 1: Although the use of alcohol varies across the lifespan, the USPSTF recommends screening for alcohol misuse in primary care settings for individuals 18 years and older, including pregnant women. Option 2: The USPSTF recommends screening for alcohol misuse in primary care settings for individuals 18 years and older, including pregnant women. Option 3: Although the use of alcohol varies across the lifespan, the USPSTF recommends screening for alcohol misuse in primary care settings for individuals 18 years and older, including pregnant women. Option 4: Although the use of alcohol varies across the lifespan, the USPSTF recommends screening for alcohol misuse in primary care settings for individuals 18 years and older, including pregnant women.

Which physiological biomarker can be helpful in detecting steady alcohol use over weeks? 1. Vitamin B12 2. Phosphatidylethanol (PEth) 3. Complete blood count (CBC) 4. Alkaline phosphatase (ALP)

ANS 2 Option 1: PEth can be helpful in detecting steady alcohol use over weeks and carbohydrate-deficient transferring can detect heavy alcohol use in weeks prior. Option 2: PEth can be helpful in detecting steady alcohol use over weeks and carbohydrate-deficient transferring can detect heavy alcohol use in weeks prior. Option 3: PEth can be helpful in detecting steady alcohol use over weeks and carbohydrate-deficient transferring can detect heavy alcohol use in weeks prior. Option 4: PEth can be helpful in detecting steady alcohol use over weeks and carbohydrate-deficient transferring can detect heavy alcohol use in weeks prior.

The clinician is ordering labs on a patient who has a history of alcohol use. Which of the following would confirm a history of excessive alcohol use? 1. Low gamma-glutamyl transpeptidase (GGT) 2. Aspartate aminotransferase (AST) elevated above alanine aminotransferase (ALT) by a ratio of 2:1 3. Decreased mean corpuscular volume (MCV) 4. Hypokalemia, hypophosphatemia, and hypomagnesemia

ANS 2 Option 1: With excessive alcohol use, AST is typically elevated above ALT by a ratio of 2:1. This, along with elevated GGT, is often indicative of alcohol-related liver disease. Option 2: With excessive alcohol use, AST is typically elevated above ALT by a ratio of 2:1. This, along with elevated GGT, is often indicative of alcohol-related liver disease. Option 3: MCV may be increased with heavy alcohol use, although it is considered an indirect biomarker. Option 4: Hypokalemia, hypophosphatemia, and hypomagnesemia may result from nutritional deficiencies, renal tubular disorders, or a combination of these.

Which of the following neurotransmitters can lead to symptoms of withdrawal and a lowered seizure threshold in alcohol withdrawal? 1. Norepinephrine 2. Dopamine 3. Histamine 4. Serotonin

ANS 2 Option 1: The neurotransmitters that are impacted by alcohol withdrawal are gamma-aminobutyric acid (GABA), glutamate, and dopamine. Option 2: Alcohol increases dopamine, which leads to the symptoms of withdrawal, including a lowered seizure threshold, when alcohol use is decreased. Option 3: The neurotransmitters that are impacted by alcohol withdrawal are GABA, glutamate, and dopamine. Option 4: The neurotransmitters that are impacted by alcohol withdrawal are GABA, glutamate, and dopamine.

Which of the following is characteristic of opioid use? 1. The potential for overdose is decreased after a period of abstinence as tolerance has decreased. 2. The route of administration, dose, potency, and onset of action play a role in both the acute effects and withdrawal. 3. Although opioid overdose is a major consequence of opioid use, there has been a sharp decrease in the number of deaths in recent years. 4. Opioid withdrawal is life threatening.

ANS 2 Option 1: The potential for overdose is often elevated after a period of abstinence as tolerance has decreased. Option 2: The route of administration, dose, potency, and onset of action play a role in both the acute effects and withdrawal. Option 3: Opioid overdose is a major consequence of opioid use and has resulted in a rising number of deaths each year. Option 4: Opioid withdrawal is not generally life threatening, but it is physically difficult.

Chronic alcohol consumption is noted to lead to depletion of which vitamins? 1. Magnesium and iron 2. Vitamins C and D 3. Thiamine and magnesium 4. Vitamin E and thiamine

ANS 3 Option 1: Although other vitamin deficient states may be present in patients who have chronic alcohol consumption, depletion of thiamine and magnesium are noted as directly related to chronic alcohol consumption. Option 2: Chronic alcohol consumption leads to depletion of thiamine and magnesium. Option 3: Chronic alcohol consumption leads to depletion of thiamine and magnesium. Option 4: Chronic alcohol consumption leads to depletion of thiamine and magnesium.

Which medication is used to reduce the severity of benzodiazepine withdrawal symptoms? 1. Paroxetine (Paxil) 2. Lamotrigine (Lamictal) 3. Carbamazepine (Tegretol) 4. Bupropion hydrochloride (Wellbutrin)

ANS 3 Option 1: Carbamazepine is one of the few agents that has been shown to reduce the severity of withdrawal symptoms. Although a selective serotonin reuptake inhibitor (SSRI) can be used in patients with depression and anxiety otherwise not treated, paroxetine has a high withdrawal potential and other alternatives be used. Option 2: Carbamazepine is one of the few agents that has been shown to reduce the severity of withdrawal symptoms. Option 3: The use of adjunctive agents has not been widely supported in the literature except for carbamazepine, which has been shown to reduce the severity of withdrawal symptoms. Option 4: Carbamazepine is one of the few agents that has been shown to reduce the severity of withdrawal symptoms.

Which of the following is a symptom that can be associated with opioid withdrawal? 1. Constipation 2. Pupil constriction 3. Lacrimation 4. Cough

ANS 3 Option 1: Constipation is not a common symptom associated with opioid withdrawal. Option 2: Pupil constriction is not noted with opioid withdrawal; it is more frequently seen with opioid use. Option 3: Symptoms of opioid withdrawal include dysphoria, nausea, vomiting, stomach cramping, diarrhea, myalgia, rhinorrhea, lacrimation, pupil dilation, diaphoresis, piloerection, yawning, fever, and insomnia. Option 4: Cough is not seen with opioid withdrawal. However, rhinorrhea can be a symptom.

Which of the following drugs is an inhibitor of the enzyme aldehyde dehydrogenase and causes tachycardia, flushing, headache, nausea, and vomiting if alcohol is ingested within 12 to 24 hours of administration? 1. Naltrexone (Revia) 2. Acamprosate (Campral) 3. Disulfiram (Antabuse) 4. Topiramate (Topamax)

ANS 3 Option 1: Disulfiram (Antabuse) is an inhibitor of the enzyme aldehyde dehydrogenase and causes tachycardia, flushing, headache, nausea, and vomiting if alcohol is ingested within 12 to 24 hours of administration. Option 2: Disulfiram (Antabuse) is an inhibitor of the enzyme aldehyde dehydrogenase and causes tachycardia, flushing, headache, nausea, and vomiting if alcohol is ingested within 12 to 24 hours of administration. Option 3: Disulfiram (Antabuse) is an inhibitor of the enzyme aldehyde dehydrogenase and causes tachycardia, flushing, headache, nausea, and vomiting if alcohol is ingested within 12 to 24 hours of administration. Option 4: Disulfiram (Antabuse) is an inhibitor of the enzyme aldehyde dehydrogenase and causes tachycardia, flushing, headache, nausea, and vomiting if alcohol is ingested within 12 to 24 hours of administration.

Which of the following is the initiation dose of disulfiram (Antabuse)? 1. 750 mg daily for 2 weeks 2. 250 mg daily for 4 weeks 3. 500 mg once a day for 1 to 2 weeks 4. 100 mg twice a day for 6 weeks

ANS 3 Option 1: Disulfiram treatment is initiated by administering 500 mg once a day for 1 to 2 weeks. For this selection, the dose is too high. Option 2: The maintenance dose of disulfiram is 250 mg daily. Option 3: Disulfiram treatment is initiated by administering 500 mg once a day for 1 to 2 weeks. Option 4: Disulfiram treatment is initiated by administering 500 mg once a day for 1 to 2 weeks. For this selection the dose is too low for an initiation dose.

A patient presents to the clinician's practice setting with seizure activity and symptoms of clouded sensorium, confusion, altered level of consciousness, and poor performance on the Mini-Mental Status Exam (MMSE). The advanced practice nurse should suspect which of the following? 1. Opioid withdrawal 2. Abrupt cessation of the alpha-2 adrenergic agonist clonidine 3. Benzodiazepine withdrawal 4. Use of naloxone

ANS 3 Option 1: Opioid withdrawal symptoms include sweating, diarrhea, gastrointestinal cramping, nausea, anxiety, and irritability. Option 2: The advanced practice nurse should suspect benzodiazepine withdrawal. Rebound hypertension is a concern with the use of clonidine. Option 3: Benzodiazepine withdrawal can result in seizure activity, which may include absence seizures manifested as clouded sensorium, confusion, altered level of consciousness, and poor performance on the Mini-Mental Status Exam (MMSE), all of which may be exhibited during benzodiazepine intoxication as well. Option 4: The advanced practice nurse should suspect benzodiazepine withdrawal. Naloxone is the standard treatment for opioid overdose.

The alpha-2 adrenergic agonist lofexidine (Lucemyra) is used for which of the following? 1. As an adjunctive treatment with naltrexone (Vivitrol) 2. In patients experiencing opioid overdose 3. To treat symptoms of opioid withdrawal 4. To treat symptoms of arrhythmia in patients who are taking opioids

ANS 3 Option 1: The alpha-2 agonists are usually used as adjuncts to treatment with methadone or buprenorphine. Option 2: The alpha-2 adrenergic agonists lofexidine (Lucemyra) and clonidine (Catapres) are used to treat the symptoms of opioid withdrawal. Naloxone is the standard treatment for opioid overdose. Option 3: The alpha-2 adrenergic agonists lofexidine (Lucemyra) and clonidine (Catapres) are used to treat the symptoms of opioid withdrawal, including sweating, diarrhea, gastrointestinal cramping, nausea, anxiety, and irritability (Sevarino, 2018). The alpha-2 agonists are usually used as adjuncts to treatment with methadone or buprenorphine. Option 4: The alpha-2 adrenergic agonists lofexidine (Lucemyra) and clonidine (Catapres) are used to treat the symptoms of opioid withdrawal.

Which of the following is considered first-line treatment for alcohol withdrawal and can work as a replacement for alcohol and reduce or eliminate withdrawal by stimulating gamma-aminobutyric acid-A (GABA-A) receptors? 1. Selective serotonin reuptake inhibitors 2. Stimulants 3. Benzodiazepines (BDZs) 4. Tricyclic antidepressants

ANS 3 Option 1: BDZs are considered first-line treatment for alcohol withdrawal and work as a replacement for alcohol and reduce or eliminate withdrawal by stimulating GABA-A receptors. Option 2: BDZs are considered first-line treatment for alcohol withdrawal and work as a replacement for alcohol and reduce or eliminate withdrawal by stimulating GABA-A receptors. Option 3: BDZs are considered first-line treatment for alcohol withdrawal and work as a replacement for alcohol and reduce or eliminate withdrawal by stimulating GABA-A receptors. Option 4: BDZs are considered first-line treatment for alcohol withdrawal and work as a replacement for alcohol and reduce or eliminate withdrawal by stimulating GABA-A receptors.

Which of the following patients should not receive Naltrexone (Vivitrol extended-release injection)? 1. A patient who has mild renal insufficiency 2. A patient who is currently not consuming alcohol but may use alcohol socially 3. A patient who is currently using an opioid 4. A patient who has diabetes mellitus type II

ANS 3 Option 1: Naltrexone should not be used in patients who currently use or may use an opioid, nor should it be used by individuals with severe hepatic impairment. Option 2: Naltrexone should not be used in patients who currently use or may use an opioid, nor should it be used by individuals with severe hepatic impairment. Option 3: Naltrexone should not be used in patients who currently use or may use an opioid, nor should it be used by individuals with severe hepatic impairment. Option 4: Naltrexone should not be used in patients who currently use or may use an opioid, nor should it be used by individuals with severe hepatic impairment. There is not a contraindication for comorbid diabetes.

Which of the following medications decreases alcohol cravings and reduces the likelihood of returning to drinking? 1. Disulfiram (Antabuse) 2. Lithium 3. Sertraline (Zoloft) 4. Naltrexone (Revia tablets)

ANS 4 Option 1: Disulfiram is used as a deterrent to alcohol use related to the significant adverse symptoms with coconsumption of alcohol. Naltrexone (Revia tablets, Vivitrol extended-release injection) decreases alcohol cravings and reduces the likelihood of returning to drinking. Option 2: Naltrexone (Revia tablets, Vivitrol extended-release injection) decreases alcohol cravings and reduces the likelihood of returning to drinking. Option 3: Sertraline (Zoloft) is not indicted for alcohol use. Naltrexone (Revia tablets, Vivitrol extended-release injection) decreases alcohol cravings and reduces the likelihood of returning to drinking. Option 4: Naltrexone (Revia tablets, Vivitrol extended-release injection) decreases alcohol cravings and reduces the likelihood of returning to drinking.

Which of the following benzodiazepines has the longest duration of action? 1. Alprazolam (Xanax) 2. Temazepam (Restoril) 3. Oxazepam (Serax) 4. Diazepam (Valium)

ANS 4 Option 1: Alprazolam (Xanax) has a short duration of action. Option 2: Temazepam (Restoril) has a short duration of action. Option 3: Oxazepam (Serax) has a short duration of action. Option 4: Valium has a long duration of action.

The advanced practice nurse is developing a treatment plan for a patient with alcohol withdrawal. Which of the following is considered a first-line choice? 1. Carbamazepine (Tegretol) 2. Phenytoin (Dilantin) 3. Divalproex sodium (Depakote) 4. Lorazepam (Ativan)

ANS 4 Option 1: Benzodiazepines (BDZs) are considered first-line treatment for alcohol withdrawal. Carbamazepine, phenytoin, and valproate have been shown to be effective in managing withdrawal symptoms and are recommended as second-line or adjunctive treatments by the World Health Organization. Option 2: Benzodiazepines (BDZs) are considered first-line treatment for alcohol withdrawal. Carbamazepine, phenytoin, and valproate have been shown to be effective in managing withdrawal symptoms and are recommended as second-line or adjunctive treatments by the World Health Organization. Option 3: Benzodiazepines (BDZs) are considered first-line treatment for alcohol withdrawal. Carbamazepine, phenytoin, and valproate have been shown to be effective in managing withdrawal symptoms and are recommended as second-line or adjunctive treatments by the World Health Organization. Option 4: Lorazepam, a benzodiazepine (BDZ), is considered first-line treatment for alcohol withdrawal. No BDZ is considered superior to others for preventing withdrawal complications, and choice is generally based on pharmacokinetics of the BDZ, comorbidities, hepatic function, age, and preference.

A patient who is presently using heroin presents to the clinician's clinical setting. He has asked when withdrawal symptoms can be expected after the last dose of this drug. What should your response be? 1. "Typically, symptoms develop around 24 hours after the last dose." 2. "Symptoms start in 1 to 3 days and gradually subside over a week." 3. "Symptoms start 1 hour before the next expected dose." 4. "Symptoms generally develop 6 to 12 hours after the last dose of a short-acting opioid such as heroin."

ANS 4 Option 1: Symptoms generally develop 6 to 12 hours after the last dose of a short-acting opioid such as heroin. Option 2: Actually, symptoms generally develop 6 to 12 hours after the last dose of a short-acting opioid such as heroin. Symptoms peak over 1 to 3 days and gradually subside over a week. Option 3: Symptoms generally develop 6 to 12 hours after the last dose of a short-acting opioid such as heroin. In this scenario, you must use the last administered dose as a guide. Option 4: Symptoms generally develop 6 to 12 hours after the last dose of a short-acting opioid such as heroin, and up to a few days later with long-acting opioids such as methadone. Symptoms peak over 1 to 3 days and gradually subside over a week.

Which medication is not approved for opioid withdrawal by the U.S. Food and Drug Administration (FDA)? 1. Naltrexone (Revia, Depade) 2. Methadone (Dolophine, Metadol) 3. Buprenorphine (Belbuca, Buprenex, Subutex, Probuphine) 4. Clonidine (Catapres)

ANS 4 Option 1: The medications that are FDA approved for opioid withdrawal include buprenorphine, methadone, and naltrexone. Option 2: The medications that are FDA approved for opioid withdrawal include buprenorphine, methadone, and naltrexone. Option 3: The medications that are FDA approved for opioid withdrawal include buprenorphine, methadone, and naltrexone. Option 4: The medications that are FDA approved for opioid withdrawal include buprenorphine, methadone, naltrexone, and lofexidine. Clonidine has been used to treat withdrawal symptoms but is not FDA approved for opioid withdrawal.

Which of the following is a consideration when planning initiation of buprenorphine in a patient with opioid use disorder? 1. Treatment beyond 9 months is not recommended. 2. Patients who are not stable on low-to-moderate doses should be initiated on a subdermal buprenorphine implant. 3. Tapering of dose should occur over 3-6 months if long-term maintenance is not desired. 4. Buprenorphine can trigger withdrawal; symptom-triggered dosing and titration are required for induction.

ANS 4 Option 1: There is not an established end-treatment guideline of 9 months for a patient who has been initiated on buprenorphine. Option 2: Patients who are stable on low-to- moderate doses (less than 8 mg per day) of buprenorphine may be eligible for Probuphine, a subdermal buprenorphine implant that is in place for 6 months and then replaced. Option 3: Tapering of dose can occur over 3 to 7 days if long-term maintenance is not desired. Option 4: Because buprenorphine can trigger withdrawal, symptom-triggered dosing and titration are required for induction, which is generally started 8 to 24 hours after the last opioid dose (24 to 36 hours after long-acting opioid or methadone).

Which action should the clinician consider when treating a patient with opioids for chronic pain? 1. When starting opioid therapy, prescribe extended-release/long-acting (ER/LA) opioids instead of immediate-release opioids. 2. Start at the highest dose expected to control the patient's pain. 3. Provide a quantity of the drug for at least 30 days for acute pain to ensure continuity of pain control is maintained. 4. When opioids are started, clinicians should prescribe the lowest effective dosage.

ANS 4 Option 1: When starting opioid therapy for chronic pain, clinicians should prescribe immediate-release opioids instead of extended-release/long-acting (ER/LA) opioids. Option 2: When opioids are started, clinicians should prescribe the lowest effective dosage. Option 3: When opioids are used for acute pain, clinicians should prescribe the lowest effective dose of immediate-release opioids and should prescribe no greater quantity than needed for the expected duration of pain severe enough to require opioids. Three days or less will often be sufficient; more than 7 days will rarely be needed. Option 4: When opioids are started, clinicians should prescribe the lowest effective dosage. Clinicians should use caution when prescribing opioids at any dosage.

Experts recommend that the use of benzodiazepines be limited to what time frame? 1. No less than 1 year 2. Six months 3. At least 12 weeks 4. No more than 2 to 4 weeks for most patients

ANS 4 Option 1: Experts recommend that the use of benzodiazepines be limited to no more than 2 to 4 weeks for most patients. Option 2: Experts recommend that the use of benzodiazepines be limited to no more than 2 to 4 weeks for most patients. Option 3: Experts recommend that the use of benzodiazepines be limited to no more than 2 to 4 weeks for most patients. Option 4: Experts recommend that the use of benzodiazepines be limited to no more than 2 to 4 weeks for most patients.

Which of the following should be monitored in a patient who has started on clonidine (Catapres)? 1. Temperature 2. Complete blood count (CBC) 3. Blood glucose 4. Blood pressure

ANS 4 Option 1: Blood pressure and pulse should be monitored when the patient is initiating clonidine therapy. Option 2: Blood pressure and pulse should be monitored when the patient is initiating clonidine therapy. Option 3: Blood pressure and pulse should be monitored when the patient is initiating clonidine therapy. Option 4: Blood pressure and pulse are monitored when the patient is initiating clonidine therapy, with target blood pressure of greater than 90/60 mm Hg and heart rate greater than 60 bpm.

Which of the following is a treatment specific for benzodiazepine intoxication? 1. Methadone (Dolophine) 2. Naloxone (Revia) 3. Topiramate (Topamax) 4. Flumazenil (Romazicon)

ANS 4 Option 1: Methadone (Dolophine, Metadol) is a long-acting mu-receptor agonist used for opioid withdrawal management and for maintenance treatment of opioid addiction. Option 2: Naloxone is the standard treatment for opioid overdose. Option 3: Flumazenil (Romazicon) is the treatment for benzodiazepine intoxication. Option 4: Flumazenil (Romazicon) is the treatment for benzodiazepine intoxication.

Which medication is used to reduce the severity of benzodiazepine withdrawal symptoms? 1. Paroxetine (Paxil) 2. Lamotrigine (Lamictal) 3. Carbamazepine (Tegretol) 4. Bupropion hydrochloride (Wellbutrin)

ANS : 3 Carbamazepine is one of the few agents that has been shown to reduce the severity of withdrawal symptoms. Although a selective serotonin reuptake inhibitor (SSRI) can be used in patients with depression and anxiety otherwise not treated, paroxetine has a high withdrawal potential and other alternatives be used. Option 2: Carbamazepine is one of the few agents that has been shown to reduce the severity of withdrawal symptoms. Option 3: The use of adjunctive agents has not been widely supported in the literature except for carbamazepine, which has been shown to reduce the severity of withdrawal symptoms. Option 4: Carbamazepine is one of the few agents that has been shown to reduce the severity of withdrawal symptoms.

According to the Centers for Disease Control (CDC) Recommendations for Prescribing Opioids for Chronic Pain Outside of Active Cancer, Palliative, and End-of-Life Care, use of opioids for acute pain beyond which time frame is noted to be rarely needed? 1. Four weeks 2. Seven days 3. Two months 4. Six months

ANS :2 Option 1: According to the CDC recommendations, 3 days or less will often be sufficient; more than 7 days will rarely be needed. Option 2: According to the CDC recommendations, 3 days or less will often be sufficient; more than 7 days will rarely be needed. Option 3: According to the CDC recommendations, 3 days or less will often be sufficient; more than 7 days will rarely be needed. Option 4: According to the CDC recommendations, 3 days or less will often be sufficient; more than 7 days will rarely be needed.

Question 1. Which drug class has been shown to be helpful as adjunct treatment during acute withdrawal or as an alternative for individuals who are intolerant to other commonly used treatments? 1. Anticonvulsants 2. Norepinephrine-dopamine reuptake inhibitors 3. Monoamine oxidase inhibitors (MAOIs) 4. Angiotensin receptor blockers

ANS: 1 Option 1: Benzodiazepines are the medication of choice for treating alcohol withdrawal, but evidence has shown that anticonvulsants can be helpful as adjunct treatment during acute withdrawal or as an alternative for individuals who are intolerant of benzodiazepines. Option 2: Evidence has shown that anticonvulsants can be helpful as adjunct treatment during acute withdrawal or as an alternative for individuals who are intolerant of benzodiazepines. Option 3: Evidence has shown that anticonvulsants can be helpful as adjunct treatment during acute withdrawal or as an alternative for individuals who are intolerant of benzodiazepines. Option 4: Angiotensin receptor blockers have not been noted as an adjunctive treatment. Evidence has shown that anticonvulsants can be helpful as adjunct treatment during acute withdrawal or as an alternative for individuals who are intolerant of benzodiazepines.