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Incorporating Alcohol Pharmacotherapies into Medical Practice

Introduction

1. Screening for and providing brief interventions to treat AUDs in general medical settings promote healthy life choices and increase the likelihood of recovery, especially for patients:

A. Who have not yet progressed to chronic alcohol dependence. B. With comorbid medical disorders being treated in these settings. C. Who otherwise would not seek or receive treatment for their AUDs. D. All of the above.

2. The most appropriate patients for brief interventions in a physician's office - and the least appropriate for long-term treatment in a substance abuse treatment program - are those whose drinking exceeds what is recommended, but who are not dependent.

A. True B. False

3. When implemented according to recommended guidelines, medication-assisted treatment combined with brief intervention or more intensive levels of nonpharmacologic treatment can do which of the following?

A. Reduce postacute withdrawal symptoms that can lead to a return to drinking. B. Lessen craving and urges to drink or use drugs. C. Decrease impulsive or situational use of alcohol. D. All of the above.

4. Risk of chronic AUDs appears higher for people with certain genetic variants.

A. True B. False

5. Nurses should be aware that neuroadaptations related to symptoms of withdrawal and persistent craving may trigger relapse even after prolonged abstinence.

A. True B. False

6. Research findings have highlighted all of the following as beneficial effects of medication-assisted treatment for AUDs, except for:

A. Lengthens periods of abstinence. B. Prevents lapses. C. Allows brain cells to readapt to a normal nonalcoholic state. D. Relieves symptoms of protracted withdrawal.

Acamprosate

7. A lower dose of acamprosate must be used with patients who have:

A. Hepatitis B. Psychosis C. Impaired renal function D. Myocardial disease

8. It is hypothesized that normalization from acamprosate leads to a reduction in all of the following common symptoms of protracted, or postacute, withdrawal which may contribute to a patient's return to alcohol use, except for:

A. Nausea B. Insomnia C. Anxiety D. Restlessness

9. Stable plasma concentrations of acamprosate are reached within _____ days of taking the medication.

A. 3 B. 5 C. 7 D. 10

10. Patients maintained on acamprosate develop a tolerance for it.

A. True B. False

11. Because acamprosate affects endogenous and exogenous opioids, it should not be used with patients receiving opioid maintenance therapy or undergoing treatment with opioids for acute or chronic pain.

A. True B. False

12. Acamprosate can be started during medically supervised withdrawal and therapy should be maintained if a patient relapses to alcohol use.

A. True B. False

13. The most common side effect of acamprosate is:

A. Insomnia B. Dizziness C. Diarrhea D. Suicidal ideation

14. Nurses should ensure that patients know:

A. The benefits and limitations of acamprosate. B. That tablets should not be crushed. C. Not to take extra medication if a dose is missed and it is time to take the next dose. D. All of the above.

15. Because of a higher risk of diminished renal function in persons 65 or older, baseline and frequent renal function tests should be performed for those taking acamprosate.

A. True B. False

16. Evidence exists that acamprosate is most effective for patients who, at treatment onset, are motivated for decreased drinking and/or complete abstinence.

A. True B. False

17. Discontinuation of acamprosate may be considered for all of the following reasons, except for:

A. The patient returns to alcohol use. B. The patient has achieved stable abstinence from alcohol. C. The patient reports diminished cravings. D. The patient is not adhering to the medication regimen.

18. Because of the withdrawal syndrome associated with discontinuing acamprosate, it is necessary to taper the dose.

A. True B. False

19. Because acamprosate must be taken three times per day, nurses must pay particular attention to patient adherence.

A. True B. False

Disulfiram

20. Disulfiram, an alcohol-aversive or alcohol-sensitizing agent, causes an acutely toxic physical reaction when mixed with alcohol.

A. True B. False

21. Patient knowledge of a possible severe reaction to alcohol consumption is thought to increase the patient's motivation to remain abstinent.

A. True B. False

22. Disulfiram inhibits which enzyme, causing a rapid rise of acetaldehyde in the blood when alcohol is consumed?

A. Alcohol dehydrogenase B. Aldehyde dehydrogenase C. Dopamine beta-hydroxylase D. All of the above

23. The disulfiram-alcohol reaction usually begins about _____ minutes after alcohol is ingested.

A. 5 - 10 B. 10 - 30 C. 20 - 45 D. 30 - 60

24. Unconsciousness may occur due to the disulfiram-alcohol reaction when the blood alcohol concentrations are:

A. 5 to 10 mg/100 mL B. 50 mg/100 mL C. 125 to 150 mg/100 mL D. 250 mg/100 mL

25. Alcohol ingestion may produce unpleasant symptoms for up to _______ after a patient has taken the last dose of disulfiram due to the time required for the body to synthesize sufficient unbound enzyme to metabolize alcohol adequately, as disulfiram irreversibly binds to the enzyme.

A. 3 days B. 7 days C. 2 weeks D. 4 weeks

26. Patients with severely impaired judgement or who are highly impulsive from a severe mental illness or cognitive impairment may be inappropriate candidates for treatment with disulfiram.

A. True B. False

27. Patients receiving disulfiram should be monitored for:

A. Hepatotoxicity B. Suicidal ideation C. Impaired renal function D. All of the above

28. Disulfiram should never be administered to a patient who is in a state of alcohol intoxication or without the patient's full knowledge.

A. True B. False

29. Disulfiram should not be administered until which of the following steps has been taken?

A. The patient has been educated about disulfiram and informed consent has been obtained. B. The patient has abstained from alcohol for at least 12 hours and/or breath or blood alcohol level is zero. C. A physical exam, baseline liver and kidney function tests, and a pregnancy test for women have been performed. D. All of the above.

30. Maximum dosage for disulfiram should never exceed:

A. 250 mg/day B. 350 mg/day C. 500 mg/day D. 800 mg/day

31. Nurses should instruct patients who miss a dose to take a double dose of disulfiram at their next dosing time.

A. True B. False

32. Severe and sometimes fatal hepatitis associated with disulfiram therapy may develop even after many months of therapy.

A. True B. False

33. Pregnant women should discontinue taking disulfiram immediately.

A. True B. False

34. Patients should not use disulfiram until which of the following is out of their system?

A. Metronidazole or paraldehyde B. Alcohol or alcohol-containing preparations C. Ethylene dibromide or its vapors D. All of the above

35. Symptoms of disulfiram overdose include:

A. Drowsiness followed by coma. B. Persistent nausea and/or vomiting. C. Ascending flaccid paralysis that can reach the cranial nerves. D. All of the above.

36. Treatment for disulfiram overdose consists of all of the following, except for:

A. Large intravenous doses of vitamin C B. Administration of oxygen therapy C. 5% intravenous glucose administration D. 1 gram intravenous sodium ascorbate administration

37. Patients seemingly on an adequate maintenance dosage of disulfiram who report that they can drink with impunity could be disposing of their tablets without taking them.

A. True B. False

38. Individuals with high intrinsic ALDH activity are more likely to exhibit high sensitivity to disulfiram, and those with low intrinsic ALDH are more likely to show little or no sensitivity to disulfiram.

A. True B. False

39. Nurses should education patients about which of the following key points regarding disulfiram therapy?

A. What to expect from disulfiram and normal time to full effect. B. Strong cautions about surreptitious drinking while on disulfiram. C. Warnings about using alcohol in disguised forms, such as in sauces, vinegars, cough mixtures, aftershave lotions, or liniments. D. All of the above.

40. Disulfiram and metronidazole should not be prescribed concomitantly.

A. True B. False

41. Which of the following types of patients is appropriate for treatment with disulfiram?

A. Patients motivated for treatment and committed to total abstinence. B. Patients capable of understanding the consequences of drinking alcohol while taking disulfiram. C. Patients who are codependent on or also abuse cocaine. D. All of the above.

Oral Naltrexone

42. Naltrexone reduces both the rewarding effects of alcohol and cravings for it.

A. True B. False

43. Peak naltrexone plasma concentrations are reached within _______ of dosing.

A. 20 minutes B. 1 hour C. 4 hours D. 12 hours

44. Patients must be fully withdrawn from all opioids before considering therapy with naltrexone.

A. True B. False

45. Naltrexone should be used cautiously in patients whose serum aminotransferase results are greater than two times the upper limit of normal.

A. True B. False

46. Patients should be educated about which of the following?

A. Administering opioids to overcome naltrexone's blockade of the opiate receptors increases the risk of overdose, respiratory arrest, coma, and death. B. After taking naltrexone for some time and then stopping it, patients may be more sensitive to lower doses of opioids and thus risk overdose if they take opioids. C. Patients should continue to take naltrexone if they slip and return to drinking because it may help limit the severity of relapse. D. All of the above.

47. Which of the following is a good candidate for treatment with naltrexone?

A. Patients with a history of opioid abuse/dependence who are seeking treatment for AUDs. B. Patients who are using opioids. C. Patients being maintained on opioid replacement therapy. D. Patients anticipating surgery or dental work that will require opioid analgesics.

48. Naltrexone also blocks:

A. Aspirin B. NSAIDs C. Lidocaine D. None of the above

49. Patients with less physical distress may have better outcomes when treated with naltrexone compared to patients with more somatic complaints.

A. True B. False

50. Because of naltrexone's efficacy in reducing the rewarding effects of alcohol consumption and reducing cravings for alcohol, patients who achieve abstinence may benefit from taking naltrexone at times when they are at higher risk of relapse, such as:

A. On vacations B. During holidays C. During personal tragedy D. All of the above

Extended-Release Injectable Naltrexone

51. Because injectable naltrexone is giving all at one, compared to oral naltrexone which is taken daily, the peak concentration of the drug to which the liver is exposed to is substantially higher for injectable naltrexone than for oral naltrexone.

A. True B. False

52. Patients being maintained on buprenorphine (Suboxone or Subutex) or methadone for the treatment of opioid dependence cannot undergo treatment with naltrexone.

A. True B. False

53. Injectable naltrexone should be administered only by a medical professional who can administer IM (gluteal) injections.

A. True B. False

54. Nurses should instruct patients to seek immediate medical attention if skin at the injection site becomes painful, red, and swollen and does not improve within 1 week after the injection.

A. True B. False

55. Patients discontinuing injectable naltrexone should be reminded that they should not take any opioid medication for at least _____ days from the date of their last injection.

A. 7 B. 14 C. 30 D. 60

Patient Management

56. At the very least, a patient being considered for pharmacologic treatment for alcohol dependence should have:

A. A physical exam B. Psychiatric status assessed C. Motivation for change assessed D. All of the above

57. An increase in which of the following biomarkers over time may suggest an increase in alcohol consumption?

A. Carbohydrate-deficient transferin B. Aspartate aminotransferase C. Gamma glutamyltransferase D. Ethyl glucuronide

58. Alcohol overuse causes anemia and has direct toxic effects on bone marrow.

A. True B. False

59. Which of the following are common deficiencies in people with chronic AUDs and contribute to abnormal cell growth?

A. Thiamine B. Folic acid C. Pyridoxine D. All of the above

60. Which of the following should not be used unless the patient's goal is complete abstinence?

A. Naltrexone B. Acamprosate C. Disulfiram D. All of the above


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