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Alcohol Pharmacotherapies

Introduction

1. From the patient's viewpoint, initiating treatment in a healthcare practitioner's office may be more acceptable than entering a specialty substance abuse treatment program.

A. True B. False

2. Which of the following contributes to substance dependence?

A. Genetics B. Personal choice C. Environmental factors D. All of the above

3. Decisions about care level, setting, and type of treatment should be based on:

A. Patient assessment B. Commitment to change C. Treatment availability D. All of the above

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

A. True B. False

5. Long-lasting neuroadaptations can be caused by chronic heavy drinking and when related to symptoms of withdrawal and persistent craving may trigger relapse even after prolonged abstinence.

A. True B. False

6. Long-term, indefinite, use of medication for patient stabilization is not reasonable.

A. True B. False

Acamprosate

7. A lower than typical dose of acamprosate may be effective with some patients and must be used with those with:

A. Impaired renal function B. Liver disease C. Diabetes D. All of the above

8. In which of the following forms can acamprosate pills be taken?

A. Crushed B. Broken C. Swallowed whole D. Any of the above

9. It is thought that acamprosate helps modulate and normalize alcohol-related changes in brain activity, thereby reducing symptoms of postacute withdrawal, such as disturbances in sleep and mood, that may trigger a relapse to drinking.

A. True B. False

10. Evidence indicates that acamprosate interacts with the _____ neurotransmitter system.

A. Dopamine B. Glutamate C. Acetylcholine D. Serotonin

11. It is hypothesized that the normalization of the neurotransmitter system leads to a reduction of all of the following common symptoms of postacute withdrawal that may contribute to a patient's return to alcohol use, except for:

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

12. The bioavailability of acamprosate after oral administration is almost 100%.

A. True B. False

13. Stable plasma concentration is reached within _____ days of taking the medication.

A. 5 B. 12 C. 21 D. 30

14. All of the following are true with regard to acamprosate's safety, except for:

A. It carries virtually no overdose risk, even at overdoses up to 56 grams. B. Most side effects are mild and transient, lessening or disappearing within the first few weeks of treatment. C. Patients maintained on acamprosate develop tolerance for and dependence on it, and it does have some potential for abuse. D. Although there is a pharmacokinetic interaction by which acamprosate can increase naltrexone blood levels, there are no other clinically significant interactions between acamprosate and other medications.

15. The most common side effect of acamprosate is:

A. Perfuse sweating B. Vomiting C. Diarrhea D. All of the above

16. Patients should be instructed not to discontinue acamprosate if they experience side effects and to inform their prescribing professional.

A. True B. False

17. Acamprosate does not affect endogenous or exogenous opioids, so it may be particularly appropriate for patients who are:

A. Receiving opioid maintenance therapy. B. At risk of relapsing to opioid use. C. Undergoing treatment with opioids for pain. D. All of the above.

18. How many times per day must acamprosate be taken?

A. 1 B. 2 C. 3 D. 4

19. Discontinuation of acamprosate may be considered under all of the following circumstances, except for:

A. The patient returns to alcohol use. B. The patient is not adhering to the medication regimen. C. The patient has achieved stable abstinence from alcohol, reports diminished cravings, and has established a sound plan and support for ongoing recovery. D. Discontinuation of acamprosate should be considered for all of the above circumstances.

Disulfiram

20. Disulfiram affects which of the following directly?

A. Brain opiate receptors B. Gamma-aminobutyric acid receptors C. Glutamate receptors D. None of the above

21. Disulfiram directly decreases the urge to drink.

A. True B. False

22. Disulfiram does which of the following?

A. It inhibits alcohol dehydrogenase. B. It inhibits aldehyde dehydrogenase. C. It speeds the rate of alcohol elimination from the body. D. All of the above.

23. Disulfiram is irreversibly bound to ALDH and can take up to _____ for the body to synthesize sufficient unbound enzyme to metabolize alcohol adequately.

A. 4 days B. 2 weeks C. 4 weeks D. 2 months

24. Disulfiram may work as an adjust to psychosocial treatment to eliminate alcohol consumption for all of the following patients, except for:

A. Those who can achieve initial abstinence of at least 24 hours. B. Those who are committed to maintaining abstinence. C. Those who agree to take the medication. D. Those who do not have contraindications to disulfiram.

25. Most experts agree that an optimum disulfiram response requires its use in a specialty substance abuse treatment program.

A. True B. False

26. Disulfiram dosage should never exceed:

A. 750 mg/day B. 500 mg/day C. 250 mg/day D. 125 mg/day

27. All of the following are symptoms of disulfiram-induced hepatic impairment, except for:

A. Vomiting B. Fever C. Metallic or garlic-like aftertaste D. Dark urine

28. Use of disulfiram should include:

A. Ongoing monitoring B. Medical management C. Counseling D. All of the above

29. Patients who are codependent on or also abuse cocaine are not appropriate patients for treatment with disulfiram?

A. True B. False

30. Prolonged disulfiram administration produces a tolerance.

A. True B. False

Oral Naltrexone

31. Naltrexone reduces:

A. The rewarding effects of alcohol. B. The craving for alcohol. C. Both (A) and (B). D. None of the above.

32. The rewarding effects of alcohol are mediated at least partly through the opiate system.

A. True B. False

33. Peak naltrexone plasma concentrations are reached within _____ of dosing.

A. 4 hours B. 1 hour C. 30 minutes D. 10 minutes

34. Healthcare providers must ensure that patients have been fully withdrawn from all opioids before considering therapy with naltrexone.

A. True B. False

35. What is currently the FDA recommended daily dose of naltrexone for treating AUDs?

A. 50 mg B. 100 mg C. 150 mg D. 250 mg

36. Women may be particularly susceptible to _____, one of the most frequently reported side effects, which supports the use of risk-minimizing strategies.

A. Nausea B. Headache C. Anxiety D. Fatigue

37. The consensus panel recommends which of the following liver function tests be performed before naltrexone treatment begins and at intervals thereafter?

A. ALT B. Gamma glutamyltransferase C. Bilirubin D. All of the above

38. Patients should continue to take naltrexone if they slip and return to drinking because it may help limit the severity of relapse.

A. True B. False

39. Naltrexone blocks the effects of:

A. Aspirin, acetaminophen, and NSAIDs B. Lidocaine C. Opioids D. All of the above

40. Which of the following may experience greater medication benefit from naltrexone?

A. Patients with intense alcohol cravings during treatment. B. Patients with more somatic complaints. C. Patients with a family history of alcohol dependence. D. All of the above.

Extended-Release Injectable Naltrexone

41. Extended-release injectable naltrexone is administered by intramuscular gluteal injection:

A. Once a week B. Every two weeks C. Once a month D. Every two months

42. The extended-release injectable form helps address patient noncompliance, which can limit the effectiveness of oral naltrexone.

A. True B. False

43. Because of its lack of first-pass metabolism, injectable naltrexone significantly reduces liver exposure to the drug, reducing the risk of potential liver toxicity.

A. True B. False

44. Treatment with injectable naltrexone should not be initiated unless the patient is opioid free for:

A. 30 days B. 7 to 10 days C. 48 hours D. 24 hours

45. Patients should be instructed to seek immediate medical attention if:

A. Skin at the injection site becomes painful, red, and swollen and does not improve within 1 week after the injection. B. A small lump at the injection site occurs. C. There is pain and tenderness at the injection site. D. All of the above.

46. For optimal results with injectable naltrexone, candidates for treatment should meet which of the following criteria?

A. They should not be using opioids currently or have evidence of recent use. B. They should not be anticipating surgery or have a condition, such as chronic pain, for which opioid analgesics may be required in the future. C. They should be willing to participate in psychosocial substance abuse treatment such as counseling and support groups. D. All of the above.

47. Patients discontinuing injectable naltrexone should be reminded that they should not take any opioid medications for at least 7 days from the date of their last injection.

A. True B. False

Patient Management

48. Which of the following can be incited or exacerbated by AUDs?

A. Hypertension B. Gastritis C. Depression D. All of the above

49. Excessive alcohol consumption increases the morbidity associated with, and can complicate medical treatment for, all of the following conditions, except for:

A. HIV B. Cardiopulmonary disease C. Viral hepatidies D. All of the above

50. Longstanding alcohol consumption may present with which "classic" physical exam feature?

A. Cirrhosis B. Encephalopathy C. Vitamin deficiencies D. All of the above

51. Blood alcohol levels and urine / breath tests for alcohol are useful measures of recent alcohol consumption and determine acute physical or legal incapacity to do specific tasks.

A. True B. False

52. An increase in _____ over time may suggest an increase in alcohol consumption.

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

53. The marker ethyl glucuronide has low sensitivity for alcohol and requires recent consumption of large quantities of alcohol to trigger a positive test result.

A. True B. False

54. Alcohol overuse results in all of the following, except for:

A. Anemia B. Toxic effects on bone marrow C. Microcytosis D. Elevated mean corpuscular volume

55. All of the following vitamin deficiencies are common in people with chronic AUDs and contribute to abnormal cell growth, except for:

A. Niacin B. Thiamine C. Folic acid D. Pyridoxine

56. Which of the following should be used with caution in patients with liver disease and also in patients with renal impairment?

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

57. All four medications used to treat AUDs are U.S. Food and Drug Administration pregnancy category C, therefore, women of childbearing age should receive a pregnancy test before pharmacotherapy is initiated.

A. True B. False

58. During the assessment, healthcare providers should assess the:

A. Quantity and frequency of alcohol consumption B. Patterns of alcohol consumption C. Consequences of alcohol consumption D. All of the above

59. Before offering treatment for alcohol dependence, healthcare providers should:

A. Assess patients' readiness to change drinking behavior. B. Order a psychiatric assessment. C. Test for vitamin deficiencies. D. Do a complete blood count.

60. If the relationship between the patient and their healthcare provider is strained by dishonesty or mistrust, initial willingness to take medication and ongoing compliance with a medication regimen may suffer.

A. True B. False

61. Literature suggests that although psychosocial interventions increase rates of abstinence and decrease alcohol consumption, a significant proportion of patients relapse to drinking within:

A. 5 years B. 2 years C. 1 year D. 6 months

62. In addition to considering the characteristics that research has indicated may be relevant to choosing a medication, healthcare providers need to consider the patient's:

A. Past experience with particular maintenance medications. B. Opinion about which medication may be most helpful. C. Level of motivation for abstinence. D. All of the above.

63. Which of the following is contraindicated for use in patients with cognitive impairment?

A. Acamprosate B. Disulfiram C. Oral Naltrexone D. Injectable Naltrexone

64. Acamprosate should not be used unless the patient's goal is complete abstinence, a goal not necessary when treating with naltrexone or disulfiram.

A. True B. False

65. Any pharmacologic treatment for alcohol dependence should be used as an adjunct to, not a replacement for, psychosocial treatment.

A. True B. False

66. All of the following are more conducive to primary care settings, except for:

A. Brief interventions B. Group therapy C. Motivational enhancement therapy D. Medical management

67. The mutual-help organization, Alcoholics Anonymous, has a 'no medication use' policy, as they see that it is substituting one addition for another.

A. True B. False

68. Which of the following is a clinical outcome to assess progress?

A. The length of time to first drink. B. Time to heavy drinking. C. Cumulative abstinence days. D. All of the above.

69. All of the following conditions warrant advising a patient to abstain from, rather than reduce, drinking, except for:

A. Advanced age. B. Are or may become pregnant. C. Have a medical or psychiatric disorder caused or exacerbated by drinking. D. Have an AUD.

70. Which of the following is a way for a healthcare provider to monitor a patient's compliance with their treatment plan?

A. Tracking the patient's record of keeping, or not keeping, appointments for medication monitoring. B. Monitoring prescription refills. C. Noting whether the patient is keeping agreements about payment for treatment. D. Any of the above.

71. More important than the method of monitoring is consistency in how the patient is asked about craving patterns and trends.

A. True B. False

72. Which of the following is an acceptable reason for the patient and healthcare provider to consider discontinuing medication?

A. The patient reports substantially diminished craving. B. The patient feels ready to discontinue the medication. C. The patient is engaged in ongoing recovery, including community supports. D. All of the above.


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