A+ NR546 EXAM QUESTIONS AND ANSWERS LATEST UPDATE
match the appropriate MAT to the client: Miranda is a 20-year-old who is 18 weeks
pregnant and uses heroin. She wants to get clean "for her baby."
Buprenorphine
a partial opioid agonist which binds with a strong affinity to the mu-opioid receptor,
preventing exogenous opioids from binding at the receptor site, and preventing the
pleasurable effects of opioid consumption. While either methadone or buprenorphine
may be prescribed in pregnancy, buprenorphine does not require daily visits to an
opioid treatment program and requires less need for dosage adjustments during
pregnancy.
Opioid Overdose
significant risk with opioid abuse
-Fentanyl and carfentanyl are frequent impurities found in opioids sold on the street
• thousands of times more potent than morphine and account for many overdoses
across the country
-Naloxone (Narcan), an opioid antagonist, is the drug of choice for an emergency opioid
overdose
• given for a known overdose of opioids or when the ingested substance is unknown
• series of small doses is preferred over 1 large dose to lessen antagonist-precipitated
withdrawal symptoms
(Acute withdrawal symptoms present within 3 minutes of injection, peaking in 10-20
minutes, and subsiding in about an hour)
Acute withdrawal symptoms after narcan
nausea/vomiting
diarrhea
runny nose
sweating
tremor
irritability
muscle spasms
signs of opioid overdose:
,-inability to wake or respond to voice or touch
-slow or absent breathing
-pinpoint pupils
-blue lips
Special considerations when prescribing MAT for opioid use disorder: Pregnancy
-Buprenorphine is an acceptable treatment during pregnancy
• is an increased risk of a neonatal withdrawal syndrome in newborns.
-Suboxone (buprenorphine/naloxone) cannot be used in pregnancy.
-Naloxone increases risk of neonatal abstinence syndrome
• Pregnant clients must be switched to buprenorphine (Subutex) monotherapy.
-Methadone is approved in pregnancy for heroin-addicted women.
• Dosing requires adjustment.
-Short-term newborn withdrawal effects may be seen and may require neonatal
intensive care unit (NICU) admission for treatment.
Special considerations when prescribing MAT for opioid use disorder: Breast
Feeding
-Naltrexone and buprenorphine are not recommended for breastfeeding mothers.
-Methadone can be prescribed with special consideration given to feeding intervals
• breastfeed prior to or 2-6 hours after dose
Special considerations when prescribing MAT for opioid use disorder: Older adult
-Buprenorphine use in the elderly may lead to confusion and drowsiness.
-Methadone has a high potential for drug interactions, associated with QT prolongation.
-It is difficult to titrate in the elderly and has a risk for accumulation due to the long half-
life.
Alcohol Use Disorder
-may affect cardiovascular health and is associated with an increased risk of several
types of cancer (especially, liver and pancreatic)
-Other system morbidities: diabetes, gout, renal dysfunction, hematological
complications, osteoporosis, and dementia
-frequently associated with trauma and accidents
MAT for Chronic Alcohol Use Disorder
, Medication selections based on clinical presentation, history of alcohol use/abuse with
comorbid liver disease or renal impairment, concurrent opioid use disorder, and other
unique client characteristics.
Meds:
-naltrexone (Revia, Vivitrol)
-acamprosate (Campral)
-disulfiram (Antabuse)
-topiramate (Topamax)
-chlorpromazine (Librium)
MAT for Chronic Alcohol Use Disorder: naltrexone (Revia, Vivitrol)
INDICATION
-Alcohol dependence
-Blockade of effects of exogenously administered opioids (Revia)
-Prevention of relapse to opioid dependence (injection)
Initial treatment for alcohol use disorder
-Started while still drinking
-Can treat concurrent opioid use disorder
-Contraindicated in liver disease
-May be given in monthly long-acting injections (Vivitrol)
-Can begin working within a few days but maximum effects may not be seen for a few
weeks
PRIOR TESTS
-Urine screen for opioids and/or naloxone challenge test prior to initiating treatment for
opioid use (opioid free 7-10 days)
-None for use in tx alcohol dependence, although baseline liver function testing, usually
obtained anyway for managing alcohol dependence, may be useful
Side effects
match the appropriate MAT to the client: Miranda is a 20-year-old who is 18 weeks
pregnant and uses heroin. She wants to get clean "for her baby."
Buprenorphine
a partial opioid agonist which binds with a strong affinity to the mu-opioid receptor,
preventing exogenous opioids from binding at the receptor site, and preventing the
pleasurable effects of opioid consumption. While either methadone or buprenorphine
may be prescribed in pregnancy, buprenorphine does not require daily visits to an
opioid treatment program and requires less need for dosage adjustments during
pregnancy.
Opioid Overdose
significant risk with opioid abuse
-Fentanyl and carfentanyl are frequent impurities found in opioids sold on the street
• thousands of times more potent than morphine and account for many overdoses
across the country
-Naloxone (Narcan), an opioid antagonist, is the drug of choice for an emergency opioid
overdose
• given for a known overdose of opioids or when the ingested substance is unknown
• series of small doses is preferred over 1 large dose to lessen antagonist-precipitated
withdrawal symptoms
(Acute withdrawal symptoms present within 3 minutes of injection, peaking in 10-20
minutes, and subsiding in about an hour)
Acute withdrawal symptoms after narcan
nausea/vomiting
diarrhea
runny nose
sweating
tremor
irritability
muscle spasms
signs of opioid overdose:
,-inability to wake or respond to voice or touch
-slow or absent breathing
-pinpoint pupils
-blue lips
Special considerations when prescribing MAT for opioid use disorder: Pregnancy
-Buprenorphine is an acceptable treatment during pregnancy
• is an increased risk of a neonatal withdrawal syndrome in newborns.
-Suboxone (buprenorphine/naloxone) cannot be used in pregnancy.
-Naloxone increases risk of neonatal abstinence syndrome
• Pregnant clients must be switched to buprenorphine (Subutex) monotherapy.
-Methadone is approved in pregnancy for heroin-addicted women.
• Dosing requires adjustment.
-Short-term newborn withdrawal effects may be seen and may require neonatal
intensive care unit (NICU) admission for treatment.
Special considerations when prescribing MAT for opioid use disorder: Breast
Feeding
-Naltrexone and buprenorphine are not recommended for breastfeeding mothers.
-Methadone can be prescribed with special consideration given to feeding intervals
• breastfeed prior to or 2-6 hours after dose
Special considerations when prescribing MAT for opioid use disorder: Older adult
-Buprenorphine use in the elderly may lead to confusion and drowsiness.
-Methadone has a high potential for drug interactions, associated with QT prolongation.
-It is difficult to titrate in the elderly and has a risk for accumulation due to the long half-
life.
Alcohol Use Disorder
-may affect cardiovascular health and is associated with an increased risk of several
types of cancer (especially, liver and pancreatic)
-Other system morbidities: diabetes, gout, renal dysfunction, hematological
complications, osteoporosis, and dementia
-frequently associated with trauma and accidents
MAT for Chronic Alcohol Use Disorder
, Medication selections based on clinical presentation, history of alcohol use/abuse with
comorbid liver disease or renal impairment, concurrent opioid use disorder, and other
unique client characteristics.
Meds:
-naltrexone (Revia, Vivitrol)
-acamprosate (Campral)
-disulfiram (Antabuse)
-topiramate (Topamax)
-chlorpromazine (Librium)
MAT for Chronic Alcohol Use Disorder: naltrexone (Revia, Vivitrol)
INDICATION
-Alcohol dependence
-Blockade of effects of exogenously administered opioids (Revia)
-Prevention of relapse to opioid dependence (injection)
Initial treatment for alcohol use disorder
-Started while still drinking
-Can treat concurrent opioid use disorder
-Contraindicated in liver disease
-May be given in monthly long-acting injections (Vivitrol)
-Can begin working within a few days but maximum effects may not be seen for a few
weeks
PRIOR TESTS
-Urine screen for opioids and/or naloxone challenge test prior to initiating treatment for
opioid use (opioid free 7-10 days)
-None for use in tx alcohol dependence, although baseline liver function testing, usually
obtained anyway for managing alcohol dependence, may be useful
Side effects
