NR546 Week 6 test your knowledge quiz
Questions and Complete Solutions
Graded A+
Addiction is often driven by the client's attempts to: - Answer: self-medicate an underlying mental
health disorder
adverse effects associated with the acute use of opioids: - Answer: -Itching
-Constipation
-Respiratory depression
-Urinary retention
-Sedation
Opioid medication: Morphine - Answer: -Prototype opioid agonist
-indicated for acute pain
-binds to opioid receptors in the CNS, inhibiting ascending pain pathways, altering the perception &
response to pain
-also produces CNS depression and potentially respiratory depression
*may be life-threatening, especially if utilized with benzodiazepines, CNS depressants, or alcohol
onset of action:
-immediate release formulation is patient-dependent, with variable absorption.
-IV is 5-10 minutes, with a duration 3-5 hours.
-Also available in controlled release formulation (MS Contin) and extended-release morphine (Avinza).
Opioid medication: Fentanyl - Answer: -has an almost immediate onset of action when given IV, with a
duration of 0.5-1 hour
-More potent than morphine, but short duration of action
,-the preferred opioid for those unable to tolerate morphine or hydromorphone and in those with severe
hepatic and renal disease
-same indications as morphine and is also used frequently in procedural sedation and general anesthesia
-Conversion between fentanyl products is NOT mcg for mcg
Opioid medication: Hydromorphone - Answer: -Similar opioid agonist as morphine but more potent
-Oral and parenteral doses are not equivalent (parenteral doses up to 5 times more potent)
Opioid medication: Meperidine - Answer: -No longer recommended as an analgesic, and not widely
available.
-Has numerous concerning adverse effects such as seizures and delirium.
Opioid medication: Methadone - Answer: -Utilized in detoxification and maintenance treatment of
opioid addiction and heroin addiction, with high variability among patients
-long acting opioid that binds to and occupies mu-opioid receptors, reducing craving for opioids and
prevents withdrawal symptoms for 24 hours
-potential for abuse, only licensed opioid treatment programs or licensed inpatient hospital units
permitted to order and dispense this medication
-potential for life threatening respiratory depression and QT prolongation
-Equianalgesic conversion ratios between methadone and other opioids are individually variable, with
deaths occurring during conversion from chronic high dose opiate history or opioid abuse to methadone
-Discontinuation requires a wean to avoid withdrawal
-pregnant, a risk benefit ratio is necessary as fetal outcomes are improved as compared to illicit drug
use, however can have decreased birth weight, length, head circumference and fetal growth
Opioid medication: Ketamine - Answer: -Medication useful in general anesthesia and procedural
sedation
-off label usage as infusions for acute pain, as both a stand-alone treatment, as an adjunctive option
with opioids, as well as an intranasal formulation.
Opioid medication: Tramadol - Answer: -Opioid agonist, with similar indications and side effect profile as
other opioids, but that also blocks reuptake of serotonin and norepinephrine.
, -Indicated for acute pain management, with added benefit for patients with neuropathic pain and
nociceptive pain.
-Has a lower risk of constipation and dependence than other opioids, but does have risk of serotonin
syndrome.
Opioid medication: Naloxone - Answer: -pure antagonist, with clinical indication for treatment of acute
opioid overdose.
-IV naloxone can dramatically reverse opioids, even in comatose states
-recent widespread community availability of intramuscular and intranasal administration options
available given the prescription and recreational opiate crisis, and related deaths. -Given the short
duration of action, patients can relapse into coma or previous overdose state, and may need continued
monitoring and potentially further doses or constant infusion.
Opioid medication: Clonidine - Answer: -antihypertensive agent, and Alpha2-Adrenergic Agonist
-off-label adjunctive treatment for medically supervised opioid withdrawal.
-Initial treatment is 0.1mg-0.2mg, with ability to repeat up to 4 doses until symptoms resolve, while
assuring stability of blood pressure and heart rate.
-Maintenance would be determined by severity of symptoms, with treatment every 6-8 hours.
-Thought to produce analgesia at presynaptic and post junction alpha-2 adrenoceptors in the spinal
cord, with pain transmission to the brain prevented.
Substance use disorder occurs when: - Answer: The recurrent use of a substance, such as alcohol or
drugs, causes clinically significant impairment, including health problems, disability, or failure to meet
responsibilities at home, work, or school.
Dual Diagnosis and Substance Use Disorders - Answer: Dual diagnoses are common in addiction
medicine
-up to 60% of adolescents in community-based substance use disorder treatment programs may meet
the diagnostic criteria for another mental health condition
-Clients may self-medicate to treat distressing symptoms of other conditions
-Common comorbidities include:
• anxiety disorders
• depression
Questions and Complete Solutions
Graded A+
Addiction is often driven by the client's attempts to: - Answer: self-medicate an underlying mental
health disorder
adverse effects associated with the acute use of opioids: - Answer: -Itching
-Constipation
-Respiratory depression
-Urinary retention
-Sedation
Opioid medication: Morphine - Answer: -Prototype opioid agonist
-indicated for acute pain
-binds to opioid receptors in the CNS, inhibiting ascending pain pathways, altering the perception &
response to pain
-also produces CNS depression and potentially respiratory depression
*may be life-threatening, especially if utilized with benzodiazepines, CNS depressants, or alcohol
onset of action:
-immediate release formulation is patient-dependent, with variable absorption.
-IV is 5-10 minutes, with a duration 3-5 hours.
-Also available in controlled release formulation (MS Contin) and extended-release morphine (Avinza).
Opioid medication: Fentanyl - Answer: -has an almost immediate onset of action when given IV, with a
duration of 0.5-1 hour
-More potent than morphine, but short duration of action
,-the preferred opioid for those unable to tolerate morphine or hydromorphone and in those with severe
hepatic and renal disease
-same indications as morphine and is also used frequently in procedural sedation and general anesthesia
-Conversion between fentanyl products is NOT mcg for mcg
Opioid medication: Hydromorphone - Answer: -Similar opioid agonist as morphine but more potent
-Oral and parenteral doses are not equivalent (parenteral doses up to 5 times more potent)
Opioid medication: Meperidine - Answer: -No longer recommended as an analgesic, and not widely
available.
-Has numerous concerning adverse effects such as seizures and delirium.
Opioid medication: Methadone - Answer: -Utilized in detoxification and maintenance treatment of
opioid addiction and heroin addiction, with high variability among patients
-long acting opioid that binds to and occupies mu-opioid receptors, reducing craving for opioids and
prevents withdrawal symptoms for 24 hours
-potential for abuse, only licensed opioid treatment programs or licensed inpatient hospital units
permitted to order and dispense this medication
-potential for life threatening respiratory depression and QT prolongation
-Equianalgesic conversion ratios between methadone and other opioids are individually variable, with
deaths occurring during conversion from chronic high dose opiate history or opioid abuse to methadone
-Discontinuation requires a wean to avoid withdrawal
-pregnant, a risk benefit ratio is necessary as fetal outcomes are improved as compared to illicit drug
use, however can have decreased birth weight, length, head circumference and fetal growth
Opioid medication: Ketamine - Answer: -Medication useful in general anesthesia and procedural
sedation
-off label usage as infusions for acute pain, as both a stand-alone treatment, as an adjunctive option
with opioids, as well as an intranasal formulation.
Opioid medication: Tramadol - Answer: -Opioid agonist, with similar indications and side effect profile as
other opioids, but that also blocks reuptake of serotonin and norepinephrine.
, -Indicated for acute pain management, with added benefit for patients with neuropathic pain and
nociceptive pain.
-Has a lower risk of constipation and dependence than other opioids, but does have risk of serotonin
syndrome.
Opioid medication: Naloxone - Answer: -pure antagonist, with clinical indication for treatment of acute
opioid overdose.
-IV naloxone can dramatically reverse opioids, even in comatose states
-recent widespread community availability of intramuscular and intranasal administration options
available given the prescription and recreational opiate crisis, and related deaths. -Given the short
duration of action, patients can relapse into coma or previous overdose state, and may need continued
monitoring and potentially further doses or constant infusion.
Opioid medication: Clonidine - Answer: -antihypertensive agent, and Alpha2-Adrenergic Agonist
-off-label adjunctive treatment for medically supervised opioid withdrawal.
-Initial treatment is 0.1mg-0.2mg, with ability to repeat up to 4 doses until symptoms resolve, while
assuring stability of blood pressure and heart rate.
-Maintenance would be determined by severity of symptoms, with treatment every 6-8 hours.
-Thought to produce analgesia at presynaptic and post junction alpha-2 adrenoceptors in the spinal
cord, with pain transmission to the brain prevented.
Substance use disorder occurs when: - Answer: The recurrent use of a substance, such as alcohol or
drugs, causes clinically significant impairment, including health problems, disability, or failure to meet
responsibilities at home, work, or school.
Dual Diagnosis and Substance Use Disorders - Answer: Dual diagnoses are common in addiction
medicine
-up to 60% of adolescents in community-based substance use disorder treatment programs may meet
the diagnostic criteria for another mental health condition
-Clients may self-medicate to treat distressing symptoms of other conditions
-Common comorbidities include:
• anxiety disorders
• depression
