NR 546 FULL EXAM STUDY GUIDE QUESTIONS WITH
COMPLETE SOLUTIONS
MAT for Chronic Alcohol Use Disorder -- Answer ✔✔ Medication selections for MAT
should be 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
Naltrexone (Revia, Vivitrol): -- Answer ✔✔ Initial treatment for alcohol use disorder
-Start while still drinking
-Can treat concurrent opioid use disorder
-Contraindicated in liver disease
-May be given in monthly long-acting injections (Vivitrol)
Acamprosate (Campral) -- Answer ✔✔ · Modulates glutamine transmission, and
resembles gamma-aminobutyric acid (GABA)
· Good option for clients who must take opioids for chronic pain
· Treats withdrawal symptoms
· Abstain prior to beginning treatment
No affect on Opioids
Disulfiram (Antabuse): -- Answer ✔✔ -Blocks oxidation of alcohol
-Creates unpleasant symptoms when the client drinks while taking medication
-Palpitations
-Headache
-Nausea/vomiting
-Flushing
·-Abstain from alcohol for at least 12 hours prior to treatment to avoid a reaction
-a disulfiram reaction can occur for up to 14 days after alcohol is consumed
,Topiramate (Topamax) -- Answer ✔✔ · An anticonvulsant that blocks sodium channels
and enhances GABA-A
· Reduces cravings for alcohol
Chlorpromazine (Librium) -- Answer ✔✔ · Benzodiazepine for acute and chronic
alcohol use
· Can cause benzodiazepine (BZO) withdrawal symptoms when stopped abruptly
· Avoid in older adults
Alcohol Withdrawal- Mild -- Answer ✔✔ Mild
· Anxiety
· Irritability
· Headache
· Insomnia
· Tremors
· Nausea/vomiting
Alcohol Withdrawal-Moderate -- Answer ✔✔ Moderate
· Increased blood pressure (BP)
· Increased heart rate (HR)
· Confusion
· Mild hyperthermia
· Rapid breathing
Alcohol Withdrawal- Severe -- Answer ✔✔ Severe
· Hallucinations
· Seizures
· Disorientation
· Impaired attention
· Delirium tremens
· Death
Alcohol Withdrawal Moderate to Severe -- Answer ✔✔ The use of pharmacologic
interventions should be considered for individuals with withdrawal symptoms due to the
risk of increased morbidity and mortality during withdrawal.
,Alcohol Withdrawal Symptom-Triggered Regimen -- Answer ✔✔ · Administer
benzodiazepine when CIWA-Ar score is 8 or above.
· PO lorazepam (Ativan), diazepam (Valium), or chlordiazepoxide (Librium) for
symptom-triggered therapy
· Reassess CIWA-Ar every hour.
Administer CIWA-Ar
· every 4-8 hours until score is lower than 8-10 for 24 hours
You are discharging this client from the hospital following admission for alcohol
withdrawal syndrome. He has no further withdrawal symptoms and he would like to
abstain from alcohol use. He informs you that has abused opioids in the past, but he has
not used them in the last several months. He is concerned that he is at risk of abusing
opioids again. Which of the following is the best pharmaceutical option for this client? --
Answer ✔✔ -naltrexone (ReVia) common initial treatment for alcohol use disorder.
-Can be initiated while the client is still drinking.
-Can also be utilized in those with opioid use disorder, as the drug can treat both
conditions
should be opioid-free for at least 7-10 days to avoid withdrawal
Alcohol Treatment in Pregnancy -- Answer ✔✔ · Teratogenic effects of alcohol on the
developing fetus are well known; however, there is limited data on the safety of
withdrawal medications in pregnancy.
· Naltrexone is commonly used to treat alcohol use disorder in pregnant women, but its
effects on the fetus remain largely unknown.
· Acamprosate is not recommended in pregnancy but may be necessary if the mother
cannot stop drinking alcohol.
Disulfiram's safety in pregnancy is not established
Alcohol treatment for Older Adult -- Answer ✔✔ · Frequent monitoring is necessary
when prescribing benzodiazepines for alcohol withdrawal in older adults. Acamprosate
should be used with caution in older adults.
Nicotine Replacement Therapy -- Answer ✔✔ · Gradual, controlled reduction of
nicotine to avoid withdrawal symptoms
· bupropion (Zyban)
, -Tobacco-free by 7 to 12 weeks of therapy
· varenicline (Chantix)
-Tobacco-free by 12 weeks
Nicotine Replacement Therapy -- Answer ✔✔ · Use for clients who smoke more than
20 cigarettes per day
· Over-the-counter (OTC) drugs
-Gum: Nicorette
-Patch: Nicotrol, Nicoderm, Habitrol
-Lozenge: Commit
· Prescription drugs
-Nasal spray: Nicotrol NS
-Inhaler: Nicotrol
Nicotine Replacement in Pregnancy -- Answer ✔✔ Gum is pregnancy category C
Transdermal patch is pregnancy category D
Nicotine Replacement Contraindicated -- Answer ✔✔ Immediately after a myocardial
infarction
Immediately after a stroke
Nicotine Gum -- Answer ✔✔ · Improves cessation success
· Buccal absorption
· Client needs to follow directions or nicotine will release too quickly, increasing
adverse drug reactions (ADRs)
· Dosing: For people who smoke within 30 minutes of awakening: the 4 mg dose is
recommended; For people who wait more than 30 minutes after awakening to smoke:
the 2 mg dose is recommended
· Client weans dose after 2 to 3 months of abstinence
Nicotine Lozenge -- Answer ✔✔ · Lozenge slowly dissolves in mouth
· Advise not to chew lozenge
· Dose: 1 lozenge every 1 to 2 hours
· Use 4 mg if client smokes within 30 minutes of waking
· Client should not eat or drink while lozenge is in mouth
· Wean after 6 weeks of abstinence
COMPLETE SOLUTIONS
MAT for Chronic Alcohol Use Disorder -- Answer ✔✔ Medication selections for MAT
should be 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
Naltrexone (Revia, Vivitrol): -- Answer ✔✔ Initial treatment for alcohol use disorder
-Start while still drinking
-Can treat concurrent opioid use disorder
-Contraindicated in liver disease
-May be given in monthly long-acting injections (Vivitrol)
Acamprosate (Campral) -- Answer ✔✔ · Modulates glutamine transmission, and
resembles gamma-aminobutyric acid (GABA)
· Good option for clients who must take opioids for chronic pain
· Treats withdrawal symptoms
· Abstain prior to beginning treatment
No affect on Opioids
Disulfiram (Antabuse): -- Answer ✔✔ -Blocks oxidation of alcohol
-Creates unpleasant symptoms when the client drinks while taking medication
-Palpitations
-Headache
-Nausea/vomiting
-Flushing
·-Abstain from alcohol for at least 12 hours prior to treatment to avoid a reaction
-a disulfiram reaction can occur for up to 14 days after alcohol is consumed
,Topiramate (Topamax) -- Answer ✔✔ · An anticonvulsant that blocks sodium channels
and enhances GABA-A
· Reduces cravings for alcohol
Chlorpromazine (Librium) -- Answer ✔✔ · Benzodiazepine for acute and chronic
alcohol use
· Can cause benzodiazepine (BZO) withdrawal symptoms when stopped abruptly
· Avoid in older adults
Alcohol Withdrawal- Mild -- Answer ✔✔ Mild
· Anxiety
· Irritability
· Headache
· Insomnia
· Tremors
· Nausea/vomiting
Alcohol Withdrawal-Moderate -- Answer ✔✔ Moderate
· Increased blood pressure (BP)
· Increased heart rate (HR)
· Confusion
· Mild hyperthermia
· Rapid breathing
Alcohol Withdrawal- Severe -- Answer ✔✔ Severe
· Hallucinations
· Seizures
· Disorientation
· Impaired attention
· Delirium tremens
· Death
Alcohol Withdrawal Moderate to Severe -- Answer ✔✔ The use of pharmacologic
interventions should be considered for individuals with withdrawal symptoms due to the
risk of increased morbidity and mortality during withdrawal.
,Alcohol Withdrawal Symptom-Triggered Regimen -- Answer ✔✔ · Administer
benzodiazepine when CIWA-Ar score is 8 or above.
· PO lorazepam (Ativan), diazepam (Valium), or chlordiazepoxide (Librium) for
symptom-triggered therapy
· Reassess CIWA-Ar every hour.
Administer CIWA-Ar
· every 4-8 hours until score is lower than 8-10 for 24 hours
You are discharging this client from the hospital following admission for alcohol
withdrawal syndrome. He has no further withdrawal symptoms and he would like to
abstain from alcohol use. He informs you that has abused opioids in the past, but he has
not used them in the last several months. He is concerned that he is at risk of abusing
opioids again. Which of the following is the best pharmaceutical option for this client? --
Answer ✔✔ -naltrexone (ReVia) common initial treatment for alcohol use disorder.
-Can be initiated while the client is still drinking.
-Can also be utilized in those with opioid use disorder, as the drug can treat both
conditions
should be opioid-free for at least 7-10 days to avoid withdrawal
Alcohol Treatment in Pregnancy -- Answer ✔✔ · Teratogenic effects of alcohol on the
developing fetus are well known; however, there is limited data on the safety of
withdrawal medications in pregnancy.
· Naltrexone is commonly used to treat alcohol use disorder in pregnant women, but its
effects on the fetus remain largely unknown.
· Acamprosate is not recommended in pregnancy but may be necessary if the mother
cannot stop drinking alcohol.
Disulfiram's safety in pregnancy is not established
Alcohol treatment for Older Adult -- Answer ✔✔ · Frequent monitoring is necessary
when prescribing benzodiazepines for alcohol withdrawal in older adults. Acamprosate
should be used with caution in older adults.
Nicotine Replacement Therapy -- Answer ✔✔ · Gradual, controlled reduction of
nicotine to avoid withdrawal symptoms
· bupropion (Zyban)
, -Tobacco-free by 7 to 12 weeks of therapy
· varenicline (Chantix)
-Tobacco-free by 12 weeks
Nicotine Replacement Therapy -- Answer ✔✔ · Use for clients who smoke more than
20 cigarettes per day
· Over-the-counter (OTC) drugs
-Gum: Nicorette
-Patch: Nicotrol, Nicoderm, Habitrol
-Lozenge: Commit
· Prescription drugs
-Nasal spray: Nicotrol NS
-Inhaler: Nicotrol
Nicotine Replacement in Pregnancy -- Answer ✔✔ Gum is pregnancy category C
Transdermal patch is pregnancy category D
Nicotine Replacement Contraindicated -- Answer ✔✔ Immediately after a myocardial
infarction
Immediately after a stroke
Nicotine Gum -- Answer ✔✔ · Improves cessation success
· Buccal absorption
· Client needs to follow directions or nicotine will release too quickly, increasing
adverse drug reactions (ADRs)
· Dosing: For people who smoke within 30 minutes of awakening: the 4 mg dose is
recommended; For people who wait more than 30 minutes after awakening to smoke:
the 2 mg dose is recommended
· Client weans dose after 2 to 3 months of abstinence
Nicotine Lozenge -- Answer ✔✔ · Lozenge slowly dissolves in mouth
· Advise not to chew lozenge
· Dose: 1 lozenge every 1 to 2 hours
· Use 4 mg if client smokes within 30 minutes of waking
· Client should not eat or drink while lozenge is in mouth
· Wean after 6 weeks of abstinence
