MCQ Quiz: Management of Substance Use Disorders

The management of Substance Use Disorders (SUDs) is a critical and evolving field within healthcare, demanding a compassionate, evidence-based, and patient-centered approach. For pharmacists, proficiency in this area is no longer optional; it is a core competency. The modern management of SUDs integrates pharmacotherapy, behavioral interventions, harm reduction strategies, and complex legal and ethical considerations. As detailed in the Patient Care VII curriculum, pharmacists must be skilled in everything from acute overdose reversal and withdrawal management to long-term maintenance therapy and patient counseling. This quiz will test your knowledge on the comprehensive management of common SUDs, including opioid, alcohol, and tobacco use disorders.

1. What is the first-line and most crucial intervention for a patient presenting with known opioid overdose and severe respiratory depression?

• a) Administering activated charcoal
• b) Providing intravenous fluids
• c) Administering naloxone
• d) Initiating buprenorphine therapy Answer: c) Administering naloxone

2. A key counseling point for a patient or caregiver receiving a naloxone kit, as covered in the Professional Practice Skills Lab, is that they should always do what after administering the first dose?

• a) Wait 30 minutes before doing anything else
• b) Call 911 for emergency medical services
• c) Administer a second dose immediately, regardless of response
• d) Check the patient’s blood pressure Answer: b) Call 911 for emergency medical services

3. Which medication for Opioid Use Disorder (OUD) is a partial mu-opioid agonist with a ceiling effect on respiratory depression?

• a) Methadone
• b) Naltrexone
• c) Buprenorphine
• d) Lofexidine Answer: c) Buprenorphine

4. The management of OUD with methadone must be initiated and dispensed through what type of facility?

• a) Any community pharmacy
• b) A hospital inpatient pharmacy only
• c) A federally licensed Opioid Treatment Program (OTP)
• d) A physician’s office Answer: c) A federally licensed Opioid Treatment Program (OTP)

5. Before initiating naltrexone for either OUD or Alcohol Use Disorder (AUD), it is critical to ensure the patient is free from which substances to avoid precipitated withdrawal?

• a) Benzodiazepines
• b) Opioids
• c) Nicotine
• d) Cannabis Answer: b) Opioids

6. The primary goal of using benzodiazepines in the management of acute alcohol withdrawal is to prevent:

• a) Cravings and relapse
• b) Seizures and delirium tremens
• c) The rewarding effects of alcohol
• d) Liver damage Answer: b) Seizures and delirium tremens

7. A patient with severe alcoholic liver disease requires treatment for alcohol withdrawal. Which benzodiazepine would be a preferred agent due to its simpler metabolic pathway?

• a) Diazepam
• b) Chlordiazepoxide
• c) Clorazepate
• d) Lorazepam Answer: d) Lorazepam

8. The “5 A’s” model is a brief intervention strategy taught for the management of what common substance use disorder?

• a) Opioid Use Disorder
• b) Alcohol Use Disorder
• c) Tobacco Use Disorder
• d) Benzodiazepine Use Disorder Answer: c) Tobacco Use Disorder

9. Varenicline is an effective medication for smoking cessation. Its management strategy is based on its mechanism as a:

• a) Full nicotinic receptor agonist
• b) Partial nicotinic receptor agonist
• c) Nicotine-metabolizing enzyme inhibitor
• d) Dopamine antagonist Answer: b) Partial nicotinic receptor agonist

10. What is a key management consideration for disulfiram therapy in AUD?

• a) It can be started while the patient is still drinking.
• b) It effectively reduces alcohol cravings.
• c) It has no significant drug interactions.
• d) Patient adherence and motivation are critical due to the risk of a severe aversive reaction with alcohol. Answer: d) Patient adherence and motivation are critical due to the risk of a severe aversive reaction with alcohol.

11. The Clinical Opiate Withdrawal Scale (COWS) is a management tool used to:

• a) Diagnose OUD
• b) Assess the severity of opioid withdrawal to guide treatment
• c) Screen for “red flags”
• d) Determine a patient’s risk of overdose Answer: b) Assess the severity of opioid withdrawal to guide treatment

12. The concept of harm reduction in the management of SUDs includes which of the following strategies?

• a) Increasing legal penalties for substance use
• b) Providing naloxone kits and promoting access to sterile syringes
• c) Mandating abstinence for all patients
• d) Focusing only on punishment Answer: b) Providing naloxone kits and promoting access to sterile syringes

13. A patient must be in a state of mild-to-moderate withdrawal before starting buprenorphine to avoid:

• a) A hypertensive crisis
• b) Serotonin syndrome
• c) Precipitated withdrawal
• d) An anaphylactic reaction Answer: c) Precipitated withdrawal

14. Which medication for AUD is thought to work by modulating glutamate neurotransmission and is a good option for patients with liver impairment?

• a) Naltrexone
• b) Disulfiram
• c) Acamprosate
• d) Diazepam Answer: c) Acamprosate

15. In the management of a toxicology emergency, activated charcoal is used for:

• a) Enhancing renal elimination of a toxin
• b) Correcting metabolic acidosis
• c) Gastrointestinal decontamination by adsorbing ingested toxins
• d) Directly reversing the effects of an opioid Answer: c) Gastrointestinal decontamination by adsorbing ingested toxins

16. A pharmacist’s “corresponding responsibility” is a legal and ethical principle that is particularly relevant to the management of patients receiving:

• a) Over-the-counter vitamins
• b) Vaccinations
• c) Controlled substance prescriptions
• d) Herbal supplements Answer: c) Controlled substance prescriptions

17. Thiamine supplementation is a standard part of managing patients with chronic heavy alcohol use to prevent:

• a) Liver cirrhosis
• b) Wernicke-Korsakoff syndrome
• c) Pancreatitis
• d) Cardiomyopathy Answer: b) Wernicke-Korsakoff syndrome

18. What is the primary management strategy for a patient who presents with a sympathomimetic toxidrome (e.g., from cocaine) including severe agitation and tachycardia?

• a) Administration of naloxone
• b) Administration of a beta-blocker
• c) Supportive care and administration of benzodiazepines
• d) Administration of flumazenil Answer: c) Supportive care and administration of benzodiazepines

19. A long-acting injectable formulation is available for which medication used to manage OUD and AUD?

• a) Acamprosate
• b) Disulfiram
• c) Naltrexone
• d) Buprenorphine Answer: c) Naltrexone

20. When managing Tobacco Use Disorder, combining a long-acting nicotine patch with a short-acting form (e.g., gum, lozenge) is a strategy used to:

• a) Increase the risk of side effects.
• b) Provide steady baseline nicotine levels while allowing for management of breakthrough cravings.
• c) Decrease the overall cost of therapy.
• d) Comply with insurance requirements. Answer: b) Provide steady baseline nicotine levels while allowing for management of breakthrough cravings.

21. The management of a patient with a suspected acetaminophen overdose, if caught early, involves the administration of:

• a) Atropine
• b) N-acetylcysteine (NAC)
• c) Sodium bicarbonate
• d) Fomepizole Answer: b) N-acetylcysteine (NAC)

22. According to the Patient Care VII curriculum, urine drug testing is a management tool used to:

• a) Punish patients who relapse
• b) Monitor for medication adherence and detect non-prescribed substance use
• c) Determine a patient’s employment status
• d) Justify higher medication costs Answer: b) Monitor for medication adherence and detect non-prescribed substance use

23. Why is co-prescription of opioids and benzodiazepines strongly discouraged in pain management?

• a) It leads to a high risk of kidney failure.
• b) It significantly increases the risk of fatal respiratory depression.
• c) The combination causes severe hypertension.
• d) The drugs chemically inactivate each other. Answer: b) It significantly increases the risk of fatal respiratory depression.

24. The management goal of using a symptom-triggered protocol (e.g., with the CIWA-Ar scale) for alcohol withdrawal is to:

• a) Use more benzodiazepines than necessary.
• b) Administer medication on a fixed schedule regardless of symptoms.
• c) Titrate benzodiazepine use to withdrawal severity, often reducing total dose and treatment duration.
• d) Ensure the patient remains heavily sedated. Answer: c) Titrate benzodiazepine use to withdrawal severity, often reducing total dose and treatment duration.

25. Which medication for Tobacco Use Disorder also has an indication as an antidepressant?

• a) Nicotine gum
• b) Varenicline
• c) Nicotine patch
• d) Bupropion Answer: d) Bupropion

26. A crucial management step after reversing an opioid overdose with naloxone is:

• a) Immediately discharging the patient home.
• b) Monitoring the patient for re-sedation, as naloxone’s duration of action may be shorter than the opioid’s.
• c) Administering a dose of buprenorphine.
• d) Providing a prescription for more opioids. Answer: b) Monitoring the patient for re-sedation, as naloxone’s duration of action may be shorter than the opioid’s.

27. The management of a tricyclic antidepressant (TCA) overdose with cardiac toxicity often involves:

• a) Intravenous sodium bicarbonate
• b) Gastric lavage after 6 hours
• c) Flumazenil
• d) Calcium channel blockers Answer: a) Intravenous sodium bicarbonate

28. A key component of managing any SUD is building a therapeutic alliance with the patient, which involves:

• a) A judgmental and authoritarian approach.
• b) Empathy, respect, and shared decision-making.
• c) Ignoring the patient’s concerns and goals.
• d) Focusing only on the prescription. Answer: b) Empathy, respect, and shared decision-making.

29. What is the primary role of the pharmacist in the management of patients receiving methadone from an OTP?

• a) To adjust the patient’s methadone dose.
• b) To screen for and manage drug-drug interactions with the patient’s other medications.
• c) To provide the patient with a 30-day supply of methadone.
• d) The pharmacist has no role. Answer: b) To screen for and manage drug-drug interactions with the patient’s other medications.

30. Which of the following is NOT a primary goal of SUD management?

• a) Reducing substance use and its harmful effects
• b) Improving the patient’s quality of life and functioning
• c) Preventing relapse
• d) Ensuring the patient never experiences cravings Answer: d) Ensuring the patient never experiences cravings

31. The management of benzodiazepine withdrawal should be:

• a) Done abruptly (“cold turkey”)
• b) Accomplished with a slow taper of the benzodiazepine or a long-acting equivalent.
• c) Managed with high doses of naloxone.
• d) Treated with an SSRI. Answer: b) Accomplished with a slow taper of the benzodiazepine or a long-acting equivalent.

32. Fomepizole is used in the management of which type of poisoning?

• a) Acetaminophen
• b) Methanol or ethylene glycol
• c) Iron
• d) Digoxin Answer: b) Methanol or ethylene glycol

33. Patient education is a critical management strategy. When dispensing nicotine replacement therapy (NRT), it is essential to counsel the patient to:

• a) Continue smoking as usual while using NRT.
• b) Stop smoking completely when starting NRT to avoid nicotine toxicity.
• c) Use the patch and gum at the exact same time.
• d) Only use the product for one week. Answer: b) Stop smoking completely when starting NRT to avoid nicotine toxicity.

34. The “treatment of choice” for a cholinergic toxidrome (e.g., organophosphate poisoning) includes:

• a) Naloxone and flumazenil
• b) Atropine and pralidoxime
• c) Benzodiazepines and supportive care
• d) Sodium bicarbonate and activated charcoal Answer: b) Atropine and pralidoxime

35. A comprehensive management plan for a patient with SUD often involves referrals to:

• a) Social workers, counselors, and peer support groups.
• b) Only other pharmacists.
• c) The emergency department for all issues.
• d) No one, as the pharmacist can manage everything. Answer: a) Social workers, counselors, and peer support groups.

36. Management of a patient asking for an early refill on a controlled substance for the third time should involve:

• a) Filling the prescription without question.
• b) Refusing the prescription and discharging the patient from the pharmacy.
• c) A conversation with the patient and a call to the prescriber to discuss the situation and potential treatment plan changes.
• d) Calling law enforcement immediately. Answer: c) A conversation with the patient and a call to the prescriber to discuss the situation and potential treatment plan changes.

37. In managing a patient with AUD, what is the primary advantage of naltrexone over disulfiram?

• a) Naltrexone does not require strict abstinence to be safe.
• b) Naltrexone is significantly more effective.
• c) Naltrexone has fewer side effects.
• d) Naltrexone is less expensive. Answer: a) Naltrexone does not require strict abstinence to be safe.

38. The management of a pregnant patient with OUD involves:

• a) Abruptly tapering the patient off all opioids.
• b) Maintaining the patient on methadone or buprenorphine to prevent withdrawal, which can harm the fetus.
• c) Initiating naltrexone immediately.
• d) Prescribing short-acting opioids for breakthrough pain. Answer: b) Maintaining the patient on methadone or buprenorphine to prevent withdrawal, which can harm the fetus.

39. A key management strategy taught in the interprofessional opioid activity is:

• a) Each profession works in a silo.
• b) The pharmacist dictates all treatment.
• c) Collaborative communication between prescribers, pharmacists, and other team members.
• d) The physician makes all decisions without input. Answer: c) Collaborative communication between prescribers, pharmacists, and other team members.

40. The overall goal of clinical toxicology management is to:

• a) Provide supportive care and prevent toxin absorption.
• b) Administer specific antidotes when available.
• c) Enhance toxin elimination.
• d) All of the above. Answer: d) All of the above.

41. The management of agitation in a patient with stimulant intoxication should first focus on:

• a) Physical restraints.
• b) Administration of haloperidol.
• c) Providing a calm, quiet environment and verbal de-escalation.
• d) Immediate intubation. Answer: c) Providing a calm, quiet environment and verbal de-escalation.

42. Which of the following is a key aspect of managing SUD in an ambulatory care setting?

• a) Performing emergency intubations.
• b) Long-term monitoring of adherence, side effects, and psychosocial stability.
• c) Dispensing daily doses of methadone.
• d) Administering activated charcoal. Answer: b) Long-term monitoring of adherence, side effects, and psychosocial stability.

43. The management of pain in a patient with an active OUD is complex and requires:

• a) Refusing to prescribe any analgesics.
• b) Using non-opioid strategies first and consulting with an addiction specialist.
• c) Prescribing large quantities of short-acting opioids.
• d) Discontinuing their buprenorphine or methadone. Answer: b) Using non-opioid strategies first and consulting with an addiction specialist.

44. What is a critical step in managing a patient who has been successfully revived with naloxone?

• a) Congratulating them on their recovery.
• b) Offering a referral to treatment and providing harm reduction education.
• c) Asking them to leave the pharmacy immediately.
• d) Calling their family to inform them of the event. Answer: b) Offering a referral to treatment and providing harm reduction education.

45. A patient with AUD is prescribed topiramate off-label. A key management concern to monitor for is:

• a) Weight gain.
• b) Cognitive side effects like word-finding difficulty.
• c) Hypertension.
• d) Increased alcohol cravings. Answer: b) Cognitive side effects like word-finding difficulty.

46. Which of the following is NOT a component of a comprehensive SUD management plan?

• a) Pharmacotherapy
• b) Psychosocial counseling
• c) Peer support
• d) A judgmental and stigmatizing attitude from the healthcare provider Answer: d) A judgmental and stigmatizing attitude from the healthcare provider

47. Managing a patient on varenicline requires monitoring for what potential serious side effect?

• a) Severe liver injury
• b) Neuropsychiatric changes, including depression and suicidal thoughts
• c) Rebound hypertension
• d) Lactic acidosis Answer: b) Neuropsychiatric changes, including depression and suicidal thoughts

48. In the management of an unknown overdose, the first priority is always:

• a) Identifying the substance ingested.
• b) Administering an antidote.
• c) Assessing and managing the patient’s airway, breathing, and circulation (ABCs).
• d) Obtaining a urine drug screen. Answer: c) Assessing and managing the patient’s airway, breathing, and circulation (ABCs).

49. An effective management strategy for preventing relapse is to:

• a) Isolate the patient from all social contact.
• b) Help the patient identify their personal triggers and develop coping skills.
• c) Ensure the patient never experiences stress.
• d) Focus only on the medication and ignore behavioral aspects. Answer: b) Help the patient identify their personal triggers and develop coping skills.

50. The successful long-term management of any Substance Use Disorder is best described as:

• a) A one-time fix.
• b) A continuous process of care, monitoring, and support for a chronic disease.
• c) Impossible to achieve.
• d) The sole responsibility of the patient. Answer: b) A continuous process of care, monitoring, and support for a chronic disease.