Substance Misuse

Question 1

What is first-line treatment for mild alcohol-use disorder?

Answer 1

CBT

Question 2

What is first-line treatment for moderate to severe alcohol-use disorder?

Answer 2

CBT plus acamprosate or naltrexone

Question 3

What is second-line treatment for moderate to severe alcohol-use disorder?

Answer 3

Disulfiram

Question 4

What is first-line treatment for delirium in alcohol withdrawal?

Answer 4

Lorazepam

Question 5

What is second-line treatment for delirium in alcohol withdrawal?

Answer 5

Haloperidol

Question 6

What is first-line treatment for alcohol withdrawal seizures?

Answer 6

Lorazepam

Question 7

Which benzodiazepines are used for alcohol withdrawal symptoms?

Answer 7

Chlordiazepoxide or diazepam

Question 8

What is the treatment for Wernicke’s encephalopathy?

Answer 8

Thiamine vitamin B1

Question 9

How should nicotine dependence treatment be delivered?

Answer 9

With behavioural support

Question 10

What type of NRT is long-acting?

Answer 10

Nicotine patch

Question 11

When should a 16-hour nicotine patch be used?

Answer 11

If nightmares occur or in pregnancy

Question 12

When should a 24-hour nicotine patch be used?

Answer 12

If the patient wakes up with cravings

Question 13

Which NRT products are short-acting?

Answer 13

Gum inhalator lozenges nasal spray oral spray sublingual tablets

Question 14

What is a caution for varenicline use?

Answer 14

Cardiovascular disease psychiatric illness epilepsy renal impairment

Question 15

What are common side effects of varenicline?

Answer 15

Nausea headache insomnia

Question 16

How effective is bupropion compared to other smoking cessation treatments?

Answer 16

Less likely to be effective

Question 17

What cautions apply to bupropion?

Answer 17

Epilepsy and psychiatric illness

Question 18

What MHRA warning is associated with bupropion?

Answer 18

Serotonin syndrome

Question 19

What is first-line treatment for opioid detoxification?

Answer 19

Methadone or buprenorphine

Question 20

How long can opioid detoxification take?

Answer 20

Up to 12 weeks

Question 21

How should opioid detoxification be conducted?

Answer 21

Personalised and slow to avoid withdrawal

Question 22

How should methadone be reduced during detoxification?

Answer 22

Reduce by 5 mg every 1 to 2 weeks

Question 23

How should buprenorphine be reduced during detoxification?

Answer 23

Reduce by 2 mg every 2 weeks then final reduction of 400 micrograms

Question 24

What are common opioid withdrawal symptoms?

Answer 24

Diarrhoea vomiting stomach cramps agitation headache insomnia

Question 25

What is a benefit of buprenorphine over methadone?

Answer 25

Lower risk of fatal overdose

Question 26

Why is buprenorphine combined with naloxone?

Answer 26

To reduce injection misuse

Question 27

How does buprenorphine compare to methadone in sedation?

Answer 27

Less mental clouding and sedation

Question 28

When is modified-release buprenorphine useful?

Answer 28

In patients with adherence issues

Question 29

Which opioid substitution treatment is better at retaining patients?

Answer 29

Methadone

Question 30

Which patients benefit most from methadone?

Answer 30

Those using large amounts of heroin

Question 31

What cardiac side effect is associated with methadone?

Answer 31

QT prolongation

Question 32

If both methadone and buprenorphine are suitable which should be chosen?

Answer 32

Methadone

Question 33

How long is daily supervised consumption required in opioid dependence?

Answer 33

First 3 months

Question 34

What should be done if a patient misses a dose of opioid substitution therapy?

Answer 34

Do not replace the missed dose

Question 35

What action is needed if a patient misses 3 or more days of doses?

Answer 35

Refer back to the prescriber

Question 36

How should opioid substitution therapy be managed in pregnancy?

Answer 36

Continue treatment

Question 37

Why is vomiting opioid substitution therapy in pregnancy a concern?

Answer 37

May cause withdrawal leading to foetal distress

Question 38

What is the antidote for opioid toxicity?

Answer 38

Naloxone

Question 39

Which prescription form is used for opioid substitution therapy?

Answer 39

FP10MDA

Question 40

What is the maximum supply allowed on an FP10MDA?

Answer 40

14 days

Question 41

What must be specified for instalment prescribing?

Answer 41

Number of instalments and interval between instalments