A 29-year-old pregnant woman is referred to the psychiatric-mental health nurse practitioner for medication-assisted treatment (MAT) for opioid use disorder (OUD). Which of the following will the PMHNP prescribe?
Naloxone
Naltrexone
Buprenorphine
Buprenorphine/Naloxone
The Correct Answer is C
Choice A reason: Naloxone is an opioid antagonist used primarily for emergency reversal of opioid overdose. It is not used as a maintenance medication in MAT, especially not during pregnancy, as it does not address withdrawal or cravings.
Choice B reason: Naltrexone is also an opioid antagonist used in MAT, but it is contraindicated during pregnancy due to insufficient safety data and the risk of precipitating withdrawal. It requires complete detoxification before initiation, which is not ideal for pregnant patients.
Choice C reason: Buprenorphine is a partial opioid agonist and is considered safe and effective for use during pregnancy. It reduces cravings and withdrawal symptoms without producing the same level of euphoria as full agonists. It is preferred over methadone in many cases due to lower risk of neonatal abstinence syndrome and better maternal outcomes.
Choice D reason: Buprenorphine/Naloxone combination is generally avoided during pregnancy because naloxone can precipitate withdrawal in the fetus. Monotherapy with buprenorphine is the recommended approach for pregnant women with OUD.
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Correct Answer is C
Explanation
Choice A reason: Prazosin is an alpha-1 adrenergic antagonist commonly used to treat PTSD-related nightmares. It does not have significant CNS depressant effects and does not interact dangerously with buprenorphine. Therefore, it can be continued during induction.
Choice B reason: Escitalopram is a selective serotonin reuptake inhibitor (SSRI) used for anxiety and depression. It does not pose a significant risk when combined with buprenorphine and is generally safe to continue during induction.
Choice C reason: Alprazolam is a benzodiazepine with potent CNS depressant effects. When combined with buprenorphine, it increases the risk of respiratory depression, sedation, and overdose. Discontinuation or tapering is recommended prior to buprenorphine induction to reduce these risks.
Choice D reason: This option implies that no medications need to be discontinued, which is incorrect. Alprazolam poses a significant safety concern and should be reconsidered before initiating buprenorphine.
Correct Answer is B
Explanation
Choice A reason: Opioid withdrawal typically presents with symptoms such as muscle aches, diarrhea, rhinorrhea, and yawning. While restlessness and insomnia may occur, tremors and autonomic instability (e.g., elevated pulse and sweating) are more characteristic of alcohol withdrawal.
Choice B reason: Alcohol withdrawal is marked by autonomic hyperactivity (elevated pulse, sweating), tremors, nausea, agitation, and insomnia. These symptoms match the clinical presentation described. If untreated, it can progress to delirium tremens, which includes hallucinations and seizures.
Choice C reason: Sedative, hypnotic, or anxiolytic withdrawal (e.g., benzodiazepines) can resemble alcohol withdrawal but typically includes more pronounced anxiety, irritability, and risk of seizures. However, the classic signs of autonomic hyperactivity and tremors are more strongly associated with alcohol withdrawal.
Choice D reason: Stimulant withdrawal often includes fatigue, depression, increased appetite, and sleep disturbances. It does not typically present with tremors, autonomic instability, or nausea, making it less likely in this case.
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