Examkin

Soru

Zorluk: ZorSubstance-Related and Addictive Disorders

Match each patient presentation with the mechanism of action of the most appropriate pharmacotherapy for their clinical scenario.

  • A 45-year-old man with severe alcohol use disorder and decompensated cirrhosis (ascites, jaundice) seeking medication to maintain abstinence.Modulation of glutamate neurotransmission at NMDA receptors
  • A 52-year-old woman with severe alcohol use disorder and end-stage renal disease on hemodialysis seeking medication to reduce cravings.Competitive antagonism at mu-opioid receptors
  • A 38-year-old man with alcohol use disorder who is highly motivated to quit; his partner has agreed to directly supervise his daily medication intake.Irreversible inhibition of aldehyde dehydrogenase
  • A 26-year-old woman with opioid use disorder who is 14 weeks pregnant and seeking medication-assisted maintenance treatment.Partial agonism at mu-opioid receptors
  • A 48-year-old man admitted for acute alcohol withdrawal who has laboratory evidence of severe alcoholic hepatitis.Positive allosteric modulation of GABA-A receptors by an agent lacking active metabolites

Cevap

The correct matches align the patient's specific comorbidities with the pharmacokinetic profiles and mechanisms of action of the indicated substance use disorder medications.
Each correct pairing reflects the safest and most effective pharmacotherapy based on the patient's underlying physiology, ensuring that drugs with hepatic metabolism are avoided in liver disease, and renally cleared drugs are avoided in kidney disease.

Adım Adım Çözüm

1
Analyze the comorbidities for the patient with decompensated cirrhosis.
Identify acamprosate as the safe agent, which modulates glutamate at NMDA receptors.
Hepatotoxic drugs like naltrexone must be avoided in liver failure.
2
Analyze the comorbidities for the patient with end-stage renal disease.
Identify naltrexone as the safe agent, which acts as a competitive mu-opioid antagonist.
Renally cleared drugs like acamprosate are absolutely contraindicated in severe renal impairment.
3
Identify the ideal scenario for disulfiram prescription.
Match with the highly motivated patient who has supervised daily administration.
Disulfiram irreversibly inhibits aldehyde dehydrogenase but suffers from poor adherence without supervision.
4
Select the appropriate maintenance therapy for opioid use disorder in pregnancy.
Match with buprenorphine, a partial mu-opioid agonist.
Buprenorphine and methadone are the standards of care to prevent maternal withdrawal and optimize fetal outcomes.
5
Determine the safest withdrawal management in severe acute alcoholic hepatitis.
Match with lorazepam/oxazepam, which are GABA-A modulators lacking active metabolites.
Long-acting benzodiazepines accumulate dangerously in severe liver disease.

Anahtar Kavram

Pharmacotherapy for substance use disorders requires tailoring the specific drug's mechanism of action and pharmacokinetic profile to the patient's underlying comorbidities.
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Konular

Substance-Related and Addictive Disorders

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