MISC. REWIEW QUESTIONS

Question 1

STAGES OF ALCOHOL WITHDRAWAL

Answer 1

alcohol withdrawal stages

Stage 1 (mild): anxiety, insomnia, nausea, abdominal pain and/or vomiting, loss of appetite, fatigue, tremors, depression, foggy thinking, mood swings, and heart palpitations

Stage 2 (moderate): increased blood pressure, body temperature and respiration, irregular heart rate, mental confusion, sweating, irritability, and heightened mood disturbances

Stage 3 (severe/delirium tremens): hallucinations, fever, seizures, severe confusion, and agitation

Question 2

time line of alcohol withdrawal symptoms

Answer 2

Roughly 8 hours after first drink: The first stage withdrawal symptoms may begin.

After 24-72 hours: Symptoms generally peak in this time period, and stage 2 and 3 symptoms can rapidly manifest.

5-7 days later: Symptoms may start to taper off and decrease in intensity.
Beyond the first week: Some side effects, particularly the psychological ones, may continue for several weeks without treatment.

Question 3

drugs approved for treatment of PTSD

Answer 3

–sertraline

–paroxetine

Question 4

symptoms of withdrawal from heavy marijuana use

Answer 4

–irritability
–Drug craving
–Sleep disturbance
–Concentration problems
–depressed mood
–Diarrhea
–Nausea

Question 5

symptoms of marijuana intoxication

Answer 5

–distorted perception
–increased appetite
–Euphoria
–Hallucinations
–injected sclera
–Increased heart rate
–Decreased blood pressure

Question 6

drug most likely causing symptoms resolving with hot bath

Answer 6

cannabis

Question 7

where is the brains reward system?

Answer 7

nucleus accumbens

Question 8

clinical difference between cocaine intoxication and bipolar mania

Answer 8

–mania must last for week or more
–Hypomania last 4 or more days and is milder
–Cocaine symptoms are intermittent

Question 9

volume of distribution of nicotine

Answer 9

180 L

Question 10

R their racial differences in nicotine absorption and accumulations

Answer 10

–African-Americans absorbed 30% more nicotine think Caucasians
–Chinese Americans have lower nicotine levels
–Women nicotine faster than men

Question 11

age group with the highest use of inhalants

Answer 11

young adults 18–25

Question 12

what is precontemplation

Answer 12

–not yet considering change
–Resistance to change
–needs coalition to show up for change

Question 13

what is contemplation

Answer 13

–ambivalence
–vacillation
–Wants to change but resist needed changes

Question 14

what is preparation

Answer 14

–begin needed steps

–Increased confidence in decision to quit

Question 15

what is action

Answer 15

–actually begins needed steps
–Needs support
–Over actions to change environment or to quit

Question 16

what is maintenance

Answer 16

–consolidation of gains
–Learning alternative coping mechanisms
–Learning the triggers of emotion precipitate abuse

Question 17

what is relapse and recycling

Answer 17

–possible but not necessary
–avoiding being stuck
–Learning from mistakes

Question 18

what his termination

Answer 18

–ultimate stage

–Patient exits treatment without fear of relapse

Question 19

difference between neuroleptic malignant syndrome and serotonin syndrome

Answer 19

both have
–Confusion
–Hyperthermia
–Increased muscle tone

neuroleptic malignant syndrome
–Akinesia
–Mutism
–rigidity

Serotonin syndrome
–Rambling speech

Question 20

drugs causing erectile dysfunction
–During intoxication
–During withdrawal

Answer 20

opioids cause sexual dysfunction during both intoxication and withdrawal

cocaine and stimulants cause sexual dysfunction only during intoxication

Question 21

which Tri-Cyclic antidepressant is most appropriate for treating daytime pain

Answer 21

desipramine is the least sedating tryicyclic antidepressants

Question 22

first-line drugs for treatment of generalized anxiety disorder

Answer 22

–paroxetine
– escitalopram
–Sertraline
–venlafaxine

Question 23

FDA approved uses for duloxetine

Answer 23

–major depressive disorder
–Generalized anxiety disorder
–Diabetic neuropathy
–Fibromyalgia
–Chronic musculoskeletal pain

Question 24

methamphetamine effects on neurotransmitters

Answer 24

synaptic levels dopamine and norepinephrine and serotonin are increased with methamphetamine

Question 25

CT or MRI evidence of alcoholic brain degeneration

Answer 25

atrophy of cerebellar vermis

Question 26

most common drug used to alter cocaine

Answer 26

levamisole, a veterinary anti-helminth drug is found and 69% of cocaine in the United States.
–It does not recorded as an adulterant on Street tests of purity of cocaine.

it produces…
– leukopenia
–Positive autoimmune factors
–Often with reticular purpuric lesions, particularly on the ears, but may be on the extremities

Question 27

ASAM levels of care

Answer 27

Six dimensions:
o Dimension I: Acute Intoxication/Withdrawal Potential
o Dimension II: Biomedical Conditions and Complications
o Dimension III: Emotional, Behavioral or Cognitive Conditions and
Complications
o Dimension IV: Readiness to Change
o Dimension V: Relapse, Continued Use or Continued Problem Potential
o Dimension VI: Recovery Environment

• Five levels of care:
o Level 0.5: Early Intervention
o Level I: Outpatient Treatment
o Level II: Intensive Outpatient/Partial Hospitalization
o Level III: Residential/Inpatient Treatment
o Level IV: Medically-Managed Intensive Inpatient Treatment

Question 28

sub specifiers in ASAM levels of care

Answer 28

D = need for detoxification
BIO = need for management of concurrent medical illness
OMT = need for opioid maintenance therapy
AOD = need for drug or substance use therapy only
DDC and DDE= psychiatric dual diagnosis present

Question 29

physician specialties with the most drug abuse

Answer 29

–psychiatry
–Emergency physicians
–Anesthesiologists

Question 30

drug abuse patterns among physicians

Answer 30

–most common drug of abuse is alcohol
–Cannabis is the most common illegal drug
–Physician drug abuse mimics general population at 8-15%

Question 31

mechanism of disulfiram

Answer 31

disulfiram irreversibly inhibits the oxidation of acetyl aldehyde by competing with the cofactor nicotinamide adenosine dinucleotide for binding sites on acetyl alcoholcetyl alcohol dehydrogenase causing a 5–10 time increase in acetalcohol causing the severe classic “hangover”

Question 32

what area of the brain is involved in the reinforcement of drugs and alcohol?

Answer 32

the basal forebrain is involved in the reinforcement effects of drugs and alcohol.
It consists of the “extended amygdala” which contains

Question 33

bupropion mimics a psycho pharmacologic action of nicotine by increasing…

Answer 33

bupropion mimics the psychopharmacological action of nicotine by increasing dopamine and norepinephrine

Question 34

what are the byproducts of metabolism of disulfiram which can be tested by breath analyzer?

Answer 34

disulfiram users will have carbon disulfide and acetone in there breath when tested by a breath analyzer

Question 35

benzodiazepines work by attaching which receptor?

Answer 35

benzodiazepine attach to the GABA–a receptor

Question 36

what is the test to determine the severity of nicotine addiction?

Answer 36

nicotine addiction severity is measured by the Fagerstrom test for nicotine dependence

Question 37

mechanism of action of pregabalin and gabapentin

Answer 37

both pregabalin and gabapentin modulate calcium influx into neurons affecting nociception

Question 38

how does sedative withdrawal cause hypertension?

Answer 38

sedative withdrawal causes hypertension by allowing a increase in norepinephrine and dopamine

Question 39

mechanism of action of disulfiram for alcohol control

Answer 39

blocks dopamine beta hydroxylase in the brain

Question 40

which receptor complex is involved in addiction to sedatives?

Answer 40

GABA a is a receptor complex involved in an addiction to sedatives.
Acts by hyper polarizing cell membrane by increasing the intracellular chloride

Question 41

mechanism of topiramate in the treatment of alcoholism

Answer 41

topiramate antagonizes glutamate and suppresses alcohol-induced dopamine release