7. Substance-related and addictive disorders

Question 1

MOA of alcohol

Answer 1

Activates GABA and inhibits glutamate…hence it is a CNS depressant

(GABA is inhibitory…glutamate is excitatory)

Question 2

________________ (ethnic group) often have less of this enzyme ______________.

Answer 2

Asians

Aldehyde dehydrogenase

Question 3

Drug of choice for alcohol withdrawl?

Answer 3

Chlordiazepoxide (Librium)

Question 4

Most common type of hallucination in DTs?

Answer 4

Visual

Question 5

Confabulations

Answer 5

Inventing stories of events that never occurred. Patient unaware that they are “making these up”
*Often associated with Korsakoff’s psychosis

Question 6

“Banana bag” for treating nutritional deficiencies in alcoholic patients

Answer 6

Thiamine
Folic acid
Multivitamin

Question 7

Drug that is used first-line for alcohol use disorder. Can be used in patients with liver disease

Answer 7

Acamprosate (Campral)

Question 8

Topiramate (Topamax)

Answer 8

Anticonvulsant…potentiates GABA, inhibits glutamate receptors

Reduces cravings for alcohol and reduces alcohol use

Question 9

Effect of alcohol on MCV

Answer 9

Increase

Question 10

Thiamine before or after glucose for patient with altered mental status?

Answer 10

Thiamine BEFORE Glucose. Or you can precipitate Wernicke-Korsakoff syndrome

Thiamine is a coenzyme used in carbohydrate metabolism.

Question 11

MOA of amphetamines

Answer 11

Block reuptake and facilitate release of DA and NE

Question 12

Grinding teeth

Answer 12

Amphetamine abuse

Question 13

PCP mechanism of action

Answer 13

Antagonizes NMDA glutamate receptors and activates dopaminergic neurons

Question 14

Drug similar to PCP but less potent

Answer 14

Ketamine

Question 15

PCP intoxication symptoms

Answer 15

“RED DANES”
Rage
Erythema of skin
Dilated pupils

Delusions
Amnesia
Nystagmus
Excitation
Skin dryness

Question 16

Synesthesia…what is it?

What drug is it associated with?

Answer 16

One sensory stimulation evokes another, such as hearing a sound produces a color

PCP

Question 17

Violence

Answer 17

PCP

Question 18

Date-Rape drug

Answer 18

GHB…Gamma-hydroxybutyrate

*Dose-specific CNS depressant that produces confusion, dizziness, drowsiness, memory loss, respiratory distress, and coma

Question 19

Opioid that causes pupil dilation

Answer 19

Meperidine

“Demerol dilates pupils”

Question 20

Treatment for barbituate overdose

Answer 20

Sodium bicarbonate: to alkalinize the urine to promote renal excretion

Question 21

Treatment for benzodiazepine overdose

Answer 21

Flumazenil

Question 22

Withdrawl from what class of drugs has the highest mortality rate?

Answer 22

Barbituates

Question 23

Gold standard for treatment of opioid addiction in pregnant women

Answer 23

Methadone

Question 24

Classic triad of opioid overdose

Answer 24

“Rebels admire morphine”

Respiratory depression
Altered mental status
Miosis

Question 25

Withdrawal symptoms of opiates? Life threatening?

Answer 25

``` Anxiety Insomnia Anorexia Fever Rhinorrea Piloerection ``` NOT life threatening

Question 26

Pill form of THC that is FDA approved for certain indications

Answer 26

Dronabinol

Question 27

MOA of cannabinoid receptors in brain

Answer 27

Inhibit adenylate cyclase

Question 28

Why is it important to identify the solvent that a patient has inhaled?

Answer 28

Some may require chelation | Ex. leaded gasoline

Question 29

MOA of caffeine

Answer 29

Adenosine antagonist | Increases cAMP and stimulates release of excitatory neurotransmitters

Question 30

Cigarette smoking during pregnancy is associated with?

Answer 30

Low birth weight SIDS postnatal morbidities

Question 31

Drug that reduces rewarding aspects of nicotine and prevents withdrawl symptoms? MOA?

Answer 31

Varenicline (Chantix) Partial agonist at alpha4beta2 nicotinic cholinergic receptor

Question 32

Antidepressant that inhibits dopaine and norepinephrine reuptake

Answer 32

Buproprion