Substance use disorders

Question 1

What is the probability after trying heroin that a person will become dependent?

Answer 1

25%

Question 2

Self-administration of any drug in a culturally disapproved manner that causes adverse consequences.

Answer 2

Abuse

Question 3

Behavior pattern of overwhelming involvement in use and securing of drug supply. Also tendency to relapse after discontinuation.

Answer 3

Addiction

Question 4

Physiological state of neuroadaptation due to repeated administration of a drug that requires continued use to prevent withdrawal.

Answer 4

Dependence

Question 5

Decreased effect after repeated administration that requires larger doses to obtain effect seen at the onset of use.

Answer 5

Tolerance

Question 6

Psychological and physiologic reaction to abrupt cessation of a dependence producing drug.

Answer 6

Withdrawal

Question 7

Substance dependence requires at least 12 month period of drug use with frequent negative consequences; at least 3 of what need to be present?

Answer 7

1. tolerance
2. withdrawal
   3 longer use or larger dose than intended
3. desire/effort to reduce use
4. Time spent in seeking, using, or recovery from use
5. give up/reduce important activities
6. continue to use despite consequences

Question 8

Substance abuse requires at least 12 month period of drug use with frequent negative consequences, at least 1 of what need to be present?

Answer 8

1. difficulty meeting obligations
2. continued use in dangerous situation
3. legal problems
4. social problems

Question 9

What neurotransmitter is stimulate, and what pathway?

Answer 9

Mesolimbic reward pathway resulting in an increase release of dopamine.

Question 10

Slurred speech, poor coordination, blood shot eyes, decreased blood pressure, memory impairment, drowsiness, dizziness are signs of?

Answer 10

BZD intoxication

Question 11

Tremor/muscle twitch, nausea/vomiting, anxiety, yawning, tachycardia, seizures, hallucinations are signs of?

Answer 11

BZD withdrawal

Question 12

How is BZD withdrawal treated?

Answer 12

Long acting BZD and slowly taper by 10% every 1-2 weeks as tolerated.

Question 13

Slurred speech, euphoria, dysphoria, apathy, psychomotor retardation, sedation, attention impairment, miosis are signs of?

Answer 13

Opiate intoxication

Question 14

Bone/muscle pain, anxiety, insomnia, tachycardia, cough, sweating, yawning, mydriasis, piloerection, hypertension are signs of?

Answer 14

Opiate withdrawal

Question 15

How is opiate withdrawal treated?

Answer 15

Symptoms are treated.
NSAIDs - pain
BZD - anxiety
Sleep aids
Antidiarrheal
Antihypertensives
antiemetics

Question 16

How is opiate dependence treated?

Answer 16

1. motive patient in structured care program

2. methadone, buprenorphine, naltrexone

Question 17

This drug is a long acting opioid agonist at mu receptors.

Answer 17

Methadone

Question 18

Euphoria, sedation, constipation, increase QT, respiratory depression are side effects of?

Answer 18

Methadone

Question 19

Methadone interacts with?

Answer 19

CYP3A4 inhibitor = increase methadone conc.

CYP3A4 inducers: decrease methadone conc

Question 20

What is the regulatory issue with methadone?

Answer 20

Only dispensed for opiate dependence by licensed opiate addiction centers

Question 21

What is the dosing for methadone?

Answer 21

initial 20-30mg. if symptoms persist after 2-4 hours, may give additional 5-10mg.
Maintenance of at least 80mg

Question 22

Which drug is used in pregnant women with opiate dependence?

Answer 22

Methadone

Question 23

Which drug is a partial agonist at mu opiate receptor and antagonist at kappa opiate receptor?

Answer 23

Buprenorphine

Question 24

What drug and ratio is buprenorphine combined with?

Answer 24

Naloxone in a 4:1 ratio

Question 25

constipation, nausea, vomiting, dizziness, precipitation of opiate withdrawal are side effects of?

Answer 25

Buprenorphine

Question 26

What interacts occur with buprenorphine?

Answer 26

CYP3A4

Question 27

What are the regulatory issues with buprenorphine?

Answer 27

Office-based prescribing after 8 hour training course. May treat up to 100 patients

Question 28

What is the dosing of buprenorphine?

Answer 28

Wait until symptoms of mild withdrawal. initial 4mg. if symptoms persist after 2-4 hours, may give an additional 4mg. Total from day 1 given on day 2, and may repeat in 2-4hours if needed. Titration until no signs of withdrawal present. Maintenance: 4-24mg/day Max 32mg/day

Question 29

Which drug is safer and more accessible? methadone or buprenorphine

Answer 29

buprenorphine

Question 30

Which drug is an opioid antagonist at mu receptor?

Answer 30

naltrexone

Question 31

Patient should be abstinent from opiates how long? otherwise naltrexone can cause?

Answer 31

at least 7 days to prevent precipitation of opiate withdrawal symptoms

Question 32

Alcohol has what 4 physiological effects?

Answer 32

1. Enhance GABA inhibition 2. Reduce glutamate presence at synapse 3. Activate opiate receptors 4. Increase the release of dopamine

Question 33

What questions are asked to screen for alcoholism?

Answer 33

1. Cut back on drinking? 2. Annoyed by criticizing drinking 3. guilty about drinking 4. eye-opener hangover

Question 34

Elevated MCV, AST, ALT, LDH. Decreased B12, folic acid Elevated uric acid, triglycerides, amylase, Bone suppression

Answer 34

Alcohol abuse findings

Question 35

Euphoria, mild attention difficulty, mild coordnation, ataxia, confusion, coma, death are signs of?

Answer 35

alcohol intoxication

Question 36

anxiety, hypertension, sweating, tachycardia, nausea, vomiting, insomnia, hallucinations, tremor, seizures, confusion, agitation are signs of?

Answer 36

alcohol withdrawal

Question 37

Delirium tremens is assoicated with?

Answer 37

alcohol withdrawal

Question 38

Treatment of alcohol withdrawal

Answer 38

1. BZD lorazepam 2mg TID | 2. Thiamine 100mg IV, 100-200mg po x1 month

Question 39

What is the purpose of giving thiamine during alcohol withdrawal?

Answer 39

Prevent wernicke's encephalopathy (ataxia, nystagmus, mental confusion)

Question 40

Those who survive wernicke's but do not recover in 48-72hours will get?

Answer 40

korsakoff psychosis, chronic amnestic disorder

Question 41

How is alcohol dependence treated?

Answer 41

Disulfiram, naltrexone, acamprosate

Question 42

Which drug is an aldehyde dehydrogenase antagonist?

Answer 42

disulfiram( Antabuse)

Question 43

How is antabuse dosed?

Answer 43

after 12-24hours of last drink. | 250mg daily

Question 44

drowsiness, garlic taste, sexual dysfunction, hepatitis, optic neuritis, peripheral neuropathy, nausea, headache are side effects of?

Answer 44

disulfiram (Antabuse)

Question 45

Which drug is effective at reducing number of drinks consumed and craving for alcohol?

Answer 45

Naltrexone (Revia, Vivitrol)

Question 46

How is naltrexone (Revia, vivitrol) dosed?

Answer 46

50mg po daily after 7-10days of opiate free | 380mg IM monthly

Question 47

abdominal pain, nausea, anxiety, headache, heptotoxicity are side effects of?

Answer 47

naltrexone

Question 48

Which drug is an antagonist at glutamate NMDA receptors?

Answer 48

acamprosate (Campral)

Question 49

How is Campral dosed?

Answer 49

2x 333mg po tid

Question 50

What caution is their with Campral, what advantage?

Answer 50

Caution renal impairment. Advantage over naltrexone and disulfiram is not hepatotoxic