SUD

Question 1

What brain structure is damaged due to the chronic administration of drug

Answer 1

Prefrontal Cortex (gray matter volume decrease)

Question 2

What is the “high” produced by a drug the result of

Answer 2

Large amounts of dopamine “the dopamine flood”

Question 3

What are the categories of substance use disorder outlined by the DSM V?

Answer 3

Mild (2-3 symptoms)
Moderate (4-5 symptoms)
Severe (> 6 symptoms)

Question 4

Where does the genetic predisposition of SUD come from?

Answer 4

Heritable family traits

Environmental effects on gene development that govern the response to drugs and stress

Question 5

What are the goals of treatment for SUD?

Answer 5

Mitigate withdrawal sx

Dampen or eliminate craving - decrease reward for dysfunctional behavior, increase reward for healthy behavior, and decrease and eliminate cues and triggers for using

Question 6

What is the role of alpha adrenergic blockade agents in mitigating withdrawal during detox?

Answer 6

Blunt of block the result of the “norepinephrine storm”

Question 7

Is detoxification considered treatment?

Answer 7

No

Question 8

What is a key part of treatment for support?

Answer 8

Peer support or a recovery coach

Question 9

Why is diet and exercise important in the treatment of SUD?

Answer 9

Diet’s are full of sugar and salt in drug users, they can’t get healthy if their diet is unhealthy or not optimized. Exercise can also act on the brain and important for restoration and protection.

Question 10

How is ETOH metabolized and by what enzyme?

Answer 10

Hepatic, alcohol dehydrogenase

Question 11

What are early symptoms of alcohol withdrawal (6-24 hours)

Answer 11

Anxiety
Sleep disturbance
Vivid dreams
Anorexia, nausea
Headache

Question 12

How long after their last drink does alcohol withdrawal delirium onset in alcoholics?

Answer 12

72-96 hours

Question 13

When do seizures usually occur after a last drink?

Answer 13

8-24 hours after last drink

Question 14

What is the treatment for seizures in alcohol withdrawal?

Answer 14

Benzos - GABA agonist

Question 15

What antipsychotic can be added to the treatment of seizures?

Answer 15

Haloperidol - works but decreases seizure threshold

Question 16

What is the triad of Wernicke-Korsakoff syndrome?

Answer 16

Mental disturbance
Ocular Paralysis (CN VI)
Ataxia

Question 17

What are the medical uses of opioids?

Answer 17

Analgesia (pain control)
Sedation
Anesthesia

Question 18

What are the symptoms of acute overdose?

Answer 18

Miosis
Altered mental status
Respiratory depression

Question 19

Why does respiratory distress occur in overdose?

Answer 19

Decreased sensitivity in the pons and medulla to rising CO2 levels

Decreased gag reflux -risk of aspiration

Bronchospasm

Histamine release - vasodilation, orthostatic hypotension

Question 20

What are the complications of IV drug use?

Answer 20

Viral transmission
Bacterial infection (osteomylitis, endocarditis)
Non-septic emboli
Rhabdomyolysis
Nephropathy

Question 21

What is the gold standard for treating opioid use?

Answer 21

Methadone

Question 22

What is the active chemical in cannabis?

Answer 22

D-9 tetrahydrocannabinol

Question 23

There is substantial evidence between cannabis and the development of what psychologic disorder among frequent cannabis users?

Answer 23

Schizophrenia

Question 24

What is the treatment of stimulant use disorder?

Answer 24

No medication treatment has been shown effective, best treatment is contingency management (boiling down the stimulant to small dose)