Number one Flashcards
Gene associated with Alcohol Dependence
GABRA2
Genes involved in alcohol metabolism and if mutated, increase the patient risk of getting an upper GI cancer
ALDH1B & ALDH2
Gene linked to Amgdala activation and linked to psychiatric issues in alcohol abuse
SLC6A4
Greater reduction of heavy drinking in alcohol abuse prescribed Noltrexone
OPRM1
Role of therapist in 12 step Facilitation program
To educate and encourage the patient to attend
Amitriptyline interaction
Marijuana and anticholinergic
Action of Benzodiazepine- direct or indirect
Indirect GABA Receptor agonist
Does Naltrexone require dose adjustment in mild to moderate hepatic impairment
No
For Alcohol detox are patients more likely to complete detox as inpatient or outpatient
Inpatient
Which race Has highest level of cannabis abuse
Native Americans
Opioid peptides include
Dynorphins, Endorphins, and Enkephalins
Gene involved in high susceptibility to cocaine addiction
CAMK4
Heroin overdose can we mimic
End stage liver disease
Which medication helps in reducing marijuana withdrawal symptoms and marijuana use
Gallivanting
Percentage of cases of marijuana with genetic linkage
58% to 67%
How many percent of alcoholic hepatitis progress to cirrhosis
80%
Chronic use of cocaine leads to cocaine-induced dystonic reactions
Reduces number of D1 receptors in the striatal pathway
Treatment is Benzodiazepines
MATRIX Intensive Outpatient program
- employs multiple treatment approaches including the 12-step model, family therapy, CBT, and psychoeducation.
- 16-week matrix intensive outpatient treatment program
- has 8 early recovery skills group sessions to help clients develop more efficient ways of changing their behavior and staying abstinent.
- 12 family education group sessions and 3 individual family sessions.
Modified Minnesota Detoxification Scale (mMINDS).
The mMINDS is used to assess the severity of alcohol withdrawal syndrome in patients admitted to the ICU or who are unable to answer verbally.
Wernicke encephalopathy triad includes
- Opthalmoplegia
- Ataxia
- Confusion
ANI- Alcoholic and non Alchoholic Liver disease index is based on
mean corpuscular volume, aspartate transaminase (AST) and alanine transaminase (ALT) ratio, body mass index, and gender
HIV prevention
Tenofivir plus emtricitabine
West Haven criteria
- grading of mental state in patients with cirrhosis.
grade 2 hepatic encephalopathy present with lethargy, disorientation to time, personality changes, and inappropriate behavior.
Grade 0 is incorrect because at grade 0 the patient will present with normal mental status without any abnormalities or changes in personality or behavior.
Grade 1 is incorrect because the patient with grade 1 hepatic encephalopathy lacks awareness, is euphoric or anxious, have a short attention span, and impaired addition or subtraction without obvious personality changes.
Grade 3 is incorrect because patients with grade 3 hepatic encephalopathy present with somnolence or semi-stupor state, are confused and grossly disoriented, and have bizarre behavior.
Grade 4 is incorrect because patients with grade 4 hepatic encephalopathy present in a comatose state.
contingency management as it uses positive reinforcement to encourage abstinence from drugs.
Contingency management focuses on the maximal usage of medical clinic offices and guarantees decreased future hospitalizations.
PCP intoxication is characterized by
agitation, aggression, delusions, multidirectional nystagmus, and hallucinations
Treatment is Benzodiazepines
Components of MI
- based on targeting a patient’s ambivalence to behavioral change. - client-centered, empathic, but directive counseling strategy.
- The counselor communicates that the client always is responsible for change.
Principles of motivational interviewing include
(i) expressing empathy by respecting the client’s decisions and concerns and demonstrating that change is ultimately their responsibility,
(ii) Roll with resistance - This involves using effective strategies to reduce resistance and avoiding arguments,
(iii) support self-efficacy - Client’s strengths are identified and acknowledged, and the clients are encouraged to use their strengths to direct change,
(iv) identify discrepancies - this allows clients to see how much effort is required to achieve the desired change
anticonvulsant that has proven to be efficacious in treating seizures due to benzodiazepine withdrawal
carbamazepine, as it is an anticonvulsant that has proven to be efficacious in treating seizures due to benzodiazepine withdrawal, which is the likely cause of symptoms in this patient.
AUDIT
AUDIT (Alcohol Use Disorder Identification Test) was developed by the World Health Organization in 1993 for screening and stratifying individuals into risk groups for evaluating alcohol dependence. It uses 10 brief questions to try to demonstrate a client’s level of drinking and help the provider determine the most appropriate treatment approach. Scores of 0-7 are associated with no or low risk for the development of dependence and may require no more than harm reduction advice. Scores of 8-15 indicate hazardous or harmful drinking (pattern of alcohol consumption that increases the risk of harmful effects for the user of others) and brief intervention alone may be required. Scores of 20-40 are associated with probable dependence and require a referral to an addiction specialist for evaluation for possible immediate treatment. Such patients may need an intense intervention with monitoring. Scores of 20-40 are associated with probable dependence and require a referral to an addiction specialist for evaluation and possible immediate treatment. A score of 50 is not possible using the AUDIT screening questionnaire.
Contingency Management
The correct response is contingency management, as it uses positive reinforcement to encourage abstinence from drugs. Contingency management focuses on the maximal usage of medical clinic offices and guarantees decreased future hospitalizations. This patient with multiple previous hospitalizations may benefit from this mode of therapy.
Cathinone / Bath salts intoxication
Cathinone intoxication (sometimes described as “bath salts”) is the correct option as the patient shows typical signs of the condition. Cathinone intoxication is associated with psychosis, combativeness, myoclonus, delirium, increased blood pressure, increased heart rate, and sometimes seizures. The most important characteristic of synthetic cathinone intoxication is the long duration of delirium and psychosis.
A reduction in brain dopamine transmission may be associated with the development of ADHD/SUD comorbidity.
Similar deficits in dopamine binding and release are seen in patients with SUDs.
Personality disorders
Antisocial PD is characterized by a pervasive pattern of failure to conform to social norms and repeated violation of the rights of others since age 15 with no remorse.
Histrionic PD is characterized by excessive emotionality and attention seeking.
Borderline PD is characterized by multiple suicide attempts, self-injurious behavior, unstable interpersonal relationships and affective instability.
Schizotypal PD is characterized by peculiar thinking and behavior. Narcissistic PD is characterized by grandiosity and lack of empathy for others.
Anxiety disorder is the most common early-onset psychiatric condition that leads to an increased risk of developing a substance use disorder in adolescents. While the other answer choices may have varying degrees of contributing to a substance use disorder, they are not the most common.
Anxiety disorder
Treatment of the substance use disorder is the first step of treating patients with co-occurring disorders. Naltrexone and disulfiram are safe to use in patients who have depression and alcohol use disorder. SSRIs are first line treatment for patients with co-occurring depression and substance use disorder. Depression is the prominent mood disturbance in most bipolar disorders cases.
Chronic alcohol consumption affects many neurological pathways, such as dopaminergic, serotoninergic, GABA, opioid and glutamate pathways, and therefore causes significant changes in the brain. The glutamate pathway is responsible for memory changes in alcohol use disorder. Serotonin pathway is mostly responsible for impulsivity and loss of control, dopamine pathway for positive craving; GABA pathway is connected to sedation and anxiety reduction. The opioid pathway is connected with the euphoric response to alcohol.
Atomoxetine is the correct option as it is a norepinephrine reuptake inhibitor and does not have addiction potential. Since the patient has a history of cocaine use disorder, there is a need for a drug that is not addictive. Stimulants are the drug of choice in patients with attention deficit hyperactivity disorder (ADHD), but due to their addiction potential, these cannot be used. Second-line drugs that are non-stimulants like antidepressants and alpha blockers should be used. Of non-stimulants, atomoxetine is the preferred drug. Other drugs that could be used include bupropion and tricyclic antidepressants.
In women with co-occurring bulimia nervosa and substance use disorders, bulimia nervosa is usually manifested before a substance use disorder develops. Bulimia nervosa is an eating disorder, characterized by eating large amounts of food in a short time, followed by purging to get rid of the food consumed through vomiting, taking laxatives, excessive exercise, etc. Women with bulimia nervosa usually have a normal body weight. The earlier manifestation of bulimia nervosa in women with co-occurring SUD may be due to certain factors. For instance, these women may be using substances to dampen or substitute the bulimic urges. Moreover, both bulimia and SUD may be caused by a common factor, with bulimia symptoms simply having an earlier onset. Eating disorders are significantly related to SUDs, and women with these disorders may have almost double the risk of developing substance dependency. In contrast to bulimia nervosa, the symptoms of anorexia nervosa are usually preceded by SUD symptoms. Eating disorders are also associated with an increased incidence of cigarette smoking.
Hyperactivity of the mesolimbic dopamine system causes positive symptoms in schizophrenia, e.g. hallucinations and delusions. Hypoactivity of the mesocortical dopamine system is linked to negative symptoms of schizophrenia e.g. apathy, lack of emotion, and poor social functioning. The 3 systems related to schizophrenia are dopamine, GABA, and glutamate. Ethanol activates GABA A receptors and also facilitates dopamine transmission causing a wide range of effects on neurotransmitters related to schizophrenia. Cannabis enhances mesolimbic dopamine activity. Moreover, cannabinoid receptors interact with GABAergic transmission in both cortical and subcortical brain areas. The most prominent effect of cocaine intake is the elevation of dopamine transmission. Dopamine is one of the important neurotransmitters relevant to schizophrenia.
False positive PCP
Vanlefexine
False positive Opiates
Rifampin
Good Urine Validation parameters
temperature: 90 ºF to 100 ºF; pH: 3.0 to 8.0; urine creatinine > 20 mg/dl; specific gravity in the range of 1.001 to 1.030
Sensitive and specific alcohol marker
GGT and CDT specifically
Ibuprofen and naproxen, which are NSAIDs, can cause false-positive urine results for
barbiturates and cannabinoids and PCP.
Phenylpropanolamine is the correct answer because it is a nasal decongestant that cross-reacts with the immunoassays used for
the detection of stimulants like amphetamine resulting in false-positive results.
The presence of which one of the following genes can increase the risk of developing alcohol use disorder?
GABRA2 by decreasing the sedation effect of alcohol
Which opioid, like morphine, has a half-life of 30 minutes but a duration of action of four to five hours due to active metabolites?
Heroin
Onset of action: Alprazolam= 60 minutes; Temazepam= 30-60 minutes; Lorazepam= 30-60 minutes; Diazepam= 15-30 minutes Oxazepam= 60-120 minutes.
Diazepam is the quickest
Secondary Prevention
Workplace drug testing
Mechanism by which alcohol causes memory loss
A decrease in glutamate is the main mechanism by which alcohol causes memory loss.
Buprenorphine is metabolized primarily by cytochrome
Buprenorphine is metabolized primarily by cytochrome P450 3A4 (CYP3A4)
Mechanism of action of THC
THC which is primarily responsible for marijuana effects- acts on the cannabinoid 1 (CB1) receptor in the Ventral Tegmental Area and the Nucleus Accumbens to release dopamine.
S2BI is the best choice for diagnosis.
CRAFFT is the best choice for screening
Cyproheptidine is the recommended treatment option for serotonin syndrome. Serotonin syndrome can be caused by combination of any two drugs that increase serum serotonin levels such as monoamine oxidase inhibitors (MAOi), selective serotonin reuptake inhibitors (SSRi), serotonin-norepinephrine reuptake inhibitors (SNRi) and tricycle antidepressants (TCAs). Drugs such as the triptans and St. John’s wort also increase serotonin levels. This patient presents with the triad of increased neuromuscular activity, autonomic stimulation and agitation/confusion. Dantrolene is the treatment of choice for neuroleptic malignant syndrome (history of antipsychotic use) and malignant hyperthermia (history of inhaled anaesthetic use). Diazepam is a benzodiazepine used to treat alchohol withrawal, anxiety and insomnia. Phentolamine it used to treat hypertensive crises which usually occurs after eating tyramine-rich foods while taking MAOi. Naloxone is used to treat opioid overdose in which patients present with respiratory and CNS depression and also pin-point pupils.
The most likely genetic variant associated with prolonged QT interval CYP2B6*6 is the cytochrome P450 2B6 enzyme involved in methadone metabolism
Genetic variability in the CYP2B6 gene can influence the plasma concentrations, clearance, and metabolism of methadone.
Cannabis Abuse Screening Test (CAST)
This screen is well validated for adolescents and young adults and helps elucidate possible cannabis abuse disorder as per DSM-V criteria
Considering the mechanism of action of an opioid, which one of the following is the responsible receptor for physical dependence of opioids?
Mu-2
Polymorphisms of DBH (dopamine beta hydroxylase gene) affect disulfiram side effects.
P-450 2A6 gene polymorphisms have been shown to have a protective effect against nicotine dependence.
These polymorphisms act by modulating the accumulation of toxic metabolites that are aversive.
P-450 2D6 is correct - polymorphisms of this gene provide a degree of protection against the nonmedical use of codeine. These polymorphisms act by modulating the accumulation of toxic metabolites that are aversive.
The initial treatment for neuropathic pain typically involves dual reuptake inhibitors of serotonin and norepinephrine, tricyclic antidepressants or calcium channel alpha 2-delta ligands (such as gabapentin or pregabalin).
Stimulants such as amphetamines, commonly prescribed for ADHD, inhibit the reuptake of dopamine.
In pregnant women, the half-life of cocaine is generally longer and the effects of the drug last for a longer duration.
This patient’s psychosis has been most likely induced by the activation of the CB1 receptor by THC.
Agonist of GABAA receptor is correct because his respiratory depression, normal pupil size, hypotonia, hyporeflexia, and history of insomnia suggest benzodiazepine overdose.
Early onset of drug use, high doses, and long duration of drug use are all strong risk factors for more severe withdrawal symptoms.
Blood, salivary, and plasma cotinine as well as expired breath carbon monoxide concentrations, blood carboxyhemoglobin concentrations, and plasma or salivary thiocyanate concentrations are biochemical markers of smoking tobacco.
Cocaine inhibits catecholamine uptake by the noradrenaline and dopamine transporters, thereby enhancing the peripheral effects of sympathetic nerve activity and producing a marked psychomotor stimulant effect.
Basal ganglia - produces rewarding effects of drugs via the neurocircuitry of the basal ganglia. These effects are experienced as ‘well-being’, ‘high’, ‘euphoria’, and relief depending on the degree of tolerance to the rewarding effects of the drug.
Amygdala - withdrawal-negative affect stage where amygdala is involved as dysphoria, anhedonia, and irritability.
Cerebellum is incorrect as it is involved in balance and movements of the body without any significant effect on a person feeling happy or light hearted due to a drug.
Habenula is incorrect as it is also involved in the withdrawal-negative affect stage, which is still to come.
Salvia divinorum is a plant extract with transient psychoactive properties when its leaves are consumed by smoking, chewing or brewing as tea. It is metabolized by cytochrome P450 and the main isoforms are CYP2D6, CYP1A1, CYP2C18, and CYP2E1.
The most likely neurobiological mechanism in this context of opioid withdrawal is loss of inhibitory effect on the enzyme activity in the locus ceruleus.
AUTS2 is correct as this gene has been associated with alcohol withdrawal responses. Genome-wide association studies of alcohol consumption identified the autism susceptibility candidate 2 (AUTS2) gene as having an effect.
CHRNA3 is incorrect as it has an association with nicotine dependence and risk of smoking-related diseases such as lung cancer and peripheral arterial disease.
CHRNB4 is incorrect as it also has association with nicotine dependence. An additional gene associated with CHRNA3 and CHRNB4 is the CHRNA5 gene. All of these are associated with nicotine dependence and eventual risk of smoking-related diseases.
P-450 2A6 is incorrect as polymorphisms of this gene are associated with protective effect against nicotine dependence. Associations with alcohol drinking habits have not been demonstrated.
P-450 2D6 is incorrect as polymorphisms of this gene are associated with a degree of protection against nonmedical use of codeine. No significant associations with alcohol have been shown.
Medications that are primarily metabolized by Cytochrome P450 1A2 (CYP1A2) would have a decreased effect in the presence of tobacco smoking as tobacco smoke is an inducer of CYP1A2.
CHRNA5 is correct as CHRNA5/CHRNA3/CHRNB4 gene cluster is associated with nicotine dependence, and risk of developing smoking related diseases, like lung cancer and peripheral arterial disease.
Inhibition of NMDA receptors is correct because this patient’s violent behavior, visual hallucination (pouring blood in drink), amnesia, hyperthermia, hypertension, and muscle rigidity raise concern for phencyclidine (PCP) intoxication.
5HT2A receptor is correct because this patient is reporting symptoms consistent with intoxication with LSD.
The production of the acute psychotropic effects of cannabis involves the binding of tetrahydrocannabinol (THC) to cannabinoid receptors resulting in a decrease in the levels of cAMP. The psychotropic effects of cannabis, such as euphoria and anxiety, are produced by a variety of chemical substances, such as cannabinoids. Tetrahydrocannabinol (THC) is the principal psychoactive cannabinoid present in cannabis.
Alprazolam has a higher abuse potential than other benzodiazepines because of its pharmacokinetic and pharmacodynamic properties, Alprazolam is highly potent, rapidly absorbed, has a low lipophilicity, and a short half-life.
Serotonin is correct. 3,4-methylenedioxymethamphetamine (MDMA) or “ecstasy” is a drug related to amphetamines. It is commonly used at “raves”/music festivals. It is primarily serotonergic; however, it is also thought to have some dopaminergic effects. Symptoms of MDMA intoxication include euphoria, sociability and increased feelings of empathy, bruxism, blurry vision, hypertension, tachycardia, hyperthermia, diaphoresis, agitation, nausea, and ataxia
The main effect is produced when DXM is metabolized into dextrorphan, which antagonizes actions at N-methyl-D-aspartate (NMDA) receptors, in a manner similar to that of PCP and ketamine (giving the dissociative effects).
The question describes a case of acute intoxication with phencyclidine (PCP). Like ketamine (dissociative anesthesia) and memantine, PCP acts on the NMDA receptor and blocks it. PCP acute intoxication involves prominent neuropsychiatric findings including violent or combative behavior, altercation, rage, visual hallucinations, psychosis, and delirium are common.
HPPD is a known neuropsychiatric disorder characterized by the persistence of hallucinations after stopping the responsible drug. HPPD is associated with an imbalance between inhibitory/excitatory signaling in lower levels of the visual pathway of the brain.
Most inhalants produce very rapid onset, short-acting alcohol-like intoxication, and regular use is often associated with damage to the brain and other organs.
It has been documented that about 5 to 10 grams or 25 milligrams per kilograms body weight dosage of caffeine can have lethal effects like cardiac arrhythmias.
COWS scores below 13 are considered mild opioid withdrawal and above 36 are considered severe withdrawal.
Signs of LSD overdose are distinctive which makes the clinical diagnosis easy. It is available in pills, capsules or liquid form. It creates a sensory perception like “expansion of consciousness.”
Acamprosate is a commonly used first-line drug for alcohol use disorder. It is a modulator of glutamatergic transmission by the effect on NMDA receptors in the CNS. It can be taken by patients of liver disease or renal disease (though dose adjustments are required for mild to moderate kidney disease, and it is contraindicated in severe kidney disease). It is highly effective and recommended to be taken for up to six months for adequate effect.
Benzodiazepines enhance the response to GABA by facilitating the opening of GABA-activated chloride channels. Binding of GABA to its receptor triggers an opening of a chloride channel, which leads to an increase in chloride conductance. The influx of chloride ions causes a small hyperpolarization that moves the postsynaptic potential away from its firing threshold and, thus, inhibits the formation of action potentials. Benzodiazepines are positive allosteric modulators.
CIWA is a tool to understand the severity of withdrawal by assessing the patient for symptoms such as nausea/vomiting, tremors, anxiety, agitation, paroxysmal sweats, orientation and clouding of sensorium, tactile, auditory, visual disturbances, and headache. For each symptom, the patient is rated on a scale of 0-7 and given corresponding points. CIWA of < 8 indicates minimal or mild withdrawal symptoms. A score of 8-15 indicates moderate withdrawal. A score >15 indicates severe withdrawal.
Modafinil has some stimulant-like properties but is considered a second line treatment for ADHD.
Patients with ethylene glycol intoxication can develop acute kidney injury due to direct effects of a metabolite glycoaldehyde and deposition of calcium oxalate crystals in renal tubules.
Approximately which of the following percentages of patients with schizophrenia abuse drugs or alcohol?
50%
Serotonin syndrome is the correct answer. It is a rare but potentially fatal complication of SSRIs when combined with other serotonin-enhancing agents including TCAs, MAO inhibitors, St John’s wort, hallucinogens, etc. It develops over hours with features of drowsiness, hypomania, myoclonus, hyperthermia and autonomic symptoms (happy drunk state). It may resemble NMS. Treatment is rehydration with IV fluids and treatment of symptoms of anxiety with benzodiazepines. Myoclonic epilepsy is unlikely because there is no previous history of any seizure (absence, myoclonus or generalized tonic clonic) and a typical history of symptoms after drug use along with H/o altered mental state. NMS may resemble serotonin syndrome, but a history of the combination of SSRIs with other serotonergic agent favors serotonin syndrome. There is no history of previous mania. Regarding psychogenic seizures-the patient should not be confused.
Phenobarbital is most useful and effective in patients with dependence on more than one drug—and high dose benzodiazepine use disorder.
This case describes a patient presenting with muscle weakness and nausea and vomiting. Her past medical history is unremarkable but she readily admits to using inhalants. Her lab work demonstrates metabolic acidosis, hypokalemia, hypophosphatemia, and elevated creatinine kinase.
Locus coeruleus (LC), a part of the reticular activating system, is a nucleus located in the pons of the brainstem. It is the main site for the production of noradrenaline in the brain. It receives and processes sensory signals from the body and is associated with arousal and vigilance. LC is the area of the brain most likely to be involved in opioid dependence and opioid withdrawal.
In the past few years, there has been a dramatic rise in the abuse of “bath salts” products that are purchased as legal alternatives to classical illicit drugs like cocaine, methamphetamine, and 3,4-methylenedioxymethamphetamine (MDMA).
Causes cardiovascular complications
This patient fulfills the criteria of caffeine withdrawal. With the sudden cessation of caffeine by a regular user, withdrawal symptoms become an inevitable hurdle to maintaining abstinence. When patients decide to overcome their dependence by sudden cessation, symptomatic management is crucial to make the withdrawal period less troublesome. Symptoms of caffeine withdrawal begin 12 to 24 hours after last caffeine dose and peak after 1-2 days of abstinence. General consensus shows that caffeine withdrawal symptoms last for 2-9 days, so it is recommended to provide symptomatic management for these days and then improvise according to patient’s response.
Pseudobulbar affect is “emotional incontinence” resulting from brain injury or neurologic disease.
Type I error is correct because this study determines that there is an association between vaping and liver cirrhosis when there is not a statistically significant difference, given the p-value of 0.3. This is an example of a type I error, which occurs when the null hypothesis is incorrectly rejected.
Genetic variations in CYP2B6 influences the pharmacological effects of bupropion for smoking cessation.
The A1 allele of DRD2 gene is most likely to be associated with an increased risk of developing alcoholism.
Which of the following genes confers a protective effect against alcohol use disorder?
ALDH2*2
Genetic variations in which of the following genes may explain the differences in NAS severity seen among different infants?
PNOC
Which of the following genes are associated with an increased risk for developing cocaine dependence?
Family with sequence similarity 53 member B (FAM53B)
In adolescent brain development, which of the following structures is last to mature?
Pre frontal Cortex
In certain circumstances, HIPAA allows health care professionals to disclose health information without requiring the permission of the patient such as when the patient is incapacitated or unconscious
Opioid overdose
To enhance patient’s motivation to enter therapy for addiction and maximize the therapeutic effect, the patient’s stage of change should be matched to the appropriate phase of intervention. The five phases are (1) recruitment, (2) retention, (3) progress, (4) process, and (5) outcomes.
Cytochrome P450 family 2 subfamily A member 6 (CYP2A6)
Protective against nicotine dependence
Which of the following genes may be associated with an increased risk of developing alcohol use disorder?
GABRA2
it is important to remember that efficacy refers to controlled circumstances and effectiveness refers to “real world” treatment effects.
Alcohol misuse is the primary cause of cirrhosis and the second most frequent indication for liver transplantation in the Western world. Patients who have genetic polymorphisms with an isoleucine-to-methionine substitution at position 148 (rs738409 C>G) in the patatin-like phospholipase domain protein 3 (PNPLA3) have an increased risk for the entire spectrum of alcoholic liver disease including alcohol-induced liver injury, alcoholic cirrhosis and hepatocellular carcinoma.
ADH1B2 is one of the two alleles (ADH1B1 and ADH1B2), produced because of a mutation ADH1B gene on chromosome 4. ADH1B2 has a protective effect against alcohol overuse, hence the carrier of this allele have low alcohol consumption and dependence rates. ADH1B*2 carriers have high rates of alcohol metabolism, thus causing accumulation of acetaldehyde in increased amounts in the circulation.
1B2 are poor drinkers
All CYP2B6 variants show stereoselectivity in favor of metabolizing (S)-Methadone
Selection bias is correct because even though not a single patient opted out of the study, this is still an example of selection bias, as the study population (inpatients) does not necessarily reflect the general population.
This question describes the patient with mild anxiety symptoms. Anxiety affects people with different levels of intensity, biologically as well as subjectively. Some people may suffer from incapacitating severe anxiety, while others may experience moderate anxiety that does not have a drastic effect on their life.
Psychotherapy- mild anxiety
Peak plasma concentration of methamphetamine
2.5 hours
Gene Linked to Cannabis Addiction
FAAH
ASAM PPC-2R
has supplement for pharmacotherapy for alcohol treatment
In patients who misabuse alcohol and are prescribed naltrexone, which of the following genes is linked to a greater reduction of heavy drinking
OPRM1
4 levels of denials
Level 1- lack of accurate information
Level 2- consciously defensive
Level 3- unconsciously defensive
Level 4- delusional
ASAM levels of care
0.5- Early intervention
I- Outpatient Treatment
II.1- Intensive Outpatient
II.5- Partial Hospitalization
III.1- Clinically Managed Low Intensity Residential Services
III.3- Clinically Managed Medium Intensity Residential Treatment
III.5- Clinically Managed High Intensity Residential Treatment
III.7- Medically Monitored Intensive Inpatient Treatment
IV- Medically Managed Intensive Inpatient Treatment
25% of the nicotine inhaled reaches the bloodstream
Benzodiazepine metabolism may be altered by concurrent therapy with oral contraceptives
Distinguish cocaine induced psychosis from patients with schizophrenia in an acute episode
Somatosensory hallucinations
peyote cactus is Serotonin type 2A
Dialectical Behavior Therapy is gold standard for
co-occurring borderline personality disorder and SUD
PPI can cause false positive for
THC
Personality disorder most common among patients with SUD
Antisocial Personality Disorder
Sertraline can cause false positive for
Benzodiazepine
gene involved in opioid addiction relapse
ALDH5A1
Bulimia nervosa
Mild- 1-3 per week
Moderate- 4-7 per week
Severe- 8-13 per week
Extreme- 14 or more per week
Altered perception of time- is most commonly find in MDMA ecstasy users
Altered perception of time- is most commonly find in MDMA ecstasy users
Monohydrate crystals are the most specific for ethylene glycol
Gene linked to Cannabis use disorder
CNR1
Inhaled Cannabis contains 3 times the tar as compared to
cigarette smoke
Dextromethorphan can cause false positive for
PCP
CYP3A4
Fluvoxamine and Methadone
Disulfiram compliance
Carbon disulfide and Acetone
Prevalence of 12-month and lifetime DSM-5 NUD
20% and 27.9%
ASAM Dimensions
- Acute Intoxication/Withdrawal Potential
- Biomedical Conditions
- Cognitive Conditions
- Dimension of Change
- Relapse
- Recovery
Labetalol can cause false positive for
Amphetamine
