Substance-Related Disorders 1

Question 1

What is the most important modifiable
risk factor in the US for health prevention?

Answer 1

Smoking

Question 2

What does nicotine withdrawal present as?

Answer 2

-Restlessness
-Anxiety
-Irritability
-Sleep abnormalities
- HA
-Depression
-Increased appetite
-Weight gain
-Chest tightness
-Nicotine craving

Question 3

_____ after nicotine abstinence is common

Answer 3

Relapse

Question 4

What are the three main treatment options for smoking cessation?

Answer 4

1. Nicotine tapering therapy
2. Bupropion
3. Varenicline

Question 5

What options are available for nicotine tapering therapy?

Answer 5

-Gum
-Nasal sprays
-Transdermal patches
-Inhaler
-Lozanges

Question 6

What is the MOA of Bupropion?

Answer 6

Dopamine and norepinephrine reuptake inhibitor

Question 7

What is the MOA of Varenicline?

Answer 7

Blocks nicotine receptors, reducing nicotine activity, mimic effects thereby reducing the reward effect and preventing withdrawal

Question 8

What is the timeline of Varenicline administration?

Answer 8

Begin one week prior to quit date an dcontinue four months after quit date

Question 9

What are the AEs of Varenicline?

Answer 9

Suicidality
-HA
-Nausea
-Insomnia
-Neuropsychiatric conditions

Question 10

What are the opioids?

Answer 10

1. Heroin
2. Hydrocodone
3. Codeine
4. Morphine
5. Dextromethorphan
6. Meperidine
7. Methadone

Question 11

How does opioid intoxication present?

Answer 11

Euphoria and sedation

(drowsiness, impaired social functioning, impaired memory, slow or slurred speech)

Question 12

Opioid intoxication may progress to ____

Answer 12

N/V, seizures and coma

Question 13

What are the hallmarks of opioid intoxication on physical exam?

Answer 13

-Pupillary constriction
-AMS
-Respiratory depression
-Bradycardia
-Hypotension

Question 14

Opioid withdrawal may cause ___ breathing

Answer 14

Biot’s (groups of quick, shallow breaths followed by regular or irregular periods of apnea)

Question 15

What is the classic GI effect of long term opioids?

Answer 15

Constipation

Question 16

What are the symptoms of opioid withdrawal?

Answer 16

-Piloerections
-Pupil dilations
-Flu-like symptoms
-Rhinorrhea
-HTN
-Lacrimation
-Priritis
-Tachycardia
-N/V/D

Question 17

Is opioid withdrawal life threatening?

Answer 17

No

Question 18

How do you treat opioid intoxication/overdose?

Answer 18

Naloxone

Question 19

What is naloxone?

Answer 19

Opioid antagonist

Question 20

What is the onset of action of naloxone?

Answer 20

2 minutes IV (5 minutes IM)

Question 21

How long does naloxone work?

Answer 21

30-60 minutes

Question 22

How is opioid withdrawal managed?

Answer 22

Symptomatic withdrawal

Question 23

What is the main medication used in opioid withdrawal?

Answer 23

Clonidine (decreases sympathetic symptoms)

Question 24

Opioid withdrawal use _______ for diarrhea

Answer 24

Loperamide

Question 25

Opioid withdrawal use _______ for abdominal cramps

Answer 25

Dicyclomine

Question 26

Opioid withdrawal use _______ for joint and muscle pain/cramps

Answer 26

NSAIDs

Question 27

Opioid withdrawal use _______ for mild withdrawal

Answer 27

Benzos

Question 28

Opioid withdrawal use _______ for severe symptoms

Answer 28

Detox with methadone or Buprenorphine + Naloxone

Question 29

What are the three options for longterm management of opioid dependence?

Answer 29

1. Methadone 2. Suboxone 3. Naltrexone

Question 30

What is the MOA of methadone?

Answer 30

Long-acting opioid agonist to control withdrawal

Question 31

____ can be used in pregnant opioid dependent women

Answer 31

methadone

Question 32

What is the adverse effect of methadone?

Answer 32

Can cause QT prolongation

Question 33

What is the MOA of buprenorphine?

Answer 33

Partial opioid agonist

Question 34

What is suboxone?

Answer 34

Buprenorphine + Naloxone

Question 35

Why is Naloxone in Suboxone?

Answer 35

Prevents intoxication from IV injection

Question 36

What is naltrexone?

Answer 36

Competitive opioid antagonist

Question 37

What is the main concern with naltrexone?

Answer 37

Precipitates withdrawal if used within seven days of heroin use

Question 38

How is naltrexone administered?

Answer 38

oral or monthly injections

Question 39

When does alcohol withdrawal onset?

Answer 39

6-36 hours after last drink

Question 40

What is the main category of alcohol w/d symptoms?

Answer 40

Increased CNS activity (tremors, anxiety, irritability, diaphoresis, palpitations, HTN, insomnia and GI

Question 41

What is "uncomplicated" withdrawal?

Answer 41

No seizures, hallucinations or delirium tremens

Question 42

When do alcohol withdrawal seizures usually start?

Answer 42

6-48 hours after last drink

Question 43

What type of seizures usually occur during alcohol withdrawal?

Answer 43

Tonic-clonic

Question 44

When do alcoholic hallucinosis usually start in alcohol withdrawal?

Answer 44

12-48 hours after last drink

Question 45

What does alcoholic hallucinosis present as?

Answer 45

-Visual or tactile hallucinations -Clear sensorium -Normal vital signs

Question 46

When do delirium tremens usually onset?

Answer 46

2-5 days after last drink

Question 47

How does delirium tremens usually present?

Answer 47

-Delirium (altered sensorium) -Hallucinations -Agitation -Abnormal vital signs -Diaphoresis

Question 48

Can alcohol withdrawal be fatal?

Answer 48

Yes

Question 49

How is alcohol withdrawal treated?

Answer 49

-IV benzos -IV fluids -IV thiamine (B1) -Magnesium -Multivitamins (including B12 and folate) -Electrolyte repletion

Question 50

What is the MOA of benzos in alcohol withdrawal?

Answer 50

Potentiates GABA-mediated CNS inhibition (because alcohol mimics GABA and withdrawal causes excessive CNS activity)

Question 51

What benzos are preferred in alcohol withdrawal for patients with cirrhosis or alcoholic hepatitis?

Answer 51

Lorazepam or Axazepam