Substance-Related Disorders

Question 1

MOA of EtOH?

Answer 1

1) Activates GABA and serotonin receptors

2) Inhibits glutamate receptors and voltage-gated Ca channels

Question 2

Most common co-ingestant in drug OD?

Answer 2

EtOH

Question 3

Most commonly abused substance in US?

Answer 3

EtOH

Question 4

DT tx?

Answer 4

Chlordiazepoxide is DOC, others = diazepam, lorazepam, carbamazepine, valproate

Question 5

Early EtOH withdrawal?

Answer 5

6 hrs = anxiety, tremors, sweating, palpitations

Question 6

EtOH withdrawal seizures?

Answer 6

12-48 hrs = single seizure or multiple in small period of time

Question 7

Alcoholic hallucinosis?

Answer 7

12-24 hrs = auditory, visual, tactile hallucinations with normal vital signs and intact sensorium

Question 8

DTs?

Answer 8

2-4 days = fever, HTN, tachycardia, diaphoresis, hallucinations, disorientation

Question 9

CIWS?

Answer 9

Clinical Institute Withdrawal Scale = monitors EtOH withdrawal and sxs

Question 10

Meds for EtOH dependence?

Answer 10

1) Disulfiram = blocks aldehyde DH in liver
2) Naltrexone = opioid receptor blocker
3) Acamprosate = inhibits glutamate
4) Topiramate = potentiates GABA and inhibits glutamate

Question 11

Best drug used in highly motivated EtOH pts?

Answer 11

Disulfiram

Question 12

CI to disulfiram?

Answer 12

1) Cardiac dz
2) Pregnancy
3) Psychosis

Question 13

Decreases desire/craving and “high” assoc with EtOH?

Answer 13

Naltrexone, best used in persons with family hx

Question 14

Should be started post-detox for relapse prevention in EtOH pts?

Answer 14

Acamprosate

Question 15

Can be used in pts with liver dz for EtOH pts?

Answer 15

Acamprosate

Question 16

Cocaine MOA?

Answer 16

Blocks dopamine reuptake

Question 17

Cocaine intoxication tx?

Answer 17

1) Reassurance
2) Haldol for agitated pt
3) Tx the arryhthmias

Question 18

Cocaine dependence tx?

Answer 18

Psychological interventions

Question 19

Amphetamine MOA?

Answer 19

Blocks the reuptake and facilitate of dopamine and NE

Question 20

MDMA and MDEA MOA?

Answer 20

Releases dopamine, NE and serotonin

Question 21

PCP MOA?

Answer 21

Blocks NDMA glutamate receptors and activate dopamine neurons

Question 22

Rotatory nystagmus?

Answer 22

PCP intoxication

Question 23

Tactile and visual hallucinations?

Answer 23

Cocaine and PCP intoxication

Question 24

PCP intoxication tx?

Answer 24

1) BZDs for agitation, anxiety, muscle spasm, seizures

2) Haldol for severe agitation or psychosis

Question 25

PCP withdrawal?

Answer 25

Nope, but can have flashbacks with recurrence of intoxication due to release of drug from body lipid stores

Question 26

GHB (gamma-hydroxybutyrate)?

Answer 26

CNS depressant = date rape drug

Question 27

Highest mortality rate from withdrawal?

Answer 27

Barb withdrawal

Question 28

AE of treating BZD OD with flumazenil?

Answer 28

Precipitates seizures

Question 29

Barb OD tx?

Answer 29

Alkalinize urine with Na bicarb

Question 30

Sedative-hypnotic withdrawal tx?

Answer 30

BZD taper

Question 31

Most COD from street heroin usage?

Answer 31

Infection secondary to needle sharing

Question 32

Opioid which may cause serotonin syndrome when combined with MAOI?

Answer 32

Meperidine

Question 33

Opioid which does not cause mioisis?

Answer 33

Meperidine

Question 34

COWS?

Answer 34

Clinical Opioid Withdrawal Scale = objective measures to assess withdrawal severity

Question 35

LSD MOA?

Answer 35

Acts on serotonergic system

Question 36

Most commonly used illicit substance?

Answer 36

Marijuana

Question 37

Marijuana MOA?

Answer 37

Inhibits adenylate cyclase in brain

Question 38

Most commonly used psychoactive substance in US?

Answer 38

Caffeine

Question 39

Caffeine MOA?

Answer 39

Adenosine blocker, increases cAMP and stimulant effect via dopaminergic system

Question 40

Smoking pregnancy complications?

Answer 40

1) LBW | 2) Persistent pulmonary HTN of newborn