Substance Use Disorders and Addiction Practice Question Flashcards
There are several factors associated with a higher risk of overdose for patients receiving opioid analgesics. Which of the following is not a risk factor?
A. Receiving Medicaid
B. Being 19-29 years of age
C. Concomitant use of anti-depressants
D. Recent release from a drug rehabilitation program
E. Being terminally ill
B) Being 19-26 years of age. Rates of drug overdose are higher in older populations (30-60 y.o). A 50 year old is more likely to be receiving opioid analgesics than a 26 year old, therefore introducing a risk of overdosing. A),C),D), and E) are all risk factors.
What does a positive result using the CAGE questionnaire indicate?
A. Risk of suicide
B. Mental Illness
C. Eligible for Medicaid
D. Risk of overdosing
E. Alcohol use disorder
E) Alcohol use disorder. The CAGE questionnaire is a specific and sensitive test used to screen people for an alcohol use disorder. A positive answer to any of the 4 questions indicates an alcohol use disorder.
Most fatal drug overdoses can be attributed to the following drug(s)?
A. Benzodiazepines
B. Cocaine and heroin
C. Loop diuretics
D. Opioid analgesics
E. NSAIDs
D) Opioid analgesics. Opioid use is the most common cause of drug overdose, even exceeding the rate of overdose from cocaine and heroin combined. N.B. There is a toxicity associated with all drugs, and thus always a risk of overdosing. The narrow therapeutic index of opioid analgesics makes it especially dangerous relative to other medications.
One of the possible criteria used to diagnose a substance use disorder detailed in DSM-5, includes displaying signs of tolerance. Which of the following is not an example of tolerance?
A. A heroin addict requires larger, more frequent injections to get high, compared with his past use.
B. An alcoholic wakes up after a long night of binge drinking, and immediately drinks alcohol to avoid “hangover”symptoms.
C. A 19 year old, who typically feels very intoxicated from 3 drinks of vodka, now feels relatively “normal” after consuming the same amount
D. A 60 year old man is prescribed an opioid analgesic for his chronic lower back pain. During a follow-up visit to his physician 1 month later, he complains that his medication stopped working last week.
B) A person with an alcohol use disorder wakes up after a long night of binge drinking, and immediately drinks alcohol to avoid “hangover” symptoms. This answer would be an example of withdrawal (this is also another criteria of a substance abuse disorder). Tolerance occurs when a higher dose is required to achieve the same effect; a simple concept that applies to both substance abuse and normal pharmacotherapy.
Which of the following is not a question from the CAGE test?
A. Have you ever felt that you should cut down on your drinking?
B. Have you noticed a tolerance develop when drinking alcohol?
C. Have you ever felt bad about your drinking?
D. Do you ever take a drink first thing in the morning?
B) Have you noticed a tolerance develop to drinking alcohol? Tolerance is not a component to the CAGE test, but is a criterion for diagnosing a substance use disorder according to DSM-5.
A 23-year-old man is seen at a university clinic. During the psychosocial history, the patient discloses he occasionally binge drinks alcohol. The attending physician administers the CAGE screening questionnaire to determine the patient’s need for additional assessment. According to the CAGE scoring criteria, what score indicates that the patient is at risk for an alcohol-related disorder?
A. 0
B. 1 or more
C. 2 or more
D. 3 or more
E. 4
B) 1 or more. A patient needs to answer affirmatively (yes) to 1 question on the CAGE to be at risk for Substance Use Disorder
A 45 year old woman is being see in in primary care. During the medical interview the patient reports that she has been using opioids outside of the prescribed recommendations. She intends only to take 1 pill per day, but often ends up taking up to 4 per day. She also has begun spending a lot of time trying to acquire new prescriptions and drives across the state border to find new pharmacies to fill her prescriptions. According to the DSM-5 diagnostic criteria for substance use disorders, this patient’s pattern of behavior appears most consistent with which of the following domains?
A. Impaired Control
B. Risky Use
C. Social Impairment
D. Pharmacological
A) Impaired Control. The vignette details 2 of the criteria that fall under the Impaired Control domain: 1) [Substance name] is often taken in larger amounts or over a longer period than intended and 2) A great deal of time is spent in activities necessary to obtain the [substance name] , use [substance name], or recover from its effects. The criteria under the domain of Social Impairment include: Recurrent [substance name] use resulting in a failure to fulfill major role obligations at work, school or home; Continued [substance name] use despite having persistent or recurrent social or interpersonal problems caused or exacerbated by the effects of [substance name]; and Important social, occupational, or recreational activities are given up or reduced because of [substance name] use. Criteria under Risky Use include: Recurrent [substance name] use in situations in which it is physically hazardous and [substance name] use is continued despite knowledge of having a persistent physical or psychological problem that is likely to have been caused or exacerbated [substance name]. Criteria under Pharmacological domain include: Tolerance, as defined by either of the following: (a) A need for markedly increased amounts of [substance name] to achieve intoxication or the desired effect or (b) Markedly diminished effect with continued use of the same amount of [substance name] and Withdrawal, as manifested by either of the following: (a) The characteristic withdrawal syndrome for [substance name] or (b) [substance name] (or a closely related substance) is taken to relieve or avoid withdrawal symptoms.
A 34-year-old patient comes to his physician’s office for a routine health examination. The patient reports that he has been using “amphetamines” and states that he most often “uses at work while driving the truck”. The patient states he has “wanted to quit, but has been unsuccessful” in his efforts. The physician concludes the patient is displaying symptoms of Stimulant Use Disorder. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), what level of severity reflects the best choice of coding for this patient?
A. Severe
B. Abuse
C. Moderate
D. Mild
E. Dependent
D. Mild
