Substance Use & Toxicology

Question 1

What is the prevalence of cigarette smoking among patients in addiction treatment and mental health treatment settings in the United States?

Answer 1

50% - 90%

Question 2

When is the time from that symptoms of heroin withdrawal will peak (after cessation)?

Answer 2

36-72 hours after cessation (1.5 to 3 days). Though the duration varies with the half-life of the drug used and the period of drug use.

Question 3

Signs of excessive cholinergic activity (as in organophosphate poisoning) and treatment.

Answer 3

SLUDGE signs (salivation, lacrimation, urination, diaphoresis (or defecation), gastrointestinal motility, and emesis). Treat with atropine (muscarinic acetylcholine receptor antagonist)

Question 4

What is the primary mechanism of action of hallucinogens such as lysergic acid diethylamide (LSD)

Answer 4

5-hydroxytryptamine receptor (5-HT) agonism

Question 5

Use of what medication causes decreased elimination of caffeine, increasing risk for caffeine intoxication?

Answer 5

OCPs

Question 6

Treatment for hallucinogen persisting perception disorder?

Answer 6

Antipsychotics that are 5-HT2A antagonists are used to reverse the psychological effects and hallucinations

Question 7

Most common cause of hepatitis in IV drug users

Answer 7

Hepatitis C

Question 8

Most common reason for liver transplantation in the US

Answer 8

Hepatitis C

Question 9

Urinary manifestations of cocaine use

Answer 9

Tea-colored urine (from rhabdomyolysis)

Question 10

What is the window of detection for phosphatidylethanol (PEth)?

Answer 10

Useful in detecting prolonged, or binge, drinking. Detection period is 4 weeks but PEth can remain in the blood for longer.

Question 11

What is the window of detection for Ethyl glucuronide (EtG)?

Answer 11

It is detectable in blood for up to 36 hrs and in the urine for up to 5 days. Sensitivity is dose and time-dependent and starts decreasing after 24-48 hrs. Can be useful to test of ethanol use and monitor for abstinence in settings where drinking is prohibited.

Question 12

Chronic exposure to benzene, an inhalant found in gasoline, is associated with what medical complications (3)?

Answer 12

1) Bone Marrow Injury (leading to aplastic anemia, MDS, multiple myeloma)
2) Increased risk for leukemia
3) Reproductive system toxicity

Question 13

Toluene is found in what substances? Chronic exposure to toluene can lead to damage to what systems?

Answer 13

1) Gasoline, paint thinners, correction fluid
2) Brain, liver, and kidney damage

Brain damage results in loss of tissue -> impaired cognition, ataxia, spasms, hearing/vision loss

Question 14

A CIWA score of at least what is associated with severe withdrawal and increased risk for DTs?

Answer 14

16

Question 15

In acute alcohol withdrawal, psychotic and perceptual disturbances begin when? What about seziures?

Answer 15

1) 8-12 hrs
2) 12-24 hrs

Question 16

The onset of delirium tremens occurs when?

Answer 16

Between 3 days to 7 days

Question 17

What gene variant likely provides a protective effect against nonmedical use of codeine? How?

Answer 17

1) Polymorphisms in the gene that encodes P450 2D6. 2) They act by modulating accumulation of toxic metabolites that are aversive

Question 18

In adults, lead poisoning causes a motor polyneuropathy that often presents as?

Answer 18

Bilateral wrist drop and/or foot drop

Question 19

What are examples of changes to the immune system, in the setting of alcoholism, that can predispose a patient to infections?

Answer 19

Alcoholism can cause increased sequestration of neutrophils, decrease in fixed macrophage phagocytic capacity, decreased white blood cell production, and overall decreased cell mediated immunity.

Question 20

What is the timeline for caffeine withdrawal symptoms?

Answer 20

They begin 12-24 hrs after cessation –> peak at 1-2 days –> and last as long as 2-9 days

Question 21

What is the most significant cause of drug-induced stroke (also a cause of seizures)?

Answer 21

Cocaine (IV and inhaled&raquo_space;»» intranasal)

Question 22

How does PCP exert its hallucinogenic effects?

Answer 22

Antagonism of NMDA receptors

Question 23

Ecstasy, also known as methylenedioxymethamphetamine, exerts its effects on which two neurotransmitters?

Answer 23

DA and 5-HT

Question 24

Mechanism of MDMA (ecstasy)?

Answer 24

Blocks reuptake of serotonin, induces massive release of serotonin, increases NE and to a smaller extent DA

Question 25

What two drugs of abuse exert their effect by way of serotonin?

Answer 25

LSD and MDMA (ecstasy)

Question 26

How long does it take for GGT to normalize after cessation of alcohol consumption?

Answer 26

8 weeks

Question 27

What are the substances (4) that can cause nystagmus during intoxication?

Answer 27

PCP, inhalants, alcohol, sedative-hypnotics