Withdrawal
Use Disorders
Opioids
Alcohol
Grab Bag
100
Someone who is on methadone hasn't taken it for 4 days and comes in with COWS 8. This is the treatment.
Methadone! Dose?
100
This is one of several screening tools validated for use in office or hospital settings.
AUDIT (Alcohol Use Disorders Identification Test): A 10-item test by the World Health Organizationthat checks for heavy or risky drinking.
AUDIT-C: A shorter, 3-question version focused just on alcohol use frequency and amount.
DAST-10 (Drug Abuse Screening Test): A 10-question tool that looks at drug use problems and risks.
ASSIST (Alcohol, Smoking, and Substance Involvement Screening Test): An 8-question test covering tobacco, alcohol, and illegal drugs.
CAGE Questionnaire: A fast 4-question yes/no tool for spotting misuse. [1, 2, 3, 4, 5]
CRAFFT: A 6-question screening tool made for youth ages 12 to 21 to check for alcohol and drug risks.
100
This is why is saying "opiates" is like nails on the chalkboard to me.
What is because it doesn't account for synthetic opioids (fentanyl) and is technically incorrect in most instances?
100
Someone ran out of alcohol and started drinking isopropanol instead. They come into the ED. This is the treatment.
What is supportive care?
100
A young person comes in with weakness and tingling in their extremities and an elevated MCV. They admit to huffing this substance (Need the chemical name, not street name).
What is nitrous oxide?
200
The SAEM GRACE-4 writers recommend this medication for moderate to severe alcohol withdrawal syndrome
What is phenobarbital or phenobarbital with benzodiazepines?
200
This is an evidence-based public health approach used to identify, reduce, and prevent risky or problematic substance use, such as alcohol and drug misuse, before it escalates into a severe disorder
SBIRT (screening, brief intervention, and referral to treatment)
200
These are the only two medications/interventions used in OUD which have been shown in studies to reduce mortality.
What are methadone and buprenorphine?
200
When I look at labs of someone with an alcohol use disorder and they have an elevated MCV, I assume they have this nutritional deficiency.
What is folate?
200
This is dextromethorphan's mechanism of action.
NMDA antagonist, small amount of opioid agonism (don't need both, just NMDA antagonist)
300
This is the treatment for kratom withdrawal.
What is buprenorphine? Will accept Suboxone or subutex as answers
300
Someone stuffed meth when getting arrested. This is the one sign/symptom that increases the patient's mortality.
What is hyperthermia?
300
A patient with severe OUD is in the hospital for an infection. You are treating opioid withdrawal well but they continue to be hypertensive and tachycardic. This is the likely reason and treatment.
What is alpha 2 agonist withdrawal; clonidine or dexmedetomidine?
300
When someone with alcohol use disorder comes in with an elevated lactate that is unexplained, I assume they have this nutritional deficiency.
What is thiamine?
300
This is a well known side effect of chronic ketamine use.
What is ketamine bladder syndrome? (any bladder answer is acceptable)
400
This is the best medication for baclofen withdrawal.
What is baclofen?
400
The SAEM Grace-4 writers recommend one of these two medications specifically for cannabinoid hyperemesis syndrome as first line in the ED
What is haloperidol or droperidol?
400
These are the two potential positive opioids on a UDS after eating a poppyseed muffin
What is codeine and morphine?
400
Hand sanitizers had this contaminant in them during covid, which was deadly when people drank them.
What is methanol?
400
This Middle Eastern and Eastern African popular plant is chewed on for a stimulant effect and the active ingredient is cathinone.
What is Khat?
500
Phenobarbital is beneficial in alcohol withdrawal at the neurotransmitter/cell signaling level for three reasons. Name at least 2.
1. holds cl- channels open longer (instead of increasing frequency)
2. doesn't require GABA
3. inhibits glutamate
500
The SAEM GRACE-4 writers recommended offering patients with Alcohol use disorder who are discharging home anti-craving medications. These are the two that they mention.
What is naltrexone or acamprosate?
500
Someone comes in with many episodes of syncope after methadone overdose. HR is 62 and BP normal in between episodes. EKG shown. This is the treatment.
What is speed up the HR (medication vs pacing)? I prefer to not hurt people with isoproterenol. If you say mag, I'm gonna need you to also say something about speeding up the HR
500
Why do people who drink much alcohol smell fruity?
What is Acetate/acetoacetate/acetone production?
500
Smoking cigs actually induces Cyp1A2. This psychiatric medication can accumulate in patients who abruptly stop smoking because they generally need more of it when they are smoking.
What is clozapine?