Neurobiology of Addiction
This most prevalent site is responsible for the pain-relief associated with drugs such as morphine and heroin.
A GABA Receptor
B mu-opioid receptor
C kappa-opioid receptor
D serotonin transporter
E dopamine receptor
Pain relief, as observed in those exposed to drugs such as morphine, is due to the binding of the mu-opioid receptor. Euphoria is also thought to result from ligand-binding at these sites, these are fax play a role on the addictive nature of painkillers. Mice lacking the gene that codes for the mu-opioid receptor do not display the analgesic and rewarding effects of morphine.
This principle is important to follow when managing acute pain in a patient who takes methadone.
A Hold the methadone until the patient is in withdrawal, then treat the pain
B Leave the patient out of the clinical decision-making process
C Increase the patient's methadone treat the pain
D Switch the methadone to a different opioid to treat the pain
E Continue the methadone and supplement with a different opioid for acute pain
Individuals who are physically dependent on opioids for pain or addiction or who are dependent on illicit opioids must have their baseline opioid requirements met in addition to receiving additional opioids for analgesia. Chronically administered opioids will not usually address other acute pain.
A 52-year-old female was prescribed hydrocodone to manage chronic back pain issues, but over the past six months has been working with her pain without using medication. During the visit, she reports using some old hydrocodone for tooth pain while taking antibiotics for a tooth infection. This type of use describes the patient's behavior.
A Appropriate use
B Misuse/inappropriate use
C Prescription drug abuse
D Catastrophic use
E Experimental drug use
Misuse/inappropriate use of a controlled substance occurs when a patient takes the medication for a reason other than it was prescribed or an ad dosage different from specified. There is no pattern of misuse leading to disability or dysfunction.
This is the mechanism of action for clonidine.
A Peripheral alpha-1 agonist
B Peripheral alpha-2 agonist
C Central alpha-1 agonist
D Central alpha 2 agonist
E Central alpha 1 antagonist
Clonidine acts as an agonist on the central alpha-2 agonist (with more affinity than alpha-1)
This is the gold standard treatment for treating co-occurring borderline personality disorder and substance use disorders.
A Transference-focused psychotherapy
B Dialectical behavioral therapy
C Schema-focused therapy
D Mentalization-based therapy
E Contingency management
Dialectical behavioral therapy (DBT) is a type of CBT that integrates Eastern mindfulness techniques that specifically address skill deficits, maladaptive cognitions, and self-injurious behavior in patients with borderline PD. DBT has been modified for patients with co-occurring SUD including standard DBT components plus a focus on abstinence issues, improving motivation for change, additional modified skills, and strategies to strengthen the therapeutic alliance by enhancing the therapist's skills and motivation to engage difficult, easily lost patients.
3,4-methylenedioxymethamphetamine (Ecstasy) is thought to create pleasant sensations through the release of this neuropeptide.
A vasopressin
B oxytocin
C TSH
D Substance P
E tachykinin
Ecstasy has been shown to increase oxytocin levels in the blood.
The Monitoring the Future (MTF) Survey collect data each year on the attitude and drug use habits of approximately 50,000 nationally representing students in grades eight, 10, and 12. An increase in substance use for this substance in high school seniors was gathered from the 2019 MTF survey.
A Past-year cannabis use
B Past-year alcohol use
C Past-year prescription opioid misuse
D Past-year vaping, including nicotine and cannabis
The 2019 MTF survey showed a significant increase in vaping use in all grades. There was also an increase in teens that associated vaping with the risk of harm even though there is an increase in the amount of teens that identify vaping as risky, the percentage is still low. In 2019, only 21.4% of 12 graders identified a great risk from occasionally vaping nicotine and only 38% if vaping regularly.
The following component is incorporated by Drug Treatment Courts (DTCs).
A Prosecutors and defense counsel in DTCs use and adversarial approach with participants.
B Eligible participants are identified late in the process for placement in DTCs.
C The philosophy of harm reduction is monitored through alcohol and drug testing.
D DTC participants frequently interact with judges throughout the process.
E Participation in DTCs is involuntary and mandated to avoid prosecution.
Ongoing judicial interaction with each DTC participant is essential to the programming. Using a non-adversarial approach, prosecutors and defense counsel work together to promote public safety while protecting participants' due process rights. Abstinence is monitored through frequent alcohol and drug testing. Participation is voluntary.
A patient with alcohol use disorder, liver cirrhosis, and lithium is afraid that because of her cirrhosis, she cannot take medications to curb her drinking. Acamprosate can be tried of this test is done to determine the appropriate dose.
A Creatinine clearance
B Serum total protein
C Liver function tests
D Serum ammonia level
E Serum osmolality
Acamprosate dose can be adjusted for patients with renal impairment by measuring creatinine clearance.
The following effect on sleep architecture is seen in individuals with alcohol use disorder.
A increased sleep latency
B increased sleep efficiency
C increased total sleep time
D increased slow-wave sleep
E decreased rapid eye movement sleep
Individuals with alcohol use disorder have decreased rapid eye movement (REM) sleep.
This part of the brain plays an important role in pain, mediating its perception via the binding of endogenous opioids to mu-opioid receptors.
A temporal lobe
B parietal lobe
C amygdala
D cerebellum
E ventral tegmental area
The amygdala plays an important role in pain, mediating its perception via the binding of endogenous opioids to mu-opioid receptors. This is also mediated by the nucleus accumbens, thalamus, and ventral pallidum.
This type of cognitive behavioral therapy promotes behaving in ways that promote valued goals instead of avoiding discomfort.
A Assertiveness training
B Mindfulness
C Behavioral medication
D Acceptance and commitment therapy
E Biofeedback/relaxation training
Acceptance and commitment therapy combines acceptance therapies to focus on behaving in ways that promote valued goals rather than acting in the service of avoidance of discomfort. This type of therapy can improve pain, reduce the fear of re-injury and interference, and enhance the quality of life.
You are required to fill out a form for your patient's leave of absence for severe alcohol use disorder. The form requires you to provide the medical diagnosis associated with the patient's request for leave. This is the best course of action for this situation.
A Fill out the form with a diagnosis of alcohol use disorder and mail it back.
B Discuss the form with the patient and recommend using a vague non-alcohol-related diagnosis.
C Discuss the form with the patient and explain that there are laws to protect them from being fired for a substance use disorder, but ask their permission before filling out the form.
D Throw the form away and do nothing.
E Give the form to the patient and advise them to vill it out as they see fit.
Some situations (such as a formal workplace leave-of-absence) require disclosing medical information. This information should never be disclosed without first discussing it with the patient and obtaining their consent.
Varenicline uses this mechanism to attenuate the withdrawal symptoms from nicotine.
A Alpha-4-beta-2-nicotinic acetylcholine receptor partial agonist
B Alpha-4-beta-2-nicotinic acetylcholine receptor antagonist
C Alpha-4-beta-2-nicotinic acetylcholine receptor full agonist
D Alpha-2-beta-4-nicotinic acetylcholine receptor partial agonist
E Alpha-2-beta-4-nicotinic acetylcholine receptor full agonist
Varenicline is an alpha-4-beta-2 nicotinic acetylcholine receptor partial agonist. This stabilizes nicotinic receptors in an intermediate state, keeping the channel less open than a full agonist like nicotine. This allows patients to tolerate withdrawal symptoms better during smoking cessation.
The fetus of a pregnant person who uses alcohol for more than light drinking (1-13 drinks per month, no more than 2 drinks in one day) is at risk for developing these psychiatric diagnoses.
A Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure and Attention-Deficit Hyperactivity Disorder
B Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure and Bipolar I Disorder
C Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure and Conduct Disorder
D Neurobehavioral Disorder Associated with Prenatal Alcohol Exposure and Schizophrenia
E Generalized Anxiety Disorder and Attention-Deficit Hyperactivity Disorder
Fetal alcohol spectrum disorders (FASDs) can lead to a range of psychiatric problems in individuals exposed to alcohol during pregnancy, even with moderate drinking. These can include attention-deficit/hyperactivity disorder (ADHD), aggression, and difficulties with social behavior, impulse control, and judgment.
This neurochemical mechanism describes the underlying the development of tolerance to opioids.
A Desensitization of the opioid receptor
B Opiate agonists bind irreversibly to opiate receptors, preventing additional opiate agonists from exerting effects
C Enzymes that metabolize opiates in the liver are down-regulated, causing lower blood levels of opiates for the same dose of opiate agents
D Agonist-induced receptor phosphorylation is one of the many critical molecular components of opioid tolerance
E Chronic opioid users eventually developed antibodies to opioids, causing partial blockage of the drugs’ effects
There are three opioid receptors (D, K, and M), plus a novel N receptor, a non-opioid branch of the opioid receptor family. Opioids act as agonists, antagonists, or partial-agonists at these receptors by binding to G protein-coupled receptors to cause cellular hyperpolarization. Most clinically relevant opioid analgesics act as agonists at the mu-opioid receptors in the central and peripheral nervous system to produce analgesia. Tolerance develops through the desensitization of the receptor.
When prescribing an adjuvant analgesic to a patient with chronic pain issues this medication is considered to be an adjuvant analgesic.
A Methadone
B Amitriptyline
C Oxycodone
D Celecoxib
E Cyclobenzaprine
Medications that have a primary indication other than analgesia but have analgesic properties under certain conditions may be termed "adjuvant analgesics." most of these medications enhance the body's pay modulating mechanisms or the effectiveness of other analgesics. Several medications are used as adjuvants, antiepileptic, local oral anesthetics, and adrenergic agonists. Amitriptyline is a tricyclic antidepressant, which has also been used to manage neuropathic pain.
Your patient presents to your office seeking treatment for alcohol use. They tell you their employer gave them an ultimatum to go to therapy or lose their job. They do not want to do therapy, but does not want to lose their job. This is the core ethical principle his situation relates to.
A Autonomy
B Beneficience
C Nonmalefience
D Justice
E Fidelity
Autonomy is an ethical principle where physicians should respect the rights of individuals to determine which course of action is appropriate for them.
This part of the plant, Cannabis sativa, has psychoactive compounds.
A Stem only
B Stem and leaves
C Flowers only
D Roots and leaves
E All parts
All parts of Cannabis sativa have psychoactive compounds. The flowering tops and dried, brown exudate from the leaves have the highest concentration of cannabinoids.
Persons with alcohol-induced brain damage with a broad-based gait and postural instability likely have damage in this part of the brain.
A White matter diffuse changes around the ventricles
B Degenerative changes in the cervical spinal cord
C Atrophy of the cerebellar vermis
D Frontal and temporal lobe atrophy
Persons with alcohol use disorder have significantly lower Purkinje cell densities in the superior and middle segments of the vermis.
Acamprosate is thought to mediate the activity of channels bound by this neurotransmitter and receptor pair.
A GABA via the NMDA receptor
B GABA via the GABA-B receptor
C Glutamate via the NMDA receptor
D Glutamate via the 5-HT transporter
E Glutamate via K+ channels
Acamprosate acts by altering the activity of glutamate (the brain’s major excitatory neurotransmitter) via modulation of the NMDA receptor and GABA via the GABA-A receptors. Acamprosate indirectly antagonizes the NMDA receptor and agonizes the GABA-A receptor. This leads to the downregulation of NMDA receptors, upregulation of GABA-A receptors, and potentiates the effects of GABA on GABA-A receptors. This counteracts chronic alcohol use’s effects, which can downregulate and desensitize GABA-A receptors and upregulate NMDA receptors, and, in EtOH withdrawal, upregulate glutamate causing excitotoxicity.
A 48-year-old female with a history of chronic back pain, arthritis, opioid use disorder, and asthma presents for pain control. She insists on receiving pain relief stating she "cannot continue living this way." she is referred to the local pain clinic that includes mental health services in their treatment plan. This is considered first-line treatment for this patient.
A Exercise therapy
B High-dose opioids
C Buprenoprhine
D Methadone
E Denial of any pain agents
This patient has a history of pain and lung disease as well as opioid use disorder. Due to these diagnoses, caution must be taken when prescribing pain medication. The goal will be pain reduction using a multidisciplinary approach, especially for mental healthcare for an individual who is in distress. Some non-opioid strategies and treatments may include over-the-counter agents, exercise therapy with physical therapy, acupuncture, yoga, acupressure, and cognitive behavioral therapy.
Your patient is approaching their 6-month sobriety milestone from opioids. Before the appointment, the patient's wife reports the patient purchased opioids from a street dealer and used daily for the last week. He drove himself to his appointment. UDS+ opioids. He denies substance use and is intermittently somnolent in the interview while expressing excitement about restarting his job as a truck driver. This should be communicated to the DMV.
A Disclose to the DMF that the patient is a clear risk to the general public's safety due to a substance use disorder.
B Disclose that the patient poses a clear risk to the general public's safety and fax his medical records to the DMV to confirm this risk.
C The physician should not tell the patient they are making a report to the DMV.
D The physician is not required to call the DMV and report the patient's driving under the influence of opioids.
E The physician should purchase a better malpractice plan to protect themselves from the lawsuit after this report to the DMV.
Depending on the state or local laws, the physician should disclose this risk with the least amount of information to protect the patient's confidentiality. Commitment to a substance withdrawal unit or treatment facility may be appropriate under some statutes and preempt the physician from having to call the DMV. The physician should disclose to the patient that he is making this report and why it is needed. Most states have clauses in their statutes that prevent a physician from being sued about making a mandated report, as long as it is done in good faith.
Nalmefene, a mu and delta-opioid receptor antagonist used to treat chronic alcohol use disorder, has been shown to have advantages over naltrexone. Unlike naltrexone, Nalmefene does not cause this side effect.
A hepatotoxicity
B nausea
C constipation
D insomnia
E dizziness
Nalmefene does not cause hepatotoxicity.
The following substance is associated with pulmonary complications with a large overdose.
A Alcohol
B Caffeine
C Nicotine
D Cannabis
E EcstasyCaffeine is a phosphodiesterase inhibitor and adenosine and benzodiazepine receptor antagonist that raises intracellular cyclic adenosine monophosphate. The effects of caffeine are similar to theophylline, including smooth muscle relaxation and mild bronchodilator properties. Caffeine may falsely elevate the serum theophylline level. Pulmonary complications are rare and usually associated with a large overdose or ingestion by children. Respiratory alkalosis, chest, pain, seizures, aspiration, respiratory failure, and pulmonary edema associated with cardiac arrhythmias occur.