Addiction Jeopardy Round 1

Pharmacology

100

This refers to the drug mechanism of action on the body 

Pharmacodynamics 

200

This property, often described as what the body does to a drug, refers to the movement of drug into, through, and out of the body. 

Pharmacokinetics 

300

One of the pharmacokinetic properties that convey greater addiction potential of a drug

1. rapid delivery of drug to the central nervous system (CNS)

2. rapid absorption

3. low protein binding and high free drug clearance.

400

What drug used commonly in addiction medicine binds to the GABA B subunit:

Baclofen

500

2 of the 4 commonly prescribed benzodiazepines that will be picked up in a basic urine drug screen.

Temazepam, Oxazepam, chlordiazepoxide , Diazepam 

_{Many basic urine drug screens only test for the breakdown metabolites, oxazepam and noroxazepam.}

_{Alprazolam , clonazepam, lorazepam , midazolam , and triazolam  do not undergo metabolism to oxazepam} 

Benzodiazepines

100

First benzodiazepine manufactured (1955). This medicine is still on the market today. This medicine is often used in outpatient treatment of alcohol withdrawal due to its medium to long half-life and active metabolite with a very long half-life.

Chlordiazepoxide/Librium 

200

You have a new patient who has been on Alprazolam 1 mg TID for the last 10 years for generalized anxiety disorder. At the visit you start Sertraline and change to Clonazepam 2 mg TID and discuss plans for a slow taper. The patient calls you 2 hours after the change and reports increased anxiety. You believe this is the most likely cause. 

Pseudo-withdrawal 

_{Withdrawal- d/c individual with dependence} 

_{Rebound anxiety symptoms higher intensity symptoms after discontinuation} 

_{recurrence return of anxiety symptoms after discontinuation but does not require dependence} 

300

Name 2 of the 3 drugs of this class that are metabolized through glucuronidation and not cytochrome P450 metabolism. Thus making them less hepatotoxic. 

Lorazepam

Oxazepam 

Temazepam 

400

Benzodiazepine use during the third trimester is associated with this birth defect. 

Floppy baby syndrome

_{hypotonia, hypothermia, lethargy, respiratory difficulties, and sucking difficulties} 

500

Three strategies for de-prescribing benzodiazepines. 

1. change to equivalent dose of long acting benzo and taper by 10% every 2 weeks 

2. inpatient phenobarbital taper (protocols run 3-10 days) 

3. anticonvulsant (high dose Gabapentin or carbamazepine) 

Stimulants

100

This drug of abuse directly prevents the re-uptake of dopamine, serotonin, and norepinephrine into pre-synaptic neurons

Cocaine 

200

This novel antidepressant with serotonergic, noradrenergic and antihistamine effects has evidence in randomized controlled trials of decreasing use of methamphetamine. Name and dose.

Mirtazapine 

_{Coffin, et al. JAMA 2020}

_{30 mg for 36 wks}

300

This medication which is FDA approved for AUD has some evidence for treatment of cocaine use disorder. 

Name the drug and proposed mechanism of action.

Disulfiram

_{inhibits dopamine beta-hydroxylase resulting in an excess of dopamine and decreased synthesis of norepinephrine.}

400

This behavioral treatment for stimulant use disorder gives patients tangible rewards for positive behaviors and has the best evidence of success.

Contingency Management 

500

In this 2021 RCT by Trivedi the combination of Vivitrol plus this medication (name and dose needed) demonstrated significant reduction in methamphetamine use. 

Bupropion XL 450 mg once daily. 

Street Wise

100

COKE, SNOW, CRACK, ROCK

Cocaine 

200

SPEED, CRANK, ICE, SHABU, CHRISTINA 

Methamphetamine 

300

syringe access programs, fentanyl strips, PrEP 

Harm reduction 

_{Harm reduction is a set of practical strategies and ideas aimed at reducing negative consequences associated with drug use. Harm Reduction is also a movement for social justice built on a belief in, and respect for, the rights of people who use drugs.}

400

purple drank, lean, sizzurp 

codeine/promethazine/dextromethorphan/soda/jolly ranchers

500

Bath salts, plant food 

synthetic cathinones 

Potpourri

100

This medication (name and dose),  FDA approved for ADHD, showed low-strength evidence from two RCTs that it reduces methamphetamine use. 

mixed amphetamine salts (Adderall 60-100 mg)

200

DEA schedule of cocaine 

Schedule 2 

300

This sedative was developed in the Soviet Union and is still marketed in Russia. It is sold on the internet for illicit use in the US. It binds to GABA B and A. 

Phenibut 

400

Using cocaine in the presence of alcohol is  proposed to be associated with increased cardio-toxicity due to this. 

Cocaethylene

_{byproduct of concurrent consumption of alcohol and cocaine as metabolized by the liver}

500

Fatal opioid overdoses often co-occur with other substances. This is the percent that occur with benzodiazepines and stimulants respectively per 2020 CDC data.

16.8 % benzos

23% stimulants

NIH 2020