Addiction and Substance Abuse: Multiple Choice Questions and Answers, Exercises of Nursing

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5 stages of addiction

1. First Use
2. Continued use
3. Tolerance
4. Dependence
5. Addiction 6% of U.S patients misuse their pain management prescriptions. Three common patient populations affected are Cancer, MVA and __________ ________ Sickle Cell This medication acts on the same opioid receptors as commonly abused opioids without reaching a point of euphoria. Also being long acting it has been used for over 40 years in countless patients quests towards recovery. Methadone Which of these medications are used for treating alcohol abuse? Acamprosate Varenicline Methadone Bupropion Acamprosate Which of these medications are used for tobacco disorder? Acamprosate Varenicline

Methadone Bupropion Varenicline Bupropion This substance is a full agonist of trace amine-associated receptors (TAAR1). Activation TAAR causes the increase of cAMP and inhibition of serotonin, dopamine, and norepinephrine transporters. The inhibition of monoamine transporters causes the reuptake and metabolism of catecholamines. Methamphetamine The following are "_________ _______" for methamphetamine: meth, crystal meth, crystal, speed, scootie, yellow powder, crank, ice, spoosh, glass, chalk, redneck cocaine, yellow barn, Tina, and tick-tick. street names Patients under the influence of methamphetamine can have the following signs or symptoms: ___________ appetite, nausea, psychosis, tachycardia, hypertension, ___________ body temperature, panic attack, mydriasis, __________ sleep patterns, violent, bizarre, and erratic behavior, hallucinations, irritability, seizures, and death from high doses. decreased increased disturbed A 65-year-old female presents to the clinic to seek a re-prescription of her pain medication. She had a motor vehicle collision (MVC) 8 months ago that left her with chronic neuralgia in bilateral arms along with low back pain. She was prescribed oxycodone/acetaminophen 7.5/ mg q6 hours. Her last scheduled refill was 20 days ago with a 30 day supply. She returns early claiming she needed multiple dosages sooner than directed due to unmanaged pain. Current vital signs are normal, but she is diaphoretic, tearing, restless, and occasionally yawning. When the provider explains, controlled medications cannot be prescribed in this manner, the patient states, "You don't understand. I need to feel normal. Without it, I feel worse than I used to feel at baseline. Please!" What stage of addiction is the patient in and what medication can be used to help her symptoms?

A young adult patient is dropped off outside the emergency department by her friends, and they drive off before any history can be obtained. The patient has altered mental status and shows signs of intoxication. Sudden dorsiflexion of her ankle produces a rhythmic reproduction of her ankle jerk reflex. Which of the following drugs did she most likely ingest? Choices:

1. Alcohol
2. 3,4-Methylenedioxymethamphetamine (MDMA)
3. Phencyclidine
4. Cannabis 3,4-Methylenedioxymethamphetamine (MDMA) Several classes of common street drugs such as cocaine, ecstasy (MDMA), and amphetamines, increase serotonin levels, which is part of what contributes to the pleasurable and addictive aspects of their use, and also what can produce a __________ syndrome and __________. serotonin clonus Psychiatric medications such as monoamine oxidase inhibitors (MAOI), selective serotonin reuptake inhibitors (SSRI), serotonin-norepinephrine reuptake inhibitors (SNRI), and tricyclic antidepressants (TCA) manipulate serotonin levels to improve __________, but too much can produce clonus as part of serotonin ____________. mood syndrome ____________ nervous system depressants like alcohol and opiates can diminish deep tendon __________ as opposed to producing clonus. Central reflexes A 66-year-old male was prescribed pain medication after a fracture followed by surgery 6 months ago. Since then, his primary care provider has noticed frequent visits to the office asking for pain medication and multiple injuries justifying the use of it. Every time there are different vague complaints, but that of pain is consistent. On his last visit, the primary care took a firm stand and did not agree to continue prescribing the opioids. Today he visits in a restless state.

Which of the following do you suspect to see on history or physical exam in this patient? Choices:

1. Constipation
2. Miosis
3. Dilated pupils
4. Bradycardia Dilated pupils Opioid withdrawal onset varies with the type of opioid used. Heroin withdrawal begins in as little as ___ hours, whereas methadone may take 2 to 3 _______. 5 days Opiod withdrawal symptoms may last days to weeks known as protracted abstinence syndrome. Signs and symptoms of withdrawal include ___________ cramps, agitation, anxiety, cravings, diarrhea, dilated pupils, high blood pressure, insomnia, goose bumps, muscle pains, ________ nose, shakiness, sneezing, sweating, tachycardia, and tearing. abdominal runny A pregnant female, admitted for possible pyelonephritis, is complaining of significant anxiety, tremulousness, and irritability. Upon assessment, she is noted to have a blood pressure of 156/ mmHg, pulse 103 bpm, and is complaining of nausea. Which of the following screening tools for this patient's most likely substance use disorder has been empirically validated for use in pregnant females? Choices:
5. AUDIT
6. CAGE
7. T-ACE/T-ACER-
8. PHQ- T-ACE/T-ACER-

Symptoms of delirium tremens can last up to seven to ten days. ______________, such as diazepam, lorazepam, or chlordiazepoxide, are used to decrease the symptoms of alcohol withdrawal and to prevent seizures. Benzodiazepines A 67-year-old male presents with a vague history of not feeling well, anxiety, and restlessness. He has had several admissions over the past few months for falls, hypoglycemia, and abdominal discomfort. He simply is unable to provide any type of medical history, and his medical chart is not yet available. On a physical exam, you note that he has tachypnea, marked gynecomastia, and spider angiomas. What is the initial working diagnosis? Choices:

1. Opioid abuse
2. Testicular cancer
3. Alcohol use disorder
4. Digoxin overdose Alcohol use disorder When people consume alcohol for at least 1 to 3 months or even consume large quantities for at least 7 to10 days, a ____________ response can occur within ___ to 24 hours after cessation of alcohol consumption. The withdrawal response is relieved immediately by consuming additional alcohol. withdrawal 6 The signs and symptoms of alcohol withdrawal may range from a simple tremor to delirium tremens characterized by autonomic ___________, diaphoresis, tachypnea, hyperthermia, and diaphoresis. Other features of alcohol use disorder include ascites, hepatosplenomegaly, and melena. Thinning of hair, spider ________, and gynecomastia also are seen. hyperactivity angioma Combining ___________ and ___________ treatments can increase smoking cessation rates from 8% to14% when compared with minimal behavioral interventions such as brief advice on quitting

behavioral pharmacological Combination interventions usually include behavioral components delivered by specialized smoking cessation counselors combined with nicotine replacement therapy. Combination interventions are made up of at least four sessions and are more successful with more sessions. Adding ___________ interventions to pharmacotherapy increases cessation rates from 18% in persons receiving pharmacotherapy alone to 21% in those using a combination of pharmacotherapy and behavioral support. behavioral A 16-year-old white male comes into your office requesting medical marijuana for his anxiety and depression. He explains that he has been using it for years and acquired it from friends. Whenever he is without it for a few days, he finds his depression and anxiety recur and sometimes even has episodes of severe anxiety with chest tightening, tingling sensations, racing heart, and dizziness. He has never sought mental health resources in the past and denies having similar symptoms in grade school or middle school. Looking back on his life he says his experience growing up at home and school were great and explicitly denies any traumatic experiences. He produces some literature published by an academic university he finds online supporting his reason to use marijuana. What is the most likely cause of his symptoms? Choices:

1. Generalized anxiety disorder
2. Major Depressive Disorder with anxious features
3. Panic disorder
4. Cannabis withdrawal Cannabis withdrawal Differentiating endogenous psychiatric illnesses from the effects of substance use requires a timeline of the symptoms. Panic attacks, anxiety, anhedonia, depressed mood, and insomnia are effects that occur with __________ withdrawal. cannabis

GUILTY

EYE

Patients in ______________ have not recognized their drinking as an issue and need help to reach that bridge. precontemplation Those in ______________ recognize the issue but have not prepared a plan to begin crossing the bridge towards recovery. contemplation When a patient is in the __________ stage, a provider can help set up a plan of action, such as obtaining a doctors appointment. preparation The _________ stage is the joint effort of the doctor and the patient to come up with an appropriate plan. action Finally, in the phase of _____________, it is the job of the interdisciplinary team to work with the patient to maintain their remission. maintenance Research has found that addicted patients have a history of being prone to such behaviors due to specific nature and nurture criteria. Amongst these are differences in responses to stressful stimuli. Specifically, the __________ pathway within the hypothalamic-pituitary axis invites notable changes in the brains of addicted patients. These patients are prone to addiction to these changes (amongst others). cortisol In essence, both an addict and a non-addict will face negative homeostatic responses to stress, especially when prolonged or chronic. However, the brain of an addict will be simultaneously engaging a more profound __________ response that finds ease through the use of drugs. Once these patients experience this "relief," they are more easily susceptible to abuse spiraling towards addiction. autonomic

Aerosolized glycerol and propylene glycol have been associated with focal squamous ___________ of the upper ___________. Glycerol itself is not associated with gastrointestinal symptoms, unlike nicotine. metaplasia airways The major constituents of ____________ aerosols include nicotine, glycerol, propylene glycol, and artificial flavorings. Isolated inhalation of nicotine has been associated with localized oxidative stress and ____________ to the pulmonary endothelium in addition to reduced levels of inflammatory mediators such as glutathione e-cigarette inflammation Heavy metals including chromium, nickel, and lead have also been found within combustible e- cigarette vapor and have known __________ effects. carcinogenic A 45-year-old male is brought to the emergency department by the police. He is being physically restrained by the officers and is screaming. The officers tell you that a friend told them that the patient was smoking something from a pipe earlier in the day. He is extremely agitated, paranoid, and appears very confused. A cursory exam reveals dyspnea, wheezing, and severe dental caries. What is the first line of treatment for chemical restraint? Choices:

1. Chlorpromazine
2. Lorazepam
3. Ketamine
4. Diphenhydramine Lorazepam Benzodiazepines are the first-line treatment for _______________-_________ agitation. They are safe and can be titrated with escalating and more frequent doses as required. There is no risk of QTc prolongation or extrapyramidal effects. methamphetamine-induced

1. Recommend admission to the hospital for close monitoring
2. Prescribe short course of azithromycin
3. Prescribe clonidine for symptoms control
4. Prescribe tapering dose of methadone Prescribe clonidine for symptoms control Opiate withdrawal is usually mild and not life-threatening. It usually resembles a flu-like illness characterized by yawning, sneezing, rhinorrhea, nausea, diarrhea, vomiting, and dilated pupils. Depending on the half-life of the drug, the symptoms may last for three to ten days. For mild symptoms, __________ can be prescribed on an as needed basis. clonidine For severe Opiate withdrawal, usually from long term high potency opiate abuse, patients may require a methadone or ______________ taper. buprenorphine __________ intoxication is commonly associated with injected conjunctiva and a temporary increase in appetite. Cannabis Cannabis use has also been shown to cause lethargy, impairment of attention, memory, executive functioning, and short-term memory, which can lead to problems in school for students. Chronic use may lead to long-term effects on ____________ performance, "a motivational syndrome," a loss of energy and will to work. cognitive Urine drug screen is the most efficient test to assess for THC toxicity, as positive results for THC have been reported up to ____ days after weekly use and up to ____ days after daily use. 10 56 A 17-year-old female with borderline personality disorder is in an inpatient psychiatric unit secondary to a recent heroin overdose. Upon a routine physical exam, she is found to have superficial skin scratches on her forearm bilaterally. What is the appropriate management? Choices:
5. Seclude and restrain her to prevent further self-harm

2. First aid, then a team conference to confront her
3. First aid, then explore preceding emotions and actions with her
4. Restrict her to her room to provide an opportunity to reflect on her behavior First aid, then explore preceding emotions and actions with her Evidence suggests that patients who are of the _______ gender, of adolescent age, or age older than 50 years are at increased risk of persistent _______ use. A pre-existing history of depression or illicit drug, alcohol, antidepressant, or benzodiazepine use are also at increased risk female opioid A __________ approach and individualized plan for managing postoperative pain should be emphasized to help reduce opioid demand while optimizing the adequacy of pain relief. multimodal Serotonin syndrome typically is caused by a combination of an _______ with other serotonergic substances such as serotonin-norepinephrine reuptake inhibitors, MAOIs, tricyclic antidepressants, amphetamines, buspirone, triptans, St. John's wort, ecstasy, or cocaine SSRI Varenicline, ____________, and nicotine patches/gum remain the only treatment options that have consistently been shown in the literature to help reduce the consumption of tobacco. bupropion ____________ in patients with cirrhosis is believed to arise from hyperestrinism due to the increased adrenal production of androstenedione with aromatization and conversion to estradiol. Gynecomastia Altered mental status in cirrhosis is likely from ____________ _____________________, which is due to a buildup of ammonium toxins from the gut that fail excretion by the liver. hepatic encephalopathy __________ hypertension is due to distorted hepatic architecture causing resistance to portal flow at the sinusoids. This causes increased hydrostatic pressure at the portosystemic collateral veins in the anterior abdomen (caput medusa). Portal _________ _____ are caused by estrogen's effects on arteriolar dilation. Lower extremity edema is due to decreased oncotic pressure secondary to the decreased synthesis of albumin by the liver.

3. Fear of academic repercussions
4. Discomfort tolerating the cessation Discomfort tolerating the cessation Most medications for alcohol addiction help reduce cravings. _________ helps through deterrence. Disulfiram The ______________ of sertraline with disulfiram, thioridazine, pimozide, or monoamine oxidase inhibitors, including linezolid or methylene blue, is contraindicated. coadministration the typical marijuana toxicity results in somnolence, mild euphoria, and occasional agitation. Although agitation may be present, patients typically do not present with aggressive behavior, nystagmus, or hypertension. This is more common in agents such as ________ cannabinoid exposure synthetic Opioid agonist therapy is the agreed upon recommendation for treatment of opioid use disorder (OUD) in ____________ females. Medically supervised opioid withdrawal is not recommended due to ________ stress. pregnant fetal ______________ from opioids in patients with OUD who become pregnant is not recommended as evidence reveals higher rates of relapse and danger to mother and fetus with opioid relapse. Abstinence The diagnosis of opioid use disorder is established in the DSM-5 guidelines and requires that the individual has significant impairment or distress as a result of opioid use. To establish the diagnosis, ______ or more of the eleven criteria must be present within a year. two The eleven criteria for _______ are: continued use despite worsening physical or psychological health, continued use leading to social and interpersonal consequences, decreased social or recreational activities, difficulty fulfilling professional duties at school or work, large amounts of time spent trying to obtain, or recover from taking them, taking more than intended, the

individual has cravings, the individual is unable to decrease the amount used, tolerance, using despite it being physically dangerous settings, and withdrawal symptoms if not taking opioids. OUD The CDC recommends that for safety in patients seeking repeated opiates; perform a urine drug test first, as it can possibly identify patients who might be at higher risk for opioid overdose misuse. If necessary treatment should be initiated with _________-_________ medications. short-acting There is a mounting body of evidence that demonstrates that _______-_______ pain control therapies are as effective as and less harmful than long-term opioid use for chronic pain syndromes. non-opioid Infections resulting from intravenous drug use involve 30% to 40% of all _________ valve infectious endocarditis (TVIE) cases. tricuspid The most prominent adverse effect of diphenhydramine is sedation. Diphenhydramine is a potent _____________ agent that also causes dry mouth and throat, increased heart rate, pupil dilation, urinary retention, constipation, hallucinations, or delirium. Other adverse effects include motor impairment, flushed skin, blurred vision, abnormal sensitivity to bright light, difficulty concentrating, memory loss, visual disturbances, irregular breathing, dizziness, irritability, itchy skin, confusion, increased body temperature, erectile dysfunction, and vomiting. Development of twitching may be delayed until the drowsiness begins to cease. anticholinergic People on methadone or buprenorphine will likely develop a __________ dependence on the medication but will be less likely to engage in the behaviors of addiction that can be so disruptive in the lives of people with substance use disorders. physiological The most common comorbidities with chronic noncancerous pain (CNCP) are _________ and ____________. Duloxetine and venlafaxine both are FDA-approved for general anxiety disorders. There is some evidence for the effectiveness of lamotrigine for post-traumatic stress disorder (PTSD), valproic acid for panic disorder, pregabalin for social phobia and generalized anxiety disorder, gabapentin for social phobia.

________ protection must be maintained. Assisted ventilation will be needed with a bag valve mask until naloxone reverses the respiratory depression. Adequate ventilation should be provided before naloxone is given. The half-life of naloxone in adults is approximately 30 to 80 minutes with an average of 60 minutes. It is about 3 hours in children. Airway After naloxone administration, patients often begin vomiting violently and become _________. Staff safety and airway protection of the patient is a priority. combative __________ ___________ disorder is a pervasive pattern of behavior characterized by unstable relationships, impulsivity, recurrent suicidal behavior or gestures, marked reactivity of mood, chronic feelings of emptiness, intense anger, or inability controlling anger. Patients will often "split" providers, easily alternating between extremes of idealization and devaluation. Borderline personality __________ disorder is a mood disorder characterized by the presence of either mania or hypomania. Borderline personality ____________ must have at least one manic episode defined as a distinct period of euphoric, expansive, or irritable mood. Manic patients will exhibit symptoms of grandiosity, increased self-esteem and confidence, decreased need for sleep, pressured speech, hypersexuality, distractibility, racing thoughts, and excessive involvement in pleasurable and possibly dangerous activities. These symptoms must cause social or occupational dysfunction. Bipolar I ______________ is defined as at least one hypomanic and one depressive episode. Hypomanic symptoms are similar to manic episodes but are less severe and do not cause social or occupation dysfunction. Bipolar II This is the best efficacy for smoking cessation in large, randomized controlled trials. It is a partial agonist at nicotinic acetylcholine receptors. Reduces smoking by binding nicotinic acetylcholine receptors in the CNS. This binding reduces cravings and withdrawal symptoms of patients. In patients who inhale tobacco this is the best first line option for smoking Varenicline

Varenicline has the most evidence of success in reducing smoking behaviors. ___________ and nicotine replacement are second line agents. Buproprion ______________ (PCP) is a dissociative recreational drug. Patient’s exhibit bizarre, agitated, violent behavior, increased strength, and diminished pain response. Patients often are hypertensive and tachycardic. Phencyclidine PCP is a noncompetitive NMDA receptor antagonist. PCP also inhibits the reuptake of ____________, norepinephrine, and serotonin. dopamine When administered 1-2 hours preoperatively has been shown to reduce opioid requirements postoperatively, especially in opioid-tolerant patients. Although the exact mechanism of action is unclear, it is thought to reduce the release of excitatory neurotransmitters that participate in nociceptive pain fiber stimulation. Gabapentin Any patient suspected of alcohol use disorder should be placed on _______________ to prevent Wernicke encephalopathy. thiamine This substance is a common cause of septal perforation. The drug has potent vasoconstrictive properties and also acts as an irritant. Cocaine Bipolar disorder includes both manic or hypomanic and _______________ episodes. depressive What is the drug of choice in the management of neuroleptic malignant syndrome? Dantrolene Dantrolene is a ___________ _________ and acts on the ryanodine receptor. It is specific for neuroleptic malignant syndrome. muscle relaxant This is a rare reaction to antipsychotic drugs that treat schizophrenia, bipolar disorder, and other mental health conditions. It affects the nervous system and causes symptoms like a high fever and muscle stiffness. The condition is serious, but it's treatable.