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Behavioral Medicine - Alcohol & Substance Abuse

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Alcohol & Substance Abuse
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Resumen del Recurso

Pregunta 1

Pregunta
Which of the following has the highest alcohol by volume (ABV) percentage?
Respuesta
  • Beer
  • Wine
  • Nyquil
  • Terpin Hydrate w/ DM

Pregunta 2

Pregunta
Which of the following is NOT an opioid?
Respuesta
  • Valium
  • Ultram
  • Suboxone
  • Demerol

Pregunta 3

Pregunta
Which of the following is NOT a benzodiazepine?
Respuesta
  • Ambien
  • Soma
  • Opana
  • Klonopin

Pregunta 4

Pregunta
Which of the following is NOT a stimulant?
Respuesta
  • dextroamphetamine
  • dextromethorphan
  • methylphenidate
  • modafinil

Pregunta 5

Pregunta
Alcohol intoxication disinhibits frontal cortical regulation of behavior.
Respuesta
  • True
  • False

Pregunta 6

Pregunta
Which of the following may occur as a result of Abstinence Syndrome/Withdrawal from ETOH? (Check all that apply)
Respuesta
  • insomnia
  • anxiety
  • tremor
  • hypotension
  • bradycardia
  • hallucinations
  • seizures
  • delirium

Pregunta 7

Pregunta
ETOH is toxic to virtually all bodily tissues.
Respuesta
  • True
  • False

Pregunta 8

Pregunta
The euphoria associated with opioid abuse wanes when physiologic dependence occurs.
Respuesta
  • True
  • False

Pregunta 9

Pregunta
Opioid intoxication may cause... (Check all that apply)
Respuesta
  • euphoria
  • increased energy
  • sedation
  • nausea/vomiting
  • diarrhea
  • pupil dilation

Pregunta 10

Pregunta
Short-term use of opioids is NOT associated with a hangover effect.
Respuesta
  • True
  • False

Pregunta 11

Pregunta
Which of the following may occur in Abstinence Syndrome/Withdrawal from Opioids? (Check all that apply)
Respuesta
  • Flu-like illness: myalgias, headache, fatigue, rhinorrhea, sneezing, hot and cold sweats, N&V, diarrhea, abdominal cramps
  • Signs of CNS depression: somnolence, ataxia, bradycardia, decreased BP, miosis
  • involuntary muscle twitches, restless legs syndrome, piloerection, tremor

Pregunta 12

Pregunta
Complications of non-lethal overdose on opioids may include all of the following EXCEPT:
Respuesta
  • aspiration
  • pneumonia
  • bowel impaction
  • A & C only
  • All of the above

Pregunta 13

Pregunta
The effects of Sedative-Hypnotic/Anxiolytic intoxication mimic ETOH intoxication in that both may cause: disinhibition of frontal cortical regulation of behavior, ataxia, slurred speech, memory “blackouts,” sexual dysfunction, loss of consciousness, cardiovascular and respiratory collapse
Respuesta
  • True
  • False

Pregunta 14

Pregunta
sedative-hypnotic/anxiolytic intoxication may manifest as mood changes and irritability.
Respuesta
  • True
  • False

Pregunta 15

Pregunta
Withdrawal from sedative-hypnotics/anxiolytics differs from ETOH withdrawal in that: it may last for weeks and has a higher incidence of seizures.
Respuesta
  • True
  • False

Pregunta 16

Pregunta
Which of the following symptoms may be the result of acute stimulant intoxication:
Respuesta
  • Hypersomnolence
  • Delusions
  • Auditory/Visual Hallucinations
  • Only B & C
  • All of the above

Pregunta 17

Pregunta
Which of the following may be the result of stimulant withdrawal? (Check all that apply)
Respuesta
  • Severe depression with elevated risk of suicide
  • Anorexia and decreased food intake
  • Severe fatigue
  • Severe hypersomnolence

Pregunta 18

Pregunta
Medical complications associated with stimulant abuse may include:
Respuesta
  • tachycardia
  • myocardial infarction
  • CVA
  • malnourishment
  • All of the above

Pregunta 19

Pregunta
The short half-life of cocaine (48 min) coupled with its intensive levels of intoxication helps drive the severe cravings and compulsiveness associated with its use.
Respuesta
  • True
  • False

Pregunta 20

Pregunta
Which of the following time estimates of addictive progression - from start to end-stage - is/are accurate? (Check all that apply)
Respuesta
  • Alcohol 10-40 years
  • Heroin 20-40 years
  • Cocaine 5-10 years

Pregunta 21

Pregunta
While commonly known to cause relaxation and euphoria, marijuana may conversely cause stimulation, agitation, and dysphoria in others.
Respuesta
  • True
  • False

Pregunta 22

Pregunta
In young, chronic users (no pun intended), marijuana may arrest cognitive development and cause memory impairments.
Respuesta
  • True
  • False

Pregunta 23

Pregunta
Binge drinking is defined by:
Respuesta
  • 5+ drinks/occasion x 1 in past 30 days
  • 5+ drinks/occasion more than once in past 30 days
  • 10+ drinks/occasion x 1 past 30 days
  • 10+ drinks/occasion more than once in past 30 days
  • None of the above

Pregunta 24

Pregunta
Nearly 1 in 4 persons, ages 12 and older, in the U.S. met criteria for "binge drinking" in a 2013 national survey.
Respuesta
  • True
  • False

Pregunta 25

Pregunta
About what percent of substance use disorders are estimated to go untreated each year in the U.S.?
Respuesta
  • 30%
  • 50%
  • 60%
  • 90%

Pregunta 26

Pregunta
At-risk drinking for men and women ages 65+ years old is considered to be:
Respuesta
  • More than 2 drinks in a day (or more than 6 per week)
  • More than 3 drinks in a day (or more than 7 in a week)
  • More than 4 drinks in a day (or more than 10 a week)
  • More than 5 drinks in a day (or more than 12 a week)

Pregunta 27

Pregunta
At-risk drinking for men under 65+ years old is considered to be:
Respuesta
  • More than 2 drink in a day (or more than 5 drinks in a week)
  • More than 3 drinks in a day (or more than 10 in a week)
  • More than 4 drinks in a day (or more than 14 in a week)
  • More than 5 drinks in a day (or more than 20 in a week)

Pregunta 28

Pregunta
Broadly speaking, the DSM-IV defines substance abuse as: recurrent or continued substance use despite adverse effects.
Respuesta
  • True
  • False

Pregunta 29

Pregunta
Which of the following are characteristic of substance dependence? (Check all that apply)
Respuesta
  • loss of control of use (i.e. compulsive use)
  • tolerance (i.e. increased tolerance with decreased effect)
  • withdrawal (or active avoidance of withdrawal)
  • use to avoid negative effects rather than obtain positive ones (i.e. no euphoria; just trying to avoid being sick)

Pregunta 30

Pregunta
The DSM-V groups criteria for substance use disorders into broad categories which include: (Check all that apply)
Respuesta
  • Impaired contol
  • Risky use
  • Social impairment
  • Pharmacological criteria

Pregunta 31

Pregunta
The DSM-V lists 11 criteria for classifying the severity of substance use disorders (SUD); which of the following does NOT accurately represent one of those classifications?
Respuesta
  • Mild SUD: 1-3 criteria met
  • Moderate SUD 4-5 criteria met
  • Severe SUD: 6+ criteria met

Pregunta 32

Pregunta
Physiological dependence and addiction are synonymous.
Respuesta
  • True
  • False

Pregunta 33

Pregunta
Physiological dependence may occur with non-problematic administration of a drug as it is intended to be used for the alleviation of symptoms.
Respuesta
  • True
  • False

Pregunta 34

Pregunta
SBIRT is an effective, evidence-based, and reimbursable method for dealing with substance use disorders in the context of an office visit. SBIRT stands for:
Respuesta
  • Selective Behavioral Intervention and Relapse Test
  • Substances, Behaviors, Interventions, Reactions, and Treatments
  • Screening Brief Intervention and Referral to Treatment
  • Self-directed Behavioral Interviewing and Rehabilitative Teaching
  • Support-Based Interventions, Relapse-prevention, and Treatment

Pregunta 35

Pregunta
Which of the following accurately describe their purpose and function in the SBIRT method: (Check all that apply)
Respuesta
  • Screening: quickly assess use and severity of alcohol, illicit drug, and prescription drug abuse.
  • Brief Intervention: a 3-5 minute motivational and awareness-raising intervention given to risky or problematic substance users.
  • Referral to Treatment: referrals to specialty care for pts with substance use disorders.

Pregunta 36

Pregunta
Which of the following are NOT considered to be "Standard Drinks" per current U.S. guidelines? (Check all that apply)
Respuesta
  • 12 oz. PBR
  • 12-16 oz. Four Loko
  • 5 oz. Franzia
  • 1.5 oz. Maker's Mark

Pregunta 37

Pregunta
This man is an alcoholic.
Image:
66625668-2075-40b9-b100-68d4daf03b74 (image/jpeg)
Respuesta
  • True
  • False

Pregunta 38

Pregunta
The CAGE questionnaire is a screening tool for ETOH abuse/dependence. Which of the following is/are NOT accurately representing the acronym?
Respuesta
  • C: have you ever felt you should Cut down on your use of ETOH?
  • A: do you ever get Annoyed by others criticizing your ETOH use?
  • G: have you ever felt bad or Guilty because of your drinking?
  • E: do you find that you drink Every day/night that you are able to do so?

Pregunta 39

Pregunta
CAGE-AID is the same CAGE screening questions used for ETOH use, except it's "Adapted to Include Drugs" (AID).
Respuesta
  • True
  • False

Pregunta 40

Pregunta
The key to the Brief Intervention in the SBIRT, includes all of the following EXCEPT:
Respuesta
  • Raise the subject
  • Provide feedback
  • Enhance motivation
  • Negotiate a plan
  • Contract for safety

Pregunta 41

Pregunta
A patient in the "Pre-Contemplation" stage has no current intention of changing his or her behavior.
Respuesta
  • True
  • False

Pregunta 42

Pregunta
In the stages of change outlined by motivational interviewing, what comes after Contemplation (aware a problem exists; no commitment to action):
Respuesta
  • Preparation (intent upon taking action)
  • Action (active modification of behavior)
  • Maintenance (sustained change - new behavior replaces old)
  • Relapse (fall back into old patterns of behavior)

Pregunta 43

Pregunta
Using the "readiness ruler" motivational strategy, one might address a patient by asking him or her:
Respuesta
  • "Are you ready to quit?"
  • "On a scale of 1-10 how ready are you to quit or cut down? And why?"
  • "Who is the ruler of your readiness to quit?"
  • "Are you willing to take any measure it takes to quit?"

Pregunta 44

Pregunta
Using the motivational strategy of "decisional balance", what questions might you ask the patient: (Check all that apply)
Respuesta
  • What do you like about drinking? What are the pros/positive aspects of drinking?
  • What would you dislike about not drinking – disadvantages?
  • What do you dislike about drinking? What are the cons/disadvantages?
  • What would you like about not drinking? What are the benefits of not drinking?

Pregunta 45

Pregunta
What are the elements of a good plan, based on the SBIRT model? (Choose all that apply)
Respuesta
  • It reduces harm and/or provides an important learning experience
  • It matches the patient’s level of readiness to change
  • It is concrete, specific, measureable, and realistic
  • It ensures the patient will not use/abuse substances before the next appointment
  • Patient agrees to it and is able to repeat it back to you

Pregunta 46

Pregunta
Patients with substance use disorders and/or those who need additional assistance with problematic use often require referrals to specialty care.
Respuesta
  • True
  • False

Pregunta 47

Pregunta
Which of the following are important factors to consider when making a referral for treatment?
Respuesta
  • Past treatment history, what worked, what didn't, and why.
  • Inpatient vs. outpatient
  • Insurance/ability to pay
  • Patient's worries regarding treatment
  • All of the above are important

Pregunta 48

Pregunta
When making a referral for treatment, you should reassure the patient that you won’t abandon them, regardless of how treatment turns out.
Respuesta
  • True
  • False

Pregunta 49

Pregunta
The largest promise of the SBIRT approach lies in which patient population?
Respuesta
  • At-risk pts w/out current SUD
  • Chronic risk pts w/ recurrent SUD
  • Medical pts w/ co-morbid SUD
  • Dual-diagnosis pts w/ mental illness & SUD

Pregunta 50

Pregunta
Controlling for environmental influences, everyone is born with the same risk of developing SUDs.
Respuesta
  • True
  • False

Pregunta 51

Pregunta
What's your Holmes Stress Scale right now?
Respuesta
  • 261
  • 300+
  • You do NOT want to know...
  • Mental math stresses me out.
  • AHHHHHHHHHHHHHHHHHHH!

Pregunta 52

Pregunta
Protective factors increase resiliency.
Respuesta
  • True
  • False

Pregunta 53

Pregunta
What is the most common cause of secondary HTN?
Respuesta
  • ETOH
  • Cocaine
  • TOB
  • PA school

Pregunta 54

Pregunta
Name that SUD! PE: pt w/ RUQ or mid-gastric pain, HTN and/or tachycarida, and a slight tremor.
Respuesta
  • ETOH
  • Opiods
  • Sedative/hypnotics/anxiolytics
  • Stimulants
  • Marijuana

Pregunta 55

Pregunta
Name that SUD! PE: mydriasis, malnutrition/weight loss, tachycarida, and poor hygiene.
Respuesta
  • ETOH
  • Opioids
  • Sedative-hypnotic/anxiolytic
  • Stimulant
  • Marijunana

Pregunta 56

Pregunta
Name that SUD! PE: pt w/ flu-like sxs, nodding off during exam, murmur of SBE.
Respuesta
  • ETOH
  • Opioids
  • Sedative-hypnotic/anxiolytics
  • Stimulants
  • Marijuana

Pregunta 57

Pregunta
Name that SUD! Labs: pt w/ elevated MCV, LFTs (especially GGT), and glucose
Respuesta
  • ETOH
  • Opioids
  • Stimulants
  • Sedative-hypnotic/anxiolytics
  • Marijuana

Pregunta 58

Pregunta
Name that SUD! Labs: pt w/ elevated LFTs due to HCV, seropostive for STDs.
Respuesta
  • ETOH
  • Opioids
  • Stimulants
  • Sedative-hypnotic/anxiolytics
  • Marijuana

Pregunta 59

Pregunta
While abstinence is recommended, a pt w/ mild to moderate SUD may be able to return to "normal" use.
Respuesta
  • True
  • False

Pregunta 60

Pregunta
Abstinence is necessary for pts for pt's w/ a hx of moderate to severe ETOH, sedative hypnotic/anxiolytic, and stimulant SUDs; however, abstinence is rarely an effective strategy for pts w/ a hx of opioid SUD.
Respuesta
  • True
  • False

Pregunta 61

Pregunta
Which of the following may be indications for inpatient substance abuse tx?
Respuesta
  • medical complications (e.g. h/o seizures in withdrawal)
  • unstable living environment
  • risk of loss of job, marriage, etc.
  • All of the above

Pregunta 62

Pregunta
While abstinence is worth a try if the patient is motivated; less than 10% remain abstinent and in recovery from opioid SUDs.
Respuesta
  • True
  • False

Pregunta 63

Pregunta
What is the treatment of choice for opioid SUDs if long-term abstinence is not achieved?
Respuesta
  • Specialized long-term inpatient care (e.g. residential treatment)
  • Narcotics Anonymous (NA)
  • Cognitive Behavioral Therapy (CBT)
  • Medication Assisted Treatment (MAT)

Pregunta 64

Pregunta
Medication Assisted Treatment (MAT) for Opioid Dependence includes which of the following medications? (Check all that apply)
Respuesta
  • Methadone
  • Buprenorphine (e.g. Suboxone, Subutex, Zubsolv, Bunavail)
  • Naltrexone (ReVia, Vivitrol)
  • Modafinil (Provigil)
  • Acamprosate (Campral)

Pregunta 65

Pregunta
Which of the following are benefits of methadone tx for opioid dependence? (Check all that apply)
Respuesta
  • Long-acting full agonist opioid (T½  24 hours)
  • Blockade (“pseudo-blockade”): No effect if use opioids
  • Relatively inexpensive
  • Easily available by Rx
  • Relatively few drug-drug interactions

Pregunta 66

Pregunta
Which of the following are disadvantages of methadone tx for opioid dependence? (Check all that apply)
Respuesta
  • Incomplete relief of withdrawal or craving
  • Potential for sedation if dose too high, or if taken with benzodiazepine
  • Potential for lethal overdose
  • Must be discontinued when opioid analgesics needed
  • Relatively Expensive

Pregunta 67

Pregunta
Which of the following are advantages of buprenorphine tx for opioid dependence? (Check all that apply)
Respuesta
  • No potential for overdose even at extremely high doses, due to “ceiling effect” (unless a large dose is combined with a large dose of benzodiazepine)
  • No sedation
  • Easily available by Rx
  • Relatively inexpensive
  • Very few drug-drug interactions

Pregunta 68

Pregunta
Which of the following are disadvantages of buprenorphine tx for opioid dependence? (Check all that apply)
Respuesta
  • Occasional treatment failures
  • Multiple drug-drug interactions
  • Must visit clinic for daily dose
  • Very expensive if patient does not have insurance ($250-800 mo)
  • incomplete relief of withdrawal or craving (rare)

Pregunta 69

Pregunta
Methadone is the strongly and unanimously recommended treatment of choice for pregnant women to reduce risk of complications
Respuesta
  • True
  • False

Pregunta 70

Pregunta
Since the Drug Abuse Treatment Act of 2000 (DATA 2000), PAs can now Rx Buprenorphine for Office-Based Opioid Treatment (OBOT).
Respuesta
  • True
  • False

Pregunta 71

Pregunta
Suboxone, a sublingual film and combination of buprenorphine and naloxone, is specifically formulated to prevent abuse and associated overdose.
Respuesta
  • True
  • False

Pregunta 72

Pregunta
Buprenorphine, sublingual tablets without naloxone, is available, primarily for pregnant women and rare patients who have sensitivity to naloxone.
Respuesta
  • True
  • False

Pregunta 73

Pregunta
Naltrexone benefits in MAT for Opioid Dependence (Check all that apply)
Respuesta
  • Long-acting pure opioid antagonist (PO T½ = 4h for parent drug (13h for active metabolite)
  • once a day PO dosing
  • Preferentially displaces opioids at receptors, blocking all opioid effects (i.e. if patient uses opioids, they have no effect)
  • available as monthly IM injection
  • Generally good compliance rates

Pregunta 74

Pregunta
Naltrexone disadvantages in MAT for Opioid Dependence (Check all that apply)
Respuesta
  • Need to monitor LFTs due to hepatic toxicity (rare)
  • Notoriously poor compliance with PO tabs
  • Must be discontinued when opioid analgesics needed (e.g., surgery; compare to buprenorphine)
  • IM injections are extremely expensive ($800-1200mo) if not covered by insurance
  • Unreliable mechanism of action; can result in accidental OD

Pregunta 75

Pregunta
Naltrexone advantages in MAT for ETOH Dependence (Check all that apply)
Respuesta
  • Impedes activation of endorphins and enkephalins (endogenous opioid reward system) by alcohol
  • Reduces craving for alcohol
  • Causes sickness in pts that use ETOH to disincentivize relapse
  • Reduces euphoria if alcohol is consumed
  • Better compliance rate with PO dosing than when using for opioid dependence (even better efficacy w/ IM injections)

Pregunta 76

Pregunta
This drug (used in MAT for ETOH dependence) interrupts the metabolism of ethanol, resulting in accumulation of acetaldehyde that causes acute illness with potential sxs of nausea, vomiting, hypotension, facial flushing, tachycardia and palpitations, anxiety, chest pain, SOB, headache.
Respuesta
  • naltrexone
  • disulfiram
  • acamprosate
  • modafinil

Pregunta 77

Pregunta
Studies have shown disulfiram (antabuse) to be no better than placebo in the tx of ETOH dependence.
Respuesta
  • True
  • False

Pregunta 78

Pregunta
For some people, drinking alcohol causes an increase in glutamate and corresponding decrease in GABA in the CNS, which is associated with feeling anxious, restless, ill-at-ease. This drug enhances GABA and modulates glutamate, thereby restoring a healthy balance in CNS.
Respuesta
  • naltrexone
  • disulfiram
  • modafinil
  • acamprosate
  • buprenorphine

Pregunta 79

Pregunta
Which of the following are used in MAT for Cocaine Dependence? (Check all that apply)
Respuesta
  • disulfiram
  • modafinil
  • baclofen
  • naltrexone
  • buprenorphine

Pregunta 80

Pregunta
Addiction is a chronic, relapsing and remitting, illness, and like other chronic diseases (e.g. diabetes, HTN), there is no cure - only effective treatment.
Respuesta
  • True
  • False

Pregunta 81

Pregunta
Relapse is a normal, expected part of the recovery process.
Respuesta
  • True
  • False

Pregunta 82

Pregunta
Recovery from SUDs is:
Respuesta
  • usually a single event in time during treatment in which a pt finally makes a conscious effort to fully and completely abstain from use
  • a process where, over time, a person has shorter, less frequent episodes, and longer periods of sobriety in between
  • not possible, because addiction is a lifelong disease
  • unlikely to occur in the vast majority of all SUDs
  • up to the addict, who must inevitably hit "rock bottom" before turning away from substance use/abuse
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