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Behavioral Medicine - Alcohol & Substance Abuse

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Alcohol & Substance Abuse
campbellpa2017
Quiz by campbellpa2017, updated more than 1 year ago
campbellpa2017
Created by campbellpa2017 almost 9 years ago
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Resource summary

Question 1

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

Question 2

Question
Which of the following is NOT an opioid?
Answer
  • Valium
  • Ultram
  • Suboxone
  • Demerol

Question 3

Question
Which of the following is NOT a benzodiazepine?
Answer
  • Ambien
  • Soma
  • Opana
  • Klonopin

Question 4

Question
Which of the following is NOT a stimulant?
Answer
  • dextroamphetamine
  • dextromethorphan
  • methylphenidate
  • modafinil

Question 5

Question
Alcohol intoxication disinhibits frontal cortical regulation of behavior.
Answer
  • True
  • False

Question 6

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

Question 7

Question
ETOH is toxic to virtually all bodily tissues.
Answer
  • True
  • False

Question 8

Question
The euphoria associated with opioid abuse wanes when physiologic dependence occurs.
Answer
  • True
  • False

Question 9

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

Question 10

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

Question 11

Question
Which of the following may occur in Abstinence Syndrome/Withdrawal from Opioids? (Check all that apply)
Answer
  • 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

Question 12

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

Question 13

Question
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
Answer
  • True
  • False

Question 14

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

Question 15

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

Question 16

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

Question 17

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

Question 18

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

Question 19

Question
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.
Answer
  • True
  • False

Question 20

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

Question 21

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

Question 22

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

Question 23

Question
Binge drinking is defined by:
Answer
  • 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

Question 24

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

Question 25

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

Question 26

Question
At-risk drinking for men and women ages 65+ years old is considered to be:
Answer
  • 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)

Question 27

Question
At-risk drinking for men under 65+ years old is considered to be:
Answer
  • 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)

Question 28

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

Question 29

Question
Which of the following are characteristic of substance dependence? (Check all that apply)
Answer
  • 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)

Question 30

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

Question 31

Question
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?
Answer
  • Mild SUD: 1-3 criteria met
  • Moderate SUD 4-5 criteria met
  • Severe SUD: 6+ criteria met

Question 32

Question
Physiological dependence and addiction are synonymous.
Answer
  • True
  • False

Question 33

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

Question 34

Question
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:
Answer
  • 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

Question 35

Question
Which of the following accurately describe their purpose and function in the SBIRT method: (Check all that apply)
Answer
  • 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.

Question 36

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

Question 37

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

Question 38

Question
The CAGE questionnaire is a screening tool for ETOH abuse/dependence. Which of the following is/are NOT accurately representing the acronym?
Answer
  • 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?

Question 39

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

Question 40

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

Question 41

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

Question 42

Question
In the stages of change outlined by motivational interviewing, what comes after Contemplation (aware a problem exists; no commitment to action):
Answer
  • 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)

Question 43

Question
Using the "readiness ruler" motivational strategy, one might address a patient by asking him or her:
Answer
  • "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?"

Question 44

Question
Using the motivational strategy of "decisional balance", what questions might you ask the patient: (Check all that apply)
Answer
  • 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?

Question 45

Question
What are the elements of a good plan, based on the SBIRT model? (Choose all that apply)
Answer
  • 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

Question 46

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

Question 47

Question
Which of the following are important factors to consider when making a referral for treatment?
Answer
  • 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

Question 48

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

Question 49

Question
The largest promise of the SBIRT approach lies in which patient population?
Answer
  • 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

Question 50

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

Question 51

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

Question 52

Question
Protective factors increase resiliency.
Answer
  • True
  • False

Question 53

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

Question 54

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

Question 55

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

Question 56

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

Question 57

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

Question 58

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

Question 59

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

Question 60

Question
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.
Answer
  • True
  • False

Question 61

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

Question 62

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

Question 63

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

Question 64

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

Question 65

Question
Which of the following are benefits of methadone tx for opioid dependence? (Check all that apply)
Answer
  • 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

Question 66

Question
Which of the following are disadvantages of methadone tx for opioid dependence? (Check all that apply)
Answer
  • 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

Question 67

Question
Which of the following are advantages of buprenorphine tx for opioid dependence? (Check all that apply)
Answer
  • 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

Question 68

Question
Which of the following are disadvantages of buprenorphine tx for opioid dependence? (Check all that apply)
Answer
  • 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)

Question 69

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

Question 70

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

Question 71

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

Question 72

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

Question 73

Question
Naltrexone benefits in MAT for Opioid Dependence (Check all that apply)
Answer
  • 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

Question 74

Question
Naltrexone disadvantages in MAT for Opioid Dependence (Check all that apply)
Answer
  • 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

Question 75

Question
Naltrexone advantages in MAT for ETOH Dependence (Check all that apply)
Answer
  • 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)

Question 76

Question
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.
Answer
  • naltrexone
  • disulfiram
  • acamprosate
  • modafinil

Question 77

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

Question 78

Question
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.
Answer
  • naltrexone
  • disulfiram
  • modafinil
  • acamprosate
  • buprenorphine

Question 79

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

Question 80

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

Question 81

Question
Relapse is a normal, expected part of the recovery process.
Answer
  • True
  • False

Question 82

Question
Recovery from SUDs is:
Answer
  • 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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