CARN Exam (Latest 2025/ 2026 Update) Questions and Answers| Verified Solutions| 100% Guaranteed Pass | GRADED A

CARN Exam (Latest 22025/ 2026 Update) Questions and Answers| Verified Solutions| 100% Guaranteed Pass | GRADED A Question: Five stages of addiction 1. First Use 2. Continued use 3. Tolerance 4. Dependence 5. Addiction Question: 6% of U.S patients misuse their pain management prescriptions. Three common patient populations affected are Cancer, MVA and __________ ________ Sickle Cell Question: 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 Question: Which of these medications are used for treating alcohol abuse? Acamprosate Varenicline Methadone Bupropion Acamprosate Question: Which of these medications are used for tobacco disorder? Acamprosate Varenicline Methadone Bupropion Varenicline Bupropion Question: This substance is a full agonist of trace amine-associated receptors (TAAR1). Activation TAAR1 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 Question: 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 Question: 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 Question: A patient presents to the emergency department with agitation, mydriasis, hypertension, and tachycardia. He states that he snorted "some crystals" with friends and that he feels energetic and anxious. He reports that his friends told him this is a treatment for weight loss and this is the reason why he tried it. Which is true of the drug most likely used by this patient? Choices: 1. Partial agonist of trace amine-associated receptors (TAAR1) 2. Gamma-aminobutyric acid (GABA) receptor agonist 3. Full agonist of trace amine-associated receptors (TAAR1) 4. Full antagonist of dopamine receptors Full agonist of trace amine-associated receptors (TAAR1) Question: A 35-year-old woman comes in for her wellness check-up. She has a 13-year-old son who is going to be starting high school next year and often hear him and his friends discuss ways to prepare for high school, so they fit in. The mother is concerned her son may use drugs as he often talks about the partying. She wants to know what she can do it prepare him to avoid smoking cannabis given its surge in popularity amongst youth. What is the most common reason for marijuana use, amongst teenagers and young adults? Choices: 1. Stress management 2. Experimentation 3. Social conformity 4. Pleasurable sensation Social conformity Question: 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) Question: 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 Question: 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 Question: 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 Question: 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 Question: 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, goosebumps, muscle pains, ________ nose, shakiness, sneezing, sweating, tachycardia, and tearing. abdominal runny Question: 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 156/94 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: 1. AUDIT 2. CAGE 3. T-ACE/T-ACER-3 4. PHQ-9 T-ACE/T-ACER-3 Question: T-ACE and T-ACER-3, CAGE, and AUDIT are screening tools for __________ use disorder. alcohol Question: T-ACE and T-ACER-3 were designed by an obstetrician with a goal of better identifying alcohol use disorder in __________ females. pregnant Question: A 66-year-old male presents to the hospital complaining of bilateral upper extremity tremors, sweating, and nausea. These symptoms have been present for the last several hours and are worsening in intensity. He has a history of heavy alcohol use, and his last drink was 12 hours ago. Which of the following should be anticipated if the patient does not receive appropriate treatment? Choices: 1. Tactile hallucinations 2. Hypotension 3. Bradycardia 4. Hypothermia Tactile hallucinations Question: Alcohol withdrawal begins about ____ hours after the last alcoholic drink. Tremors, sweating, insomnia, elevated blood pressure, and tachycardia are common symptoms early in the presentation of alcohol withdrawal due to the removal of the ethanol as a __________ leading to overexcitation of the central nervous system. Patients also may complain of nausea, anxiety, and headache. 6 depressant Question: Without appropriate treatment, 24 to 48 hours after the last alcoholic drink symptoms can progress to __________ tremens, which can present with tactile, visual, or auditory hallucinations and agitation. A patient also may develop generalized tonic-clonic ___________. delirium seizures 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 Question: 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 Question: 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 Question: 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 Question: 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 Question: 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 Question: 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 Question: 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 Question: Cannabis withdrawal typically occurs in heavy users and starts within the first _______, and symptoms usually peak by day ________. week three Question: A 40-year-old male with a history of alcohol use disorder is admitted to the hospital for skin lacerations following a motor vehicle accident. Urgent care is given with intravenous fluids and sutures where required. On physical examination, the blood pressure is 130/82 mmHg. The pulse is 86/min, respiratory rate is 18/min, and temperature is 98.7 F. After 5 hours, the nurse goes to draw blood, and the patient refuses, citing restlessness and agitation. The patient yells and states that his heart is pounding and he would not let anyone come close to him. He has a previous history of hepatitis C that has been treated. What is the next step in management? Choices: 1. Administer lithium 2. Administer oxazepam 3. Administer lactulose 4. Administer diazepam Administer oxazepam Question: ___________ is an FDA-approved benzodiazepine used for the treatment of alcohol withdrawal, management of anxiety disorders, and agitation. Oxazepam Question: For alcohol withdrawal in adults, administer oxazepam 15 mg PO TID. Diazepam should not be used in this patient because it is metabolized in the liver. Oxazepam, on the other hand, is excreted through the _________. kidneys Question: CAGE stands for the following: (1) Have you felt the need to _______ down your drinking?, (2) Have people __________ you or criticized you about your drinking?, (3) Have you felt ________ about your drinking?, (4) Have you ever used alcohol as an _______ opener? A max score is a 4 and a low is 0. CUT ANNOYED GUILTY EYE Question: Patients in ______________ have not recognized their drinking as an issue and need help to reach that bridge. precontemplation Question: Those in ______________ recognize the issue but have not prepared a plan to begin crossing the bridge towards recovery. contemplation Question: When a patient is in the __________ stage, a provider can help set up a plan of action, such as obtaining a doctors appointment. preparation Question: The _________ stage is the joint effort of the doctor and the patient to come up with an appropriate plan. action Question: Finally, in the phase of _____________, it is the job of the interdisciplinary team to work with the patient to maintain their remission. maintenance Question: 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 Question: 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 Question: 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 Question: Heavy metals including chromium, nickel, and lead have also been found within combustible e-cigarette vapor and have known __________ effects. carcinogenic Question: 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 Question: 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 Question: Some antipsychotics such as ____________ are effective but have _____________ side effects. Other antipsychotics such as haloperidol may affect the QTc interval. chlorpromazine anticholinergic Question: ___________ also is effective but leads to blood pressure and heart rate elevation. This may exacerbate the methamphetamine-induced hyperadrenergic symptoms. _______________________ may worsen tachycardia induced by methamphetamine. Ketamine Diphenhydramine Question: The last stage of methamphetamine abuse happens when the person who abuse methamphetamine become __________ and irritable because of lack of sleep for about 3 to 15 days. This behavior is called "tweaking," and the person with this behavior is known as the "__________" paranoid tweaker Question: A _________ toxicology study may provide important information as to why the patient has been experiencing these symptoms. Many substances, specifically cannabis, cocaine, and amphetamines, can induce severe psychotic symptoms. urinary Question: Antipsychotics and to a lesser extent, antidepressants, can cause _________. It can present mildly whereby patients may tolerate it without wanting any intervention whatsoever, or severely such that a person cannot cope whatsoever. A rapidly absorbed benzodiazepine could be akathisia Question: A 32-year-old young male presents to the emergency department with complaints of rhinorrhea, diarrhea, and malaise. History reveals that he had recent surgery for an ankle fracture after a fall and required intensive physical therapy along with high doses of opiate medications for pain control. On examination, he is afebrile with normal blood pressure and heart rate. The physical exam is essentially normal except for mild pupil dilation. What is the next step in the management of this patient? Choices: 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 Question: 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 Question: For severe Opiate withdrawal, usually from long term high potency opiate abuse, patients may require a methadone or ______________ taper. buprenorphine Question: __________ intoxication is commonly associated with injected conjunctiva and a temporary increase in appetite. Cannabis Question: 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, "amotivational syndrome," a loss of energy and will to work. cognitive Question: 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 Question: 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: 1. 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 Question: 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 Question: 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 Question: 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 Question: 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 Question: ____________ 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 Question: 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 Question: __________ 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 Question: _________ _____ 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. Spider nevi Question: ______________ ____________ syndrome is described as a triad of vomiting, abdominal pain, and compulsive bathing in the setting of chronic cannabis use. This actually distinguishes it from other causes of cyclic vomiting. These include cyclic vomiting syndrome, drug withdrawal syndrome, bulimia nervosa, Addison disease and other metabolic conditions, psychogenic vomiting, and migraine headaches. Cannabinoid hyperemesis Question: ___________ ___________ usually present with autonomic excitation, tremors, agitation, and an altered sensorium 48 - 96 hours after the last alcohol drink consumption. Delirium tremens Question: Those with alcohol use disorder can present in ______ fibrillation due to both underlying electrolyte abnormalities from malnourishment as well as the potential for nonischemic dilated cardiomyopathy. atrial Question: __________ ketoacidosis is very common due to a diet of "tea and toast" and overall malnourishment. Patients may have mild hyperglycemia but the typical symptoms of diabetic ketoacidosis are not present. Therapy for these patients is actually to give glucose-containing fluids as well as replete electrolytes and supplement with multivitamins and thiamine. Alcoholic Question: An 18-year-old male in college with a history of anxiety, attention deficit hyperactivity disorder, insomnia, and daily chronic cannabis use comes in to see his provider for a follow-up. Since starting a part-time job, he is required to have a primary care physician and had arranged a physical. Over a series of visits, psychotropics are discussed, psychotherapy is initiated, and he is counseled about the detrimental effects of marijuana on his mental health. He is ready to quit and would like recommendations as to how he should approach this as prior attempts have failed. What is the most likely risk for failing the cessation of marijuana? Choices: 1. Impulsivity 2. Fear of losing their job 3. Fear of academic repercussions 4. Discomfort tolerating the cessation Discomfort tolerating the cessation Question: Most medications for alcohol addiction help reduce cravings. _________ helps through deterrence. Disulfiram Question: The ______________ of sertraline with disulfiram, thioridazine, pimozide, or monoamine oxidase inhibitors, including linezolid or methylene blue, is contraindicated. coadministration Question: 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 Question: 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 Question: ______________ 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 Question: 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 Question: 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 Question: 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 Question: There is a mounting body of evidence that demonstrates that _______-_______ pain control therapies are as effective and less harmful than long-term opioid use for chronic pain syndromes. non-opioid Question: Infections resulting from intravenous drug use involve 30% to 40% of all _________ valve infectious endocarditis (TVIE) cases. tricuspid Question: 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 Question: 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 Question: 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. anxiety depression Question: ________________ are more effective for pain caused by arthritis, post-herpetic neuralgia (shingles), fibromyalgia, diabetic neuropathy, peripheral neuropathy, spinal cord injury, stroke, radiculopathy, pelvic pain, migraine, facial pain, and low-back pain. The mechanism of pain relief due to antidepressants is not completely understood. Antidepressants Question: Antidepressants can cause an increase in neurotransmitters that reduce pain signals. Patients might feel the pain relief within 7 to 10 days, but the maximum effect is after several weeks. ____________ are the most common antidepressant used for pain control. Tricyclics Question: Nalbuphine is a mixed opioid agonist-antagonist used to treat pain. In a patient taking morphine or codeine, the addition of nalbuphine may precipitate a ___________ syndrome. withdrawal Question: Phenelzine is a ___________ _________ inhibitor used as an antidepressant and can cause serotonin syndrome when used in combination with sumatriptan. monoamine oxidase Question: ___________ substance use disorder (SUD) requires 4-5 symptoms of SUD be present within a 12 month period.If 2-3 symptoms are present the SUD is considered mild, and SUD is severe with 6+ symptoms present. Moderate Question: Criteria symptoms for SUD must all relate to the ________ _____________ when applying to the severity of a specific SUD. Polysubstance use can make diagnosing each specific SUD, especially challenging. same substance Question: The most common cause of chronic ______________ is alcohol, which accounts for 70% of cases. However, less than 10% of patients with excessive alcohol use develop pancreatitis Question: a classic presentation of opioid overdose causing respiratory depression, hypotension, and pinpoint pupils. The best treatment is _______. naloxone Question: ________ 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 Question: After naloxone administration, patients often begin vomiting violently and become _________. Staff safety and airway protection of the patient is a priority. combative Question: __________ ___________ 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 Question: __________ disorder is a mood disorder characterized by the presence of either mania or hypomania. Borderline personality Question: ____________ 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 Question: ______________ 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 Question: 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 patient's who inhale tobacco this is the best first line option for smokin Varenicline Question: Varenicline has the most evidence of success in reducing smoking behaviors. ___________ and nicotine replacement are second line agents. Buproprion Question: ______________ (PCP) is a dissociative recreational drug. Patients exhibit bizarre, agitated, violent behavior, increased strength, and diminished pain response. Patients often are hypertensive and tachycardic. Phencyclidine Question: PCP is a noncompetitive NMDA receptor antagonist. PCP also inhibits the reuptake of ____________, norepinephrine, and serotonin. dopamine Question: 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 Question: Any patient suspected of alcohol use disorder should be placed on _______________ to prevent Wernicke encephalopathy. thiamine Question: This substance is a common cause of septal perforation. The drug has potent vasoconstrictive properties and also acts as an irritant. Cocaine Question: Bipolar disorder includes both manic or hypomanic and _______________ episodes. depressive Question: What is the drug of choice in the management of neuroleptic malignant syndrome? Dantrolene Question: Dantrolene is a ___________ _________ and acts on the ryanodine receptor. It is specific for neuroleptic malignant syndrome. muscle relaxant Question: 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. Neuroleptic malignant syndrome Question: This is a vision condition in which the eyes make repetitive, uncontrolled movements. These movements often result in reduced vision and depth perception and can affect balance and coordination. These involuntary eye movements can occur from side to side, up and down, or in a circular pattern. Nystagmus Question: __________ is a dissociative anesthetic that acts at the NMDA receptors as a glutamate antagonist. PCP Question: ______________ ______________ disorder is diagnosed when a patient has at least 5 of the following symptoms in the same 2-week period: Depressed mood, anhedonia, weight change, appetite disturbance, sleep disturbance, psychomotor retardation, fatigue or dimished energy, feeling of worthlessness, diminished concentration ability, thoughts of death or suicidal ideation. Major depressive Question: ___________________ is a selective serotonin reuptake inhibitor commonly used as a first-line treatment for major depressive disorder. It is a preferred antidepressant as it is highly efficacious and well-tolerated compared to other classes of antidepressant medications. . Sertraline Question: Sertraline is considered safe in patients with a history of ______________ conditions. cardiac Question: Opioids act directly on the ______ opioid receptor, which in excess can manifest as pinpoint pupils, respiratory depression and hypo-tension. mu Question: The ___________ region of he brain, including the nucleus accumbens is affected by drug abuse. limbic Question: A __________ pimp is a trafficker or pimp that resorts to violence to control a victim. gorilla Question: What is the main sensory loss with methanol intoxication? Vision Question: Methanol can potentially cause _______ blindness. Question: What type of hallucination do patients with severe alcohol use disorder tend to develop initially? Auditory Question: Which of the following medications increases the half-life of alprazolam? Warfarin Fluoxetine Fluvoxamine Paroxetine Fluvoxamine Question: Which Clostridium species is associated with the use of black tar heroin injections under the dermis referred to as "popping"? sordellii Question: ______ % of people in the United States with substance use disorder go untreated. 90 Question: _________________ is a competitive adenosine receptor antagonist, which increases dopamine release in the nucleus accumbens. Caffeine Question: Methamphetamine snorting leads to vasoconstriction of arterioles supplying the teeth accelerating the ____________ disease. periodontal Question: ______________ disorder where a person experiences a variety of physical symptoms over an extended period of time. The person needs to have many symptoms (pain, GI stress, sexual stress, and neurological) Somatoform Question: The ___________ is responsible for metabolism of methadone. liver Question: Alcohol abuse and ______________ is the most common cause of cerebellar disease of the US hydrocephalus Question: What percent of patients with untreated major depression commit suicide? 15 Question: When a patient feels sick with every office visit they may suffer from what psychological disorder? Somatization Question: The organ responsible for metabolism of methadone is what? Liver Question: What type of intoxication would result in a patient that is confused, disoriented and presents with muscle rigidity increase deep tendon reflexes, increase salivation and nystagmus. Patient is hypertensive and catatonic. PCP intoxication Question: Alcohol abuse is the most common cause of _____________ disease in the US. cerebellar Question: What percent of patients with untreated major depression commit suicide? 15 Question: Tricyclic antidepressant overdose is poisoning caused by excessive medication of the tricyclic antidepressant (TCA) type. Symptoms may include elevated body temperature, blurred vision, dilated pupils, sleepiness, confusion, seizures, rapid heart rate, and cardiac arrest. This classification of medications account to the major toxicity by its Anti- ______________ effects. cholinergic Question: Pathophysiology of schizophrenia is due to excess ____________________ dopamine Question: 7-Inhibitory effect of alcohol are related to decreasing effects of __________________ glutamate Question: Tricyclic antidepressants can cause sedation, urinary retention and flattened ____ waves on an EKG T Question: Schizophrenia is a disease process which is characterized by the _____________ ____________ model. stress vulnerability Question: Clozapine is a D___ receptor _____________ 4 antagonist Question: Which Neonatal withdrawal syndromes may present weeks after birth? Name the drug. Methadone Question: _____________ _____________ is the best form of communication. Active listening Question: The medication of choice for the treatment of psychotic symptom in a patient with delirium is what? Haloperidol Question: Of the four medications listed, which is NOT used to treat Schizophrenia? Halopredol Thorazine Lithium Quetiapine Lithium Question: Tarasoff versus Regents of the University of California confirmed The Duty to _________ warn Question: Which of these is NOT a potentially severe side effect of quetiapine? - Neuroleptic Malignant syndrome - Tardive dyskinesias - Orthostatic hypertension - Myocardial infarction Myocardial infarction Question: There are five types of dopamine receptors with different functions. Which dopamine receptor best correlates? Question: Memory, attention, impulse control, regulation of renal function, locomotion D1 Question: There are five types of dopamine receptors with different functions. Which dopamine receptor best correlates? Locomotion, attention, sleep, memory, learning D2 Question: There are five types of dopamine receptors with different functions. Which dopamine receptor best correlates? Question: Cognition, impulse control, attention, sleep D3 & D4 Question: There are five types of dopamine receptors with different functions. Which dopamine receptor best correlates? Question: Decision making, cognition, attention, renin secretion D5 Question: MAO inhibitors (MAOIs) were the first type of antidepressants developed that interact with foods containing ____________ which include cheese, aged, dried, fermented, salted, smoked, pickled and processed meats, wine, etc tyramine Question: Phenylephrine is a medication primarily used as a decongestant to dilate the pupil to increase blood pressure and to relive hemorrhoids. A patient may suffer from a hypertensive crises if taken with Phenelzine (Nardil). Phenelzine's drug classification is what? MAOIs Question: Of the listed medications, which is the least effective in the treatment of generalized anxiety disorder? - Sertraline - Venlafaxine - Buspiron - Bupropion Bupropion Question: What nerve palsies is most common in alcoholic patients? Radial Question: In patients who verbalize a plan and displaying suicidal behavior, which of the following substances are shown to be lower than average? - Creatinine - 5 Hydroxyindoleacetic acid (5HIAA) - Choline - Norepinephrine 5 Hydroxyindoleacetic acid (5HIAA) Question: Which of the following is defined as a catastrophic psychological sstressor by a DSM-V? - Divorce - Rape - Overwhelming natural disaster - Death of a spouse Overwhelming natural disaster Question: The ________ __________ is part of the brain that has been theorized to be involved in obsessive compulsive disorder. Basal ganglia Question: Standard alcoholic drink - 14.5 grams of pure alcohol - _______ ounces of beer - ______ ounces of wine - 1.5 ounces of 80 prof distilled spirits or liquor 12 5 Question: Having 5 or more drinks in one sitting is considered ___________ drinking binge Question: Alcohol metabolizes in the liver (about 90%) and the other 10% is excreted in the urine or in your breath and averages about ___ oz per ___ hours 1 3 Question: Alcohol depresses the ___________ ___________ system. central nervous Question: ______________ Model is a major model in the treatment of alcohol and drug abuse involves a month long stay in an inpatient rehab facility . Minnesota Question: Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar) has a maximum score of __________. Mild is less than or equal to __________, moderate is _____-______ and sever is greater than _________. 67 15 16-20 20 Question: The Diagnostic and Statistical Manual of Mental Disorders is a manual for assessment and diagnosis of mental disorders and does not include information or guidelines for treatment of any disorder. What is the abbreviated form? DSM-5 Question: What does CAGE stand for? It's measured as being Negative if less than 2 and Positive is greater than 2 Cut down Annoyed Guilty Eye opener Question: In alcohol use, the nuerotransmitters that are affected are GABA and Glutamate. _______ is down regulated while _____________ is Upregulated. GABA Glutamate Question: In the treatment of alcohol withdrawal, the first line of treatment to prevent severe w/d symptoms and treat psychomotor agitation are what? Benzodiazepines Question: The Benzo with the fastest onset used in ETOH w/d treatment is what? Diazepam Question: All benzodiazepines are metabolized in the Liver. In a patient with poor liver function, a Doctor will prescribe Ativan over Valium because Ativan metabolizes by the process of ________________ along with temazepam and oxazepam. glucuronidation Question: Glucuronidation is when a glucuronic acid is added to a substrate from UDP-glucuronic acid via a UDP glucuronysyltransferase which is seen in the metabolism of what three benzodiazepines? Ativan Temazepam Oxazepam Question: Some benzodiazepines that are metabolized in the liver through the Cytochrome P450 (microsomal oxidation) pathway and potentially have many more drug-drug interactions include _____________ and _____________. Midazolam Diazepam Question: Prior and during treatment, it is important to monitor patients that are taking Benzo's ___________ function and _________ rate. liver respiratory Question: When treating alcohol w/d with IV Lorazepam, it is crucial to monitor BUN/Creat and _________ _____where anything greater than 10 m0sm/kg indicates the presence of abnormal unmeasured osmotically active molecules. osmolal gap Question: The most common cause of an elevated osmolar gap is ingestion of an ___________, including ethanol, methanol, ethylene glycol, diethylene glycol, propylene glycol, and isopropanolol alcohol. alcohol Question: Chronic alcohol users may suffer from sufficient vitamin B1 known as _____________. This may cause conditions such as Wernicke's encephalopathy and Korakoff syndrome. Thiamine Question: While being separate conditions with different symptoms Wernicke-Korsakoff syndrome often co-occur in those who struggle with long-term alcohol dependence abuse often caused by Cobalamin (Vitamin ______) or thiamine deficiency. B12 Question: These symptoms are associated with what condition that is often caused by deficiency in Cobalamin (Vit. B12) or Thiamine. - Loss of muscle coordination starting with leg tremor and leading to progressive ataxia - Vision changes including double vision, eyelid drooping and abnormal eye motions called nystagmus - ETOH w/d sx. while also appearing drunk - Extreme confusion - Loss of mental activity, possibly progressing to coma or death Wernicke's Encephalopathy Question: This is more likely to trigger this type of psychosis where symptoms include: - Inability to remember events or create new memories - Loss of previous memories - Confabulation, or making up stories to replace lost memories - Seeing or hearing things that are not there or experiencing other hallucinations Korsakoff's Psychosis Question: Excessive alcohol consumption depresses neuronal excitability and impulse conduction and enhances the neurotransmitter effects of _______________. GABA Question: Chronic alcohol use inhibits activity of the excitatory neurotransmitter ____________ resulting in functions at a far higher level in alcoholics. Glutamate Question: When a heavy drinker suddenly cuts back sharply or stops drinking entirely, neurotransmitters that had been suppressed by chronic alcohol use rebound, causing brain ________________ and mild to severe ________. hyperexcitability AWS Question: Alcohol abuse and dependency affect some lab values where Albumin is __________ and Aspartate aminotransferase(ALT) are ____________. decreased increased Question: Alcohol abuse and dependency affect some lab values where Ratio of ALT to alanine aminotransferase may exceed 1.0 with alcoholic _____________. cirrhosis Question: Alcohol abuse and dependency affect some lab values where Gamma glutamyl transferase are _____________ and Mean corpuscular volume is _____________ in liver disease and alcoholism. Increased Elevated Question: Alcohol abuse and dependency affect some lab values where Total bilirubin are ____________ and Uric acid is ____________ increased increased Question: What does SBIRT stand for? Screening Brief Intervention Referral to Treatment Question: Antabuse is the brand name for _____________ which is a medication that can treat problem drinking by creating an unpleasant reaction to alcohol. Disulfiram Question: Vivitrol is the common brand name for ______________ which is a medication that can help prevent relapses into alcohol or drug abuse suppressing ETOH cravings and antagonize opioid receptors Naltrexone Question: Campral is the common brand name of ________________ which is a medication used to reduce the desire to drink alcohol. Acamprosate Question: What category or schedule drug is described? Question: drugs, substances, or chemicals are defined as drugs with no currently accepted medical use and a high potential for abuse. Some examples drugs are: -heroin -lysergic acid diethylamide (LSD) -marijuana (cannabis) -3,4-methylenedioxymethamphetamine (ecstasy), -methaqualone -peyote Schedule I Question: What category or schedule drug is described? Question: Drugs, substances, or chemicals are defined as drugs with a high potential for abuse, with use potentially leading to severe psychological or physical dependence. These drugs are also considered dangerous. Some examples drugs are: -Combination products with less than 15 milligrams of hydrocodone per dosage unit (Vicodin) -cocaine -methamphetamine -methadone -hydromorphone (Dilaudid) -meperidine (Demerol) -oxycodone (OxyContin) -fentanyl -Dexedrine -Adderall -Ritalin Schedule II Question: What category or schedule drug is described? Question: drugs, substances, or chemicals are defined as drugs with a moderate to low potential for physical and psychological dependence. drugs abuse potential is less than Schedule I and Schedule II drugs but more than Schedule IV. Some example drugs are: -Products containing less than 90 milligrams of codeine per dosage unit (Tylenol with codeine) -ketamine -anabolic steroids -testosterone Schedule III Question: What category or schedule drug is described? Question: drugs, substances, or chemicals are defined as drugs with a low potential for abuse and low risk of dependence. Some examples of drugs are: -Xanax -Soma -Darvon -Darvocet -Valium -Ativan -Talwin -Ambien -Tramadol Schedule IV Question: What category or schedule drug is described? Question: drugs, substances, or chemicals are defined as drugs with lower potential for abuse than Schedule IV and consist of preparations containing limited quantities of certain narcotics. These drugs are generally used for antidiarrheal, antitussive, and analgesic purposes. Some examples of drugs are: -cough preparations with less than 200 milligrams of codeine or per 100 milliliters (Robitussin AC) -Lomotil -Motofen -Lyrica -Parepectolin Schedule V Question: ________________ disorder is associated with chronic, frequent, alternating episodes of moderate depression and hypomania. Cyclothymic Question: Diagnosis of bipolar I requires at least one severe _________ or mixed episode which usually results in hospitalization. manic Question: Diagnosis of bipolar II requires a _________ episode which causes symptoms less intense/impairing and shorter duration than mania. hypomanic Question: Which of the following substances can cause slurred speech, pupillary constriction, euphoria, and impairment of memory and attention? - MDMA (Ecstasy) - Heroin - Lysergic acid diethylamide (LSD) - Cannabis Heroin Question: Like methamphetamine, cocaine prevents the reuptake of ______________ which results in a higher sympathetic tone. These hormones are made by the adrenal glands which include dopamine; norepinephrine, and epinephrine. catecholamines Question: Elevation of AST to ALT ratio best screens for alcoholic induced __________ disease. The ratio of greater than 2:1 has a 79% sensitivity and 90% specificity for this ETOH induced disease. liver Question: This substance intoxication presents with psychomotor agitation, bizarre behavior, hypertension, vertical and horizontal nystagmus, psychosis and homicidality PCP intoxication Question: This substance intoxication presents with hallucination, delusions, pupillary dilation, impaired judgement, and increased energy and alertness. Methamphetamine intoxication Question: This substance intoxication presents with pupillary dilation, hallucinations, paranoia, increased energy, and potential sudden cardiac death. Cocaine intoxication Question: This substance intoxication presents with euphoria, increased appetite, impaired judgement, paranoid delusions, dry mouth, and conjunctival injection. Marijuana intoxication Question: What three states rank the highest in reported cases and referrals of human trafficking? California Texas Florida Question: In a patient with a diagnosis of HIV is placed on antiretroviral treatment involving nevirapine, it is appropriate to adjust her methadone dose by _____________ due to Nevirapine up-regulating the function of CYP2B6 an enzyme that metabolizes methadone. increasing Question: Treatment of cocaine-induced tachydysrhythmia should begin with IV ______________ to decrease central nervous system stimulation which is often the primary cause. benzodiazepines Question: Codeine has an agonistic effect on the opioid receptors where pain relief is primarily achieved by the action of this drug on opioid receptors in which organ? - Cerebral cortex - Midbrain - Medulla - Spinal cord Midbrain Question: Within the nervous system, activation of mu receptors in the midbrain is considered as the primary mechanism of opioid-induced _________________. analgesia Question: Codeine is a _______ agonist and does not possess any antagonistic properties. pure Question: In the treatment for respiratory depression caused by midazolam overdose, you would use the medication ____________ Flumazenil Question: The second most common cause of acute pancreatitis in the US is ETOH use with ____________ being the number one cause. gallstones Question: Respiratory depression is a hallmark finding of this drug toxicity. The half life of this drug is 30 minutes and individuals frequently wake up suddenly without further evidence of intoxication "Lazarus Effect". GHB Question: In 2000 The Trafficking Victims Protection Act (TVPA) defined human trafficking as the exploitation of a person or persons for sex or labor. What are the three methods that are commonly used? Force Fraud Coercion Question: For alcohol based hand sanitizers to be effective, one should use about _______ mL and be rubbed on both sides of the hand and in between the fingers for _____ seconds until they are dry. 2.4 30 Question: A _________ or finesse pimp is a trafficker who uses a false romance, false promise of money, clothing or other gifts, false hope of marriage to lure victims. Romeo Question: Longest detection window for drug testing of scalp hair have a detection window of up to _____ months where body hair up to _____ months. 3 12 Question: Blood and ______ fluid have a detention window of minutes to hours for drug testing oral Question: Drug testing detection window of urine is hours to __________ days Question: ________________ is contraindicated for initial administration without a monitored setting for patients with known or suspected respiratory compromise such as those with bronchial asthma or adenocarcinoma of the lung. Hydrocodone Question: Which of the following is the longest acting benzodiazepine? - Clonazepam - Zolpidem - Alprazolam - Diazepam Diazepam Question: ______-opioid binding sites are distributed in the brain, spinal cord, and spinal nucleus of the trigeminal nerve. Mu Question: When heroin is injected into the skin outside a vein it is known as skin ______________. This has serious potential consequences including abscess formation, compartment syndrome and loss of the affected limb. popping Question: Flumazenil is the antidote for benzodiazepine overdose. Abrupt decrease in GABA concentrations can lead to ____________ activity where patients should be monitored. seizure Question: Methadone has the longest _______-______ averaging around 22hrs but in some people as long as 100hrs half life Question: 39 y/o male with significant smoking history is prescribed Varenicline. What baseline lab test should be obtained before initiating? Urea and Creatinine Question: A man is considered an "at risk" drinker if he drinks more than 4 drinks per occasion and if he drinks more than _____ drinks a week. A woman is considered an "at risk" drinker if she drinks more than 3 drinks per occasion. 14 Question: Buprenorphine is a partial agonist and can cause opiate _____________ withdrawal after heroin use if administered too soon. precipitated Question: Cocaine inhibits the reuptake of norepinephrine, dopamine, and serotonin (monoamines) from the _________ _________ synaptic cleft Question: Blockage of __________ receptors is the mechanism of action of phencyclidine (PCP) NMDA Question: Increased affinity of binding to gamma-aminobutyric acid (GABA) receptors is a mechanism of both ____________ and ___________ benzodiazepines barbiturates Question: Opiods are active on mu, kappa, delta and the __________ receptors. The sedative effects are due to their activity on the kappa receptors. nociceptin Question: ____________ opioid receptors are known primarily for their dysphoric and hallucinogenic effects when bound by agonists and can produce sedation. Kappa Question: _______ opioid receptors are known for pain control, euphoria, and respiratory depression when bound by agonists. Mu Question: _______ opioid receptors are known for antidepressant effects when bound by agonists. Delta Question: A patient with alcohol use disorder experiencing delirium tremens can be treated using a long acting benzodiazepine. Besides Diazepam what is another long acting benzo used to treat DT? Chlordiazepoxide PCP can cause dissociative ______________ anesthesia Question: Pressured speech, grandiosity, sleep disturbance, increased activity and distractibility are all characteristics of _____________. mania Question: Schizophrenia is a thought disorder which have characteristics including hallucinations and _____________. delusions Question: Within 2 to 8 days after abrupt discontinuation of ______________, nervousness, tremor, agitation and hypotension may occur and is associated with a fatal withdrawal syndrome. barbiturates Question: ____________ duration of __________ sleep is a commonly seen sleep abnormality in patients with depression. Increased REM Question: After achieving abstinence with the aid of Disulfiram, a patient can possibly start _____________ also known as Campral to reduce the desire to consume alcohol. acamprosate Question: Long term cannabis use has been associated with ___________ _________ syndrome which is characterized by recurrent episodes of intense nausea and vomiting lasting from hours to days without any functional or infectious illness. cyclic vomiting Question: Schizophreniform disorder is diagnosed if psychosis persists up to ____ months 6 Question: A patient was given a purified protein derivative on the inside of the forearm 48hrs ago. A 12-mm induration has developed which is most likely indictive of exposure to _____________. tuberculosis Question: Primary sites where addictive drugs act are nucleus accumbens and ___________ tegmental ventral Question: Underlying CNS changes that occur following repeated use such that person develops tolerance and/or withdrawal is known as what? Neuroadaptation Question: Biological factors associated with extended vulnerability to relapse include neurocognitive factors and ___________ factors. Genetic Question: Behavioral factors associated with extended vulnerability to relapse include poor coping/life skills and ______________ problems. interpersonal Question: Environmental factors associated with extended vulnerability to relapse include poor social support for recovery and high risk ______________ neighborhoods Question: Co-occuring factors associated with extended vulnerability to relapse may include depression and ____________ PTSD CAGE MAST DAST-10 AUDIT Question: These are all what? SUD screenings Question: This assessment was developed to implement an integrated biopsychosocial model of treatment assessment, planning, and outcome monitoring that can be used for evaluation, clinical practice, and administrative purposes GAIN Question: This assessment instrument is a semi-structured interview designed to address seven potential problem areas in substance-abusing patients: Medical status, employment and support, drug use, alcohol use, legal status, family/social status and psychiatric status. ASI Question: Most psychoactive pharmaceuticals and drugs of abuse have their main effects on the ___________ nervous system. central Question: Codeine is 1/5th the potency of ____________. morphine Question: Fentanyl is a __________ ___________ synthetic opioid Question: Fentanyl is most likely abused by this medical profession. Anesthesiologists