FLORIDA Addic on Medicine Final Exam With complete
solu on LATEST 2025/2026 UPDATED NEW
How Gaba and glutamate lead to excita on of the VTA - Answers 1. The VTA can project to the
prefrontal cortex which projects back to the VTA and releases glutamate to ac vate
dopaminergic VTA neurons
2. The VTA can project to the nucleus accumbens which then projects to the ventral pallidum.
Both the NA and VP release gaba, so inhibi on of inhibi on = excita on
3. The VTA-->Prefrontal-->NA-->VP-->VTA
Nico ne acts on these receptors - Answers Nico nic ionotropic Ach receptors
MOA Cocaine - Answers Blocks DAT for dopamine reuptake
(Note Amphetamines block both VMAT-2 and DAT)
If you lesion neurons with DAT vs knock them out, why is there a different effect on cocaine
reward? - Answers If you lesion the DAT neurons, not all of them have been removed and
there is less of a reward.
If you knock them out, 5HT and norepinephrine transporters will start working for dopamine
and cocaine will now have an effect on these so it s ll produces a euphoric effect.
MOA of amphetamines - Answers VMAT-2 compe ve inhibitor - Displaces dopamine from
pre-synap c vesicles which causes dopamine to leak out into the extracellular space because
DATs will start to run backwards. They do also block dopamine reuptake to a lesser extent
, MOA of opiates - Answers they affect the mu opioid GPCRs. They ac vate the Gi Go and Gq
subunits to affect K+ and Ca++ Channels
Knockout Mu opiate receptors and - Answers there is no longer any reward
Endogenous ligands of opiate receptors - Answers endomorphine, enkephalin, dynorphin
What is methadone used for? - Answers opioid replacement therapy, it has a much longer
half life so it has less of an addic on poten al
MOA of cannabinoids - Answers binds to CB1 in the CNS and CB2 in the periphery
Dopaminergic cells in the VTA have a very high density of CB1 receptors (more than any other
type of receptor)
Endogenous ligand of CB-1 receptors - Answers anandaminde
Diazepam vs Lorazepam vs Chlordiazepoxide - Answers Chlordiazepoxide and Diazepam are
long ac ng, less potent benzos
Lorazepam is short ac ng and more potent
MOA of Phencyclidine - Answers Phencyclidine (PCP) blocks NMDA and nico nic
acetylcholine receptors
MOA of Lysergic Acid (LSD) - Answers Par al 5HT(2A) agonist (also affects all monoaminergic
receptors)
Mechanism of EtOH - Answers Disinhibits VTA neurons
,S mulates Gaba receptors
Inhibits NMDA receptors
Cellular changes related to EtOH withdrawal - Answers VTA Neuronal excitotoxicity
Downregula on of Gaba-A neurons
Upregula on of NMDA receptors
Profile of the most stressed (at-risk) physician - Answers <48 yrs old
Female
Solo Prac ce
>Hours
Most hours in direct pa ent care
<Vaca on Days
Most commonly abused drugs by physicians - Answers Alcohol>Opiates>S mulants
50%>36%>8%
Most common medical special es with drug abuse disorders - Answers
Anesthesiology>Emergency Medicine>Psychiatry
Contributors to Physician Burn out - Answers Dysfunc onal family, personality structure, self-
imposed demands, hours, isola on, etc.
% of physicians with a substance abuse disorder - Answers 10% (same as general popula on)
Physicians are also just as likely to have experimented with illicit substances in their life me as
the general popula on but are less likely to be current users of illicit substances.
, Med students most at risk for burnout - Answers >$100,000 in debt, unmarried, younger
MassachuseHs Mandated Repor ng - Answers There is a legal obliga on to report a
colleague to the board of medicine if they are in viola on of regula ons/licensing statues (Ch
112 sec on 5F)
However, if the physician has not directly harmed a pa ent, there is a bypass op on to go to the
PHS (physician health services) but if the physician does not comply with treatment for 30 days,
then it is required to report them to the board and then their license may be in jeopardy.
AA vs SMART - Answers AA depends on admission of lack of power over the substance and
that a power greater than us can restore us. The problem is with the PERSON not the
SUBSTANCE. 12-step program, non-denomina onal but spiritual
SMART recovery focuses on self empowerment and that everyone may have a different path to
recovery. It is based on cogni ve behavioral therapy.
Four Points of SMART Recovery - Answers 1. Enhance/Maintain Mo va on to Abstain
2. Cope with Urges
3. Problem Solving (Thoughts/Feelings/Behavior)
4. Lifestyle Balance (Momentary/Enduring Sa sfac on)
% of injury related deaths related to substance abuse disorders in the US - Answers 30%
Most commonly abused drugs in the US - Answers Alcohol>CigareHes (e-cigareHes included)
>Marijuana>Pain Relievers
NESARC Clusters - Answers Cluster 1: Young adults, low risk, oLen college-aged binge
drinking falls into this category
solu on LATEST 2025/2026 UPDATED NEW
How Gaba and glutamate lead to excita on of the VTA - Answers 1. The VTA can project to the
prefrontal cortex which projects back to the VTA and releases glutamate to ac vate
dopaminergic VTA neurons
2. The VTA can project to the nucleus accumbens which then projects to the ventral pallidum.
Both the NA and VP release gaba, so inhibi on of inhibi on = excita on
3. The VTA-->Prefrontal-->NA-->VP-->VTA
Nico ne acts on these receptors - Answers Nico nic ionotropic Ach receptors
MOA Cocaine - Answers Blocks DAT for dopamine reuptake
(Note Amphetamines block both VMAT-2 and DAT)
If you lesion neurons with DAT vs knock them out, why is there a different effect on cocaine
reward? - Answers If you lesion the DAT neurons, not all of them have been removed and
there is less of a reward.
If you knock them out, 5HT and norepinephrine transporters will start working for dopamine
and cocaine will now have an effect on these so it s ll produces a euphoric effect.
MOA of amphetamines - Answers VMAT-2 compe ve inhibitor - Displaces dopamine from
pre-synap c vesicles which causes dopamine to leak out into the extracellular space because
DATs will start to run backwards. They do also block dopamine reuptake to a lesser extent
, MOA of opiates - Answers they affect the mu opioid GPCRs. They ac vate the Gi Go and Gq
subunits to affect K+ and Ca++ Channels
Knockout Mu opiate receptors and - Answers there is no longer any reward
Endogenous ligands of opiate receptors - Answers endomorphine, enkephalin, dynorphin
What is methadone used for? - Answers opioid replacement therapy, it has a much longer
half life so it has less of an addic on poten al
MOA of cannabinoids - Answers binds to CB1 in the CNS and CB2 in the periphery
Dopaminergic cells in the VTA have a very high density of CB1 receptors (more than any other
type of receptor)
Endogenous ligand of CB-1 receptors - Answers anandaminde
Diazepam vs Lorazepam vs Chlordiazepoxide - Answers Chlordiazepoxide and Diazepam are
long ac ng, less potent benzos
Lorazepam is short ac ng and more potent
MOA of Phencyclidine - Answers Phencyclidine (PCP) blocks NMDA and nico nic
acetylcholine receptors
MOA of Lysergic Acid (LSD) - Answers Par al 5HT(2A) agonist (also affects all monoaminergic
receptors)
Mechanism of EtOH - Answers Disinhibits VTA neurons
,S mulates Gaba receptors
Inhibits NMDA receptors
Cellular changes related to EtOH withdrawal - Answers VTA Neuronal excitotoxicity
Downregula on of Gaba-A neurons
Upregula on of NMDA receptors
Profile of the most stressed (at-risk) physician - Answers <48 yrs old
Female
Solo Prac ce
>Hours
Most hours in direct pa ent care
<Vaca on Days
Most commonly abused drugs by physicians - Answers Alcohol>Opiates>S mulants
50%>36%>8%
Most common medical special es with drug abuse disorders - Answers
Anesthesiology>Emergency Medicine>Psychiatry
Contributors to Physician Burn out - Answers Dysfunc onal family, personality structure, self-
imposed demands, hours, isola on, etc.
% of physicians with a substance abuse disorder - Answers 10% (same as general popula on)
Physicians are also just as likely to have experimented with illicit substances in their life me as
the general popula on but are less likely to be current users of illicit substances.
, Med students most at risk for burnout - Answers >$100,000 in debt, unmarried, younger
MassachuseHs Mandated Repor ng - Answers There is a legal obliga on to report a
colleague to the board of medicine if they are in viola on of regula ons/licensing statues (Ch
112 sec on 5F)
However, if the physician has not directly harmed a pa ent, there is a bypass op on to go to the
PHS (physician health services) but if the physician does not comply with treatment for 30 days,
then it is required to report them to the board and then their license may be in jeopardy.
AA vs SMART - Answers AA depends on admission of lack of power over the substance and
that a power greater than us can restore us. The problem is with the PERSON not the
SUBSTANCE. 12-step program, non-denomina onal but spiritual
SMART recovery focuses on self empowerment and that everyone may have a different path to
recovery. It is based on cogni ve behavioral therapy.
Four Points of SMART Recovery - Answers 1. Enhance/Maintain Mo va on to Abstain
2. Cope with Urges
3. Problem Solving (Thoughts/Feelings/Behavior)
4. Lifestyle Balance (Momentary/Enduring Sa sfac on)
% of injury related deaths related to substance abuse disorders in the US - Answers 30%
Most commonly abused drugs in the US - Answers Alcohol>CigareHes (e-cigareHes included)
>Marijuana>Pain Relievers
NESARC Clusters - Answers Cluster 1: Young adults, low risk, oLen college-aged binge
drinking falls into this category
