National Institutes of Health Stroke Scale
v c vc vc vc v c v
(NIHSS)
c
CARN STUDY MATERIAL Q AND A
5vcstagesvcofvcaddictionvc-vcanswer--1.vcFirstvcUse
2.vcContinuedvcuse
3.vcTolerance
4.vcDependencevc
5.vcAddiction
6%vcofvcU.Svcpatientsvcmisusevctheirvcpainvcmanagementvcprescriptions.vcThreevccommonvcpatientvcpopulationsvcaffect
vcarevcCancer,vcMVAvcandvc__________vc________vc-vcanswer--SicklevcCell
Thisvcmedicationvcactsvconvcthevcsamevcopioidvcreceptorsvcasvccommonlyvcabusedvcopioidsvcwithoutvcreachingvcavcpoint
vceuphoria.vcAlsovcbeingvclongvcactingvcitvchasvcbeenvcusedvcforvcovervc40vcyearsvcinvccountlessvcpatientsvcquestsvctoward
recovery.vc-vcanswer--Methadone
Whichvcofvcthesevcmedicationsvcarevcusedvcforvctreatingvcalcoholvcabuse?vc
Acamprosatevc
Varenicline
Methadonevc
Bupropionvc-vcanswer--Acamprosate
Whichvcofvcthesevcmedicationsvcarevcusedvcforvctobaccovcdisorder?
Acamprosatevc
Varenicline
Methadonevc
Bupropionvc-vcanswer--Vareniclinevc
Bupropion
Thisvcsubstancevcisvcavcfullvcagonistvcofvctracevcamine-
associatedvcreceptorsvc(TAAR1).vcActivationvcTAAR1vccausesvcthevcincreasevcofvccAMPvcandvcinhibitionvcofvcserotonin,
opamine,vcandvcnorepinephrinevctransporters.vcThevcinhibitionvcofvcmonoaminevctransportersvccausesvcthevcreuptakevc
dvcmetabolismvcofvccatecholamines.vc-vcanswer--Methamphetamine
Thevcfollowingvcarevc"_________vc_______"vcforvcmethamphetamine:vcmeth,vccrystalvcmeth,vccrystal,vcspeed,vcscootie
ellowvcpowder,vccrank,vcice,vcspoosh,vcglass,vcchalk,vcredneckvccocaine,vcyellowvcbarn,vcTina,vcandvctick-tick.vc-vcanswer
streetvcnames
Patientsvcundervcthevcinfluencevcofvcmethamphetaminevccanvchavevcthevcfollowingvcsignsvcorvcsymptoms:vc__________
appetite,vcnausea,vcpsychosis,vctachycardia,vchypertension,vc___________vcbodyvctemperature,vcpanicvcattack,vcmyd
sis,vc__________vcsleepvcpatterns,vcviolent,vcbizarre,vcandvcerraticvcbehavior,vchallucinations,vcirritability,vcseizures,vcan
cdeathvcfromvchighvcdoses.vc-vcanswer--decreased
increased
disturbed
1vc/
vc24
, National Institutes of Health Stroke Scale
v c vc vc vc v c v
(NIHSS)
c
Avc65-year-oldvcfemalevcpresentsvctovcthevcclinicvctovcseekvcavcre-
prescriptionvcofvchervcpainvcmedication.vcShevchadvcavcmotorvcvehiclevccollisionvc(MVC)vc8vcmonthsvcagovcthatvcleftvchervcw
hvcchronicvcneuralgiavcinvcbilateralvcarmsvcalongvcwithvclowvcbackvcpain.vcShevcwasvcprescribedvcoxycodone/
acetaminophenvc7.5/325vcmgvcq6vchours.vcHervclastvcscheduledvcrefillvcwasvc20vcdaysvcagovcwithvcavc30vcdayvcsupply.vcS
creturnsvcearlyvcclaimingvcshevcneededvcmultiplevcdosagesvcsoonervcthanvcdirectedvcduevctovcunmanagedvcpain.vcCurren
vitalvcsignsvcarevcnormal,vcbutvcshevcisvcdiaphoretic,vctearing,vcrestless,vcandvcoccasionallyvcyawning.vcWhenvcthevcprovid
rvcexplains,vccontrolledvcmedicationsvccannotvcbevcprescribedvcinvcthisvcmanner,vcthevcpatientvcstates,vc"Youvcdon'tvcunde
tand.vcIvcneedvctovcfeelvcnormal.vcWithoutvcit,vcIvcfeelvcworsevcthanvcIvcusedvctovcfeelvcatvcbaseline.vcPlease!"vcWhatvcstagev
caddictionvcisvcthevcpatientvcinvcandvcwhatvcmedicationvccanvcbevcusedvctovchelpvchervcsymptoms?
Choices:vc
1.vcTolerancevcandvcacamprosate
2.vcTolerancevcandvc-vcanswer--Dependencevcandvcmethadone
Avcpatientvcpresentsvctovcthevcemergencyvcdepartmentvcwithvcagitation,vcmydriasis,vchypertension,vcandvctachycardia.vc
vcstatesvcthatvchevcsnortedvc"somevccrystals"vcwithvcfriendsvcandvcthatvchevcfeelsvcenergeticvcandvcanxious.vcHevcreportsvct
tvchisvcfriendsvctoldvchimvcthisvcisvcavctreatmentvcforvcweightvclossvcandvcthisvcisvcthevcreasonvcwhyvchevctriedvcit.vcWhichvcisvc
evcofvcthevcdrugvcmostvclikelyvcusedvcbyvcthisvcpatient?
Choices:vc
vc
1.vcPartialvcagonistvcofvctracevcamine-associatedvcreceptorsvc(TAAR1)vc
2.vcGamma-aminobutyricvcacidvc(GABA)vcreceptorvcagonistvc
3.vcFullvcagonistvcofvctracevcamine-associatedvcreceptorsvc(TAAR1)vc
4.vcFullvcantagonistvcofvcdopaminevcreceptorsvc-vcanswer--Fullvcagonistvcofvctracevcamine-associatedvcreceptorsvc(TAAR
Avc35-year-oldvcwomanvccomesvcinvcforvchervcwellnessvccheck-up.vcShevchasvcavc13-year-
oldvcsonvcwhovcisvcgoingvctovcbevcstartingvchighvcschoolvcnextvcyearvcandvcoftenvchearvchimvcandvchisvcfriendsvcdiscussvcwa
vctovcpreparevcforvchighvcschool,vcsovctheyvcfitvcin.vcThevcmothervcisvcconcernedvchervcsonvcmayvcusevcdrugsvcasvchevcoftenv
lksvcaboutvcthevcpartying.vcShevcwantsvctovcknowvcwhatvcshevccanvcdovcitvcpreparevchimvctovcavoidvcsmokingvccannabisvcgi
nvcitsvcsurgevcinvcpopularityvcamongstvcyouth.vcWhatvcisvcthevcmostvccommonvcreasonvcforvcmarijuanavcuse,vcamongstvcte
agersvcandvcyoungvcadults?
vc
Choices:vc
1.vcStressvcmanagementvc
2.vcExperimentationvc
3.vcSocialvcconformityvc
4.vcPleasurablevcsensationvc-vcanswer--Socialvcconformity
Avcyoungvcadultvcpatientvcisvcdroppedvcoffvcoutsidevcthevcemergencyvcdepartmentvcbyvchervcfriends,vcandvctheyvcdrivevcoff
eforevcanyvchistoryvccanvcbevcobtained.vcThevcpatientvchasvcalteredvcmentalvcstatusvcandvcshowsvcsignsvcofvcintoxication.
uddenvcdorsiflexionvcofvchervcanklevcproducesvcavcrhythmicvcreproductionvcofvchervcanklevcjerkvcreflex.vcWhichvcofvcthevcfo
wingvcdrugsvcdidvcshevcmostvclikelyvcingest?
Choices:vc
1.vcAlcoholvc
2.vc3,4-Methylenedioxymethamphetaminevc(MDMA)vc
3.vcPhencyclidinevc
4.vcCannabisvc-vcanswer--3,4-Methylenedioxymethamphetamine vc(MDMA)
2vc/
vc24
, National Institutes of Health Stroke Scale
v c vc vc vc v c v
(NIHSS)
c
Severalvcclassesvcofvccommonvcstreetvcdrugsvcsuchvcasvccocaine,vcecstasyvc(MDMA),vcandvcamphetamines,vcincreasev
erotoninvclevels,vcwhichvcisvcpartvcofvcwhatvccontributesvctovcthevcpleasurablevcandvcaddictivevcaspectsvcofvctheirvcuse,vcan
calsovcwhatvccanvcproducevcavc__________vcsyndromevcandvc__________.vc-vcanswer--serotonin
clonus
Psychiatricvcmedicationsvcsuchvcasvcmonoaminevcoxidasevcinhibitorsvc(MAOI),vcselectivevcserotoninvcreuptakevcinhibito
vc(SSRI),vcserotonin-
norepinephrinevcreuptakevcinhibitorsvc(SNRI),vcandvctricyclicvcantidepressantsvc(TCA)vcmanipulatevcserotoninvclevelsvc
improvevc__________,vcbutvctoovcmuchvccanvcproducevcclonusvcasvcpartvcofvcserotoninvc____________.vc-vcanswer--
mood
syndrome
____________vcnervousvcsystemvcdepressantsvclikevcalcoholvcandvcopiatesvccanvcdiminishvcdeepvctendonvc_________
casvcopposedvctovcproducingvcclonus.vc-vcanswer--Central
reflexes
Avc66-year-
oldvcmalevcwasvcprescribedvcpainvcmedicationvcaftervcavcfracturevcfollowedvcbyvcsurgeryvc6vcmonthsvcago.vcSincevcthen,vc
vcprimaryvccarevcprovidervchasvcnoticedvcfrequentvcvisitsvctovcthevcofficevcaskingvcforvcpainvcmedicationvcandvcmultiplevcinj
esvcjustifyingvcthevcusevcofvcit.vcEveryvctimevctherevcarevcdifferentvcvaguevccomplaints,vcbutvcthatvcofvcpainvcisvcconsistent.v
nvchisvclastvcvisit,vcthevcprimaryvccarevctookvcavcfirmvcstandvcandvcdidvcnotvcagreevctovccontinuevcprescribingvcthevcopioids.v
odayvchevcvisitsvcinvcavcrestlessvcstate.vcWhichvcofvcthevcfollowingvcdovcyouvcsuspectvctovcseevconvchistoryvcorvcphysicalvcex
mvcinvcthisvcpatient?vc
Choices:vc
1.vcConstipationvc
2.vcMiosisvc
3.vcDilatedvcpupilsvc
4.vcBradycardiavc-vcanswer--Dilatedvcpupils
Opioidvcwithdrawalvconsetvcvariesvcwithvcthevctypevcofvcopioidvcused.vcHeroinvcwithdrawalvcbeginsvcinvcasvclittlevcasvc___vc
urs,vcwhereasvcmethadonevcmayvctakevc2vctovc3vc_______.vc-vcanswer--5
days
Opiodvcwithdrawalvcsymptomsvcmayvclastvcdaysvctovcweeksvcknownvcasvcprotractedvcabstinencevcsyndrome.vcSignsvcan
symptomsvcofvcwithdrawalvcincludevc___________vccramps,vcagitation,vcanxiety,vccravings,vcdiarrhea,vcdilatedvcpupils,
ighvcbloodvcpressure,vcinsomnia,vcgoosebumps,vcmusclevcpains,vc________vcnose,vcshakiness,vcsneezing,vcsweating,
achycardia,vcandvctearing.vc-vcanswer--abdominal
runny
Avcpregnantvcfemale,vcadmittedvcforvcpossiblevcpyelonephritis,vcisvccomplainingvcofvcsignificantvcanxiety,vctremulousnes
candvcirritability.vcUponvcassessment,vcshevcisvcnotedvctovchavevcavcbloodvcpressurevcofvc156/94vcmmHg,vcpulsevc103vcbp
vcandvcisvccomplainingvcofvcnausea.vcWhichvcofvcthevcfollowingvcscreeningvctoolsvcforvcthisvcpatient'svcmostvclikelyvcsubsta
evcusevcdisordervchasvcbeenvcempiricallyvcvalidatedvcforvcusevcinvcpregnantvcfemales?vc
Choices:vc
1.vcAUDITvc
2.vcCAGEvc
3.vcT-ACE/T-ACER-3vc
4.vcPHQ-9vc-vcanswer--T-ACE/T-ACER-3
3vc/
vc24
v c vc vc vc v c v
(NIHSS)
c
CARN STUDY MATERIAL Q AND A
5vcstagesvcofvcaddictionvc-vcanswer--1.vcFirstvcUse
2.vcContinuedvcuse
3.vcTolerance
4.vcDependencevc
5.vcAddiction
6%vcofvcU.Svcpatientsvcmisusevctheirvcpainvcmanagementvcprescriptions.vcThreevccommonvcpatientvcpopulationsvcaffect
vcarevcCancer,vcMVAvcandvc__________vc________vc-vcanswer--SicklevcCell
Thisvcmedicationvcactsvconvcthevcsamevcopioidvcreceptorsvcasvccommonlyvcabusedvcopioidsvcwithoutvcreachingvcavcpoint
vceuphoria.vcAlsovcbeingvclongvcactingvcitvchasvcbeenvcusedvcforvcovervc40vcyearsvcinvccountlessvcpatientsvcquestsvctoward
recovery.vc-vcanswer--Methadone
Whichvcofvcthesevcmedicationsvcarevcusedvcforvctreatingvcalcoholvcabuse?vc
Acamprosatevc
Varenicline
Methadonevc
Bupropionvc-vcanswer--Acamprosate
Whichvcofvcthesevcmedicationsvcarevcusedvcforvctobaccovcdisorder?
Acamprosatevc
Varenicline
Methadonevc
Bupropionvc-vcanswer--Vareniclinevc
Bupropion
Thisvcsubstancevcisvcavcfullvcagonistvcofvctracevcamine-
associatedvcreceptorsvc(TAAR1).vcActivationvcTAAR1vccausesvcthevcincreasevcofvccAMPvcandvcinhibitionvcofvcserotonin,
opamine,vcandvcnorepinephrinevctransporters.vcThevcinhibitionvcofvcmonoaminevctransportersvccausesvcthevcreuptakevc
dvcmetabolismvcofvccatecholamines.vc-vcanswer--Methamphetamine
Thevcfollowingvcarevc"_________vc_______"vcforvcmethamphetamine:vcmeth,vccrystalvcmeth,vccrystal,vcspeed,vcscootie
ellowvcpowder,vccrank,vcice,vcspoosh,vcglass,vcchalk,vcredneckvccocaine,vcyellowvcbarn,vcTina,vcandvctick-tick.vc-vcanswer
streetvcnames
Patientsvcundervcthevcinfluencevcofvcmethamphetaminevccanvchavevcthevcfollowingvcsignsvcorvcsymptoms:vc__________
appetite,vcnausea,vcpsychosis,vctachycardia,vchypertension,vc___________vcbodyvctemperature,vcpanicvcattack,vcmyd
sis,vc__________vcsleepvcpatterns,vcviolent,vcbizarre,vcandvcerraticvcbehavior,vchallucinations,vcirritability,vcseizures,vcan
cdeathvcfromvchighvcdoses.vc-vcanswer--decreased
increased
disturbed
1vc/
vc24
, National Institutes of Health Stroke Scale
v c vc vc vc v c v
(NIHSS)
c
Avc65-year-oldvcfemalevcpresentsvctovcthevcclinicvctovcseekvcavcre-
prescriptionvcofvchervcpainvcmedication.vcShevchadvcavcmotorvcvehiclevccollisionvc(MVC)vc8vcmonthsvcagovcthatvcleftvchervcw
hvcchronicvcneuralgiavcinvcbilateralvcarmsvcalongvcwithvclowvcbackvcpain.vcShevcwasvcprescribedvcoxycodone/
acetaminophenvc7.5/325vcmgvcq6vchours.vcHervclastvcscheduledvcrefillvcwasvc20vcdaysvcagovcwithvcavc30vcdayvcsupply.vcS
creturnsvcearlyvcclaimingvcshevcneededvcmultiplevcdosagesvcsoonervcthanvcdirectedvcduevctovcunmanagedvcpain.vcCurren
vitalvcsignsvcarevcnormal,vcbutvcshevcisvcdiaphoretic,vctearing,vcrestless,vcandvcoccasionallyvcyawning.vcWhenvcthevcprovid
rvcexplains,vccontrolledvcmedicationsvccannotvcbevcprescribedvcinvcthisvcmanner,vcthevcpatientvcstates,vc"Youvcdon'tvcunde
tand.vcIvcneedvctovcfeelvcnormal.vcWithoutvcit,vcIvcfeelvcworsevcthanvcIvcusedvctovcfeelvcatvcbaseline.vcPlease!"vcWhatvcstagev
caddictionvcisvcthevcpatientvcinvcandvcwhatvcmedicationvccanvcbevcusedvctovchelpvchervcsymptoms?
Choices:vc
1.vcTolerancevcandvcacamprosate
2.vcTolerancevcandvc-vcanswer--Dependencevcandvcmethadone
Avcpatientvcpresentsvctovcthevcemergencyvcdepartmentvcwithvcagitation,vcmydriasis,vchypertension,vcandvctachycardia.vc
vcstatesvcthatvchevcsnortedvc"somevccrystals"vcwithvcfriendsvcandvcthatvchevcfeelsvcenergeticvcandvcanxious.vcHevcreportsvct
tvchisvcfriendsvctoldvchimvcthisvcisvcavctreatmentvcforvcweightvclossvcandvcthisvcisvcthevcreasonvcwhyvchevctriedvcit.vcWhichvcisvc
evcofvcthevcdrugvcmostvclikelyvcusedvcbyvcthisvcpatient?
Choices:vc
vc
1.vcPartialvcagonistvcofvctracevcamine-associatedvcreceptorsvc(TAAR1)vc
2.vcGamma-aminobutyricvcacidvc(GABA)vcreceptorvcagonistvc
3.vcFullvcagonistvcofvctracevcamine-associatedvcreceptorsvc(TAAR1)vc
4.vcFullvcantagonistvcofvcdopaminevcreceptorsvc-vcanswer--Fullvcagonistvcofvctracevcamine-associatedvcreceptorsvc(TAAR
Avc35-year-oldvcwomanvccomesvcinvcforvchervcwellnessvccheck-up.vcShevchasvcavc13-year-
oldvcsonvcwhovcisvcgoingvctovcbevcstartingvchighvcschoolvcnextvcyearvcandvcoftenvchearvchimvcandvchisvcfriendsvcdiscussvcwa
vctovcpreparevcforvchighvcschool,vcsovctheyvcfitvcin.vcThevcmothervcisvcconcernedvchervcsonvcmayvcusevcdrugsvcasvchevcoftenv
lksvcaboutvcthevcpartying.vcShevcwantsvctovcknowvcwhatvcshevccanvcdovcitvcpreparevchimvctovcavoidvcsmokingvccannabisvcgi
nvcitsvcsurgevcinvcpopularityvcamongstvcyouth.vcWhatvcisvcthevcmostvccommonvcreasonvcforvcmarijuanavcuse,vcamongstvcte
agersvcandvcyoungvcadults?
vc
Choices:vc
1.vcStressvcmanagementvc
2.vcExperimentationvc
3.vcSocialvcconformityvc
4.vcPleasurablevcsensationvc-vcanswer--Socialvcconformity
Avcyoungvcadultvcpatientvcisvcdroppedvcoffvcoutsidevcthevcemergencyvcdepartmentvcbyvchervcfriends,vcandvctheyvcdrivevcoff
eforevcanyvchistoryvccanvcbevcobtained.vcThevcpatientvchasvcalteredvcmentalvcstatusvcandvcshowsvcsignsvcofvcintoxication.
uddenvcdorsiflexionvcofvchervcanklevcproducesvcavcrhythmicvcreproductionvcofvchervcanklevcjerkvcreflex.vcWhichvcofvcthevcfo
wingvcdrugsvcdidvcshevcmostvclikelyvcingest?
Choices:vc
1.vcAlcoholvc
2.vc3,4-Methylenedioxymethamphetaminevc(MDMA)vc
3.vcPhencyclidinevc
4.vcCannabisvc-vcanswer--3,4-Methylenedioxymethamphetamine vc(MDMA)
2vc/
vc24
, National Institutes of Health Stroke Scale
v c vc vc vc v c v
(NIHSS)
c
Severalvcclassesvcofvccommonvcstreetvcdrugsvcsuchvcasvccocaine,vcecstasyvc(MDMA),vcandvcamphetamines,vcincreasev
erotoninvclevels,vcwhichvcisvcpartvcofvcwhatvccontributesvctovcthevcpleasurablevcandvcaddictivevcaspectsvcofvctheirvcuse,vcan
calsovcwhatvccanvcproducevcavc__________vcsyndromevcandvc__________.vc-vcanswer--serotonin
clonus
Psychiatricvcmedicationsvcsuchvcasvcmonoaminevcoxidasevcinhibitorsvc(MAOI),vcselectivevcserotoninvcreuptakevcinhibito
vc(SSRI),vcserotonin-
norepinephrinevcreuptakevcinhibitorsvc(SNRI),vcandvctricyclicvcantidepressantsvc(TCA)vcmanipulatevcserotoninvclevelsvc
improvevc__________,vcbutvctoovcmuchvccanvcproducevcclonusvcasvcpartvcofvcserotoninvc____________.vc-vcanswer--
mood
syndrome
____________vcnervousvcsystemvcdepressantsvclikevcalcoholvcandvcopiatesvccanvcdiminishvcdeepvctendonvc_________
casvcopposedvctovcproducingvcclonus.vc-vcanswer--Central
reflexes
Avc66-year-
oldvcmalevcwasvcprescribedvcpainvcmedicationvcaftervcavcfracturevcfollowedvcbyvcsurgeryvc6vcmonthsvcago.vcSincevcthen,vc
vcprimaryvccarevcprovidervchasvcnoticedvcfrequentvcvisitsvctovcthevcofficevcaskingvcforvcpainvcmedicationvcandvcmultiplevcinj
esvcjustifyingvcthevcusevcofvcit.vcEveryvctimevctherevcarevcdifferentvcvaguevccomplaints,vcbutvcthatvcofvcpainvcisvcconsistent.v
nvchisvclastvcvisit,vcthevcprimaryvccarevctookvcavcfirmvcstandvcandvcdidvcnotvcagreevctovccontinuevcprescribingvcthevcopioids.v
odayvchevcvisitsvcinvcavcrestlessvcstate.vcWhichvcofvcthevcfollowingvcdovcyouvcsuspectvctovcseevconvchistoryvcorvcphysicalvcex
mvcinvcthisvcpatient?vc
Choices:vc
1.vcConstipationvc
2.vcMiosisvc
3.vcDilatedvcpupilsvc
4.vcBradycardiavc-vcanswer--Dilatedvcpupils
Opioidvcwithdrawalvconsetvcvariesvcwithvcthevctypevcofvcopioidvcused.vcHeroinvcwithdrawalvcbeginsvcinvcasvclittlevcasvc___vc
urs,vcwhereasvcmethadonevcmayvctakevc2vctovc3vc_______.vc-vcanswer--5
days
Opiodvcwithdrawalvcsymptomsvcmayvclastvcdaysvctovcweeksvcknownvcasvcprotractedvcabstinencevcsyndrome.vcSignsvcan
symptomsvcofvcwithdrawalvcincludevc___________vccramps,vcagitation,vcanxiety,vccravings,vcdiarrhea,vcdilatedvcpupils,
ighvcbloodvcpressure,vcinsomnia,vcgoosebumps,vcmusclevcpains,vc________vcnose,vcshakiness,vcsneezing,vcsweating,
achycardia,vcandvctearing.vc-vcanswer--abdominal
runny
Avcpregnantvcfemale,vcadmittedvcforvcpossiblevcpyelonephritis,vcisvccomplainingvcofvcsignificantvcanxiety,vctremulousnes
candvcirritability.vcUponvcassessment,vcshevcisvcnotedvctovchavevcavcbloodvcpressurevcofvc156/94vcmmHg,vcpulsevc103vcbp
vcandvcisvccomplainingvcofvcnausea.vcWhichvcofvcthevcfollowingvcscreeningvctoolsvcforvcthisvcpatient'svcmostvclikelyvcsubsta
evcusevcdisordervchasvcbeenvcempiricallyvcvalidatedvcforvcusevcinvcpregnantvcfemales?vc
Choices:vc
1.vcAUDITvc
2.vcCAGEvc
3.vcT-ACE/T-ACER-3vc
4.vcPHQ-9vc-vcanswer--T-ACE/T-ACER-3
3vc/
vc24
