Substances of abuse all raise release of the neurotransmitter dopamine in the brain's reward pathway, producing pleasure and euphoria.
Missing Word
dopamine
Dopamine is the reward neurotransmitter. Drugs of abuse raise it beyond what natural rewards do, and over time the reward circuitry adapts, which drives craving and loss of control.
Category: Substance Use Concepts
Question 2
The substance-specific changes in behavior and body function that follow recent use of a psychoactive substance are called intoxication.
Missing Word
intoxication
Intoxication depends on the substance, dose, frequency and route; for example, IV heroin acts faster and more strongly than oral use. Withdrawal is the opposite set of effects after use stops.
Category: Substance Use Concepts
Question 3
A patient taking disulfiram is taught to avoid kombucha, a fermented tea drink that can contain alcohol.
Missing Word
kombucha
Kombucha is made by fermenting sweetened tea, and the fermentation produces some alcohol. Because disulfiram can cause a reaction to even small amounts of alcohol, patients are taught to avoid hidden sources such as kombucha, mouthwashes, cough syrups and hand sanitizers.
Category: Alcohol Deterrent Therapy
Question 4
The synthetic opioid that now drives most U.S. overdose deaths and is often found mixed into other street drugs, including cocaine, is fentanyl.
Missing Word
fentanyl
Fentanyl is a potent synthetic opioid. Because it contaminates other drugs, a person may not know they took it, and standard urine screens can miss it.
Category: Opioid Overdose Reversal
Question 5
The opioid antagonist sold over the counter as a nasal spray for emergency overdose reversal is naloxone.
Missing Word
naloxone
Naloxone is a pure mu antagonist that reverses overdose within minutes. Because the person who overdosed is usually too sedated to use it, family and friends should be trained to give it.
Category: Opioid Overdose Reversal
Question 6
The partial mu opioid agonist with high receptor affinity, used to reduce cravings and withdrawal in opioid use disorder, is buprenorphine.
Missing Word
buprenorphine
Buprenorphine eases withdrawal and cravings while its partial agonist effect limits respiratory depression. Its high affinity lets it displace full agonists, so it is started once withdrawal begins.
Category: Opioid Use Disorder Drugs
Question 7
The long-acting full mu opioid agonist dispensed through certified opioid treatment programs for opioid use disorder is methadone.
Missing Word
methadone
Methadone prevents withdrawal and allows a gradual taper. Because it carries the misuse risk of any full agonist, it is dispensed in monitored settings, often by directly observed therapy.
Category: Opioid Use Disorder Drugs
Question 8
The nicotine replacement form that slowly dissolves in the mouth like a hard candy, without chewing, is the lozenge.
Missing Word
lozenge
A nicotine lozenge releases nicotine that is absorbed through the lining of the mouth. Like other replacement forms, it supplies nicotine without the toxic chemicals of tobacco smoke.
Category: Nicotine Cessation Drugs
Question 9
The opioid antagonist given as a monthly intramuscular injection to prevent relapse in opioid use disorder is naltrexone.
Missing Word
naltrexone
Naltrexone blocks opioid euphoria, and the long-acting injection improves adherence compared with daily tablets. It is started only after the patient has been opioid-free for several days.
Category: Opioid Use Disorder Drugs
Question 10
Alcohol enhances GABA signaling, which increases the inward flow of chloride ions and hyperpolarizes neurons.
Missing Word
chloride
The GABA-A receptor is a chloride channel. More chloride entering the neuron makes it more negative and harder to fire, which is the basis of alcohol's and benzodiazepines' CNS depression.
Category: Alcohol Withdrawal Drugs
Question 11
After chronic drinking stops, unopposed activity of the excitatory neurotransmitter glutamate produces tremor, anxiety and seizures.
Missing Word
glutamate
Chronic alcohol use downregulates GABA receptors. When alcohol is removed, excitatory glutamate activity dominates, explaining why withdrawal can progress to seizures and delirium tremens.
Category: Alcohol Withdrawal Drugs
Question 12
Disulfiram blocks the breakdown of the toxic alcohol metabolite acetaldehyde, so even a small drink causes flushing, nausea and headache.
Missing Word
acetaldehyde
Alcohol is metabolized to acetaldehyde, which is normally cleared by acetaldehyde dehydrogenase. Disulfiram irreversibly inhibits that enzyme, so acetaldehyde builds up and makes drinking unpleasant.
Category: Alcohol Deterrent Therapy
Question 13
The smoking-cessation drug that acts as a partial agonist at nicotinic receptors, easing withdrawal while blocking nicotine's effects, is varenicline.
Missing Word
varenicline
Varenicline binds nicotinic receptors more tightly than nicotine and stimulates them only partly, much as buprenorphine does at opioid receptors. Patients are monitored for mood changes and abnormal dreams.
Category: Nicotine Cessation Drugs
Question 14
The only antidepressant approved by the FDA as a smoking-cessation aid is bupropion.
Missing Word
bupropion
Bupropion inhibits reuptake of norepinephrine and dopamine, which reduces cravings and withdrawal symptoms. Because it can make seizures more likely, seizure risk is screened before it is started.
Category: Nicotine Cessation Drugs
Question 15
Disulfiram slows the breakdown of the oral vitamin K antagonist warfarin, so the patient's INR is monitored closely when both drugs are taken.
Missing Word
warfarin
Warfarin is an oral anticoagulant that blocks the liver's production of vitamin K-dependent clotting factors. Disulfiram slows its metabolism and raises its effect, which increases bleeding risk, so the INR is checked and the warfarin dose adjusted as needed.
Category: Alcohol Deterrent Therapy