16 hour, MAT Quiz 2023 with complete solution
Dopamine release leads to subjective feelings of ______
pleasure, reward
Why would addiction be considered a disease?
Dz= a disorder of structure or function that produces specific signs or symptoms
Addiction has defined causes (genetics, envir...
16 hour, MAT Quiz 2023 with complete solution
Dopamine release leads to subjective feelings of ______
pleasure, reward
Why would addiction be considered a disease?
Dz= a disorder of structure or function that produces specific signs or symptoms
Addiction has defined causes (genetics, environment) and observable consequences
(behavioral, biological)
underlying change in brain circuits may persist beyond detoxification, particularly in
individuals with severe disorders. (varies with drugs and intensity of use. Amphetamine
may take a year of abstinence to regain brain dopamine functionality)
Should buprenorphine be prescribed from Emergency rooms?
Twice as likely to follow-up for addiction treatment vs referral alone
What studies support group/social interactions in recovery?
Skinner box with rats: they use more drugs when caged than when in group
65% of vietnam soldiers that were addicted in vietnam did not use opioids on return to
USA.
physical exam should always include
looking for injection site marks
-pupils
-bowel sounds
-neuro exam
lab tests at OUD evaluation
HCV, HIV, LFTs, pregnancy test, urine drug screening
Most common formulation of methadone
liquid concentrate or powder used in OTPs
-tablets MC outside of OTPs
define detox program and goal
narcotic drug is dispensed in decreasing doses, not exceeding one hundred and eighty
days, "to alleviate adverse physiological or psychological effects incident to withdrawal
from the continuous or sustained use of a narcotic drug," with the ultimate goal of
bringing a patient to a narcotic drug-free state
What did CARA (Comprehensive Addiction and Recovery Act) 2016 accomplish?
CARA temporarily expands the types of practitioners who may dispense a narcotic drug
in Schedule III, IV, or V for the purpose of maintenance treatment or detoxification
treatment without being separately registered as a narcotic treatment
program. Whereas prior to the CARA, only qualified physicians were permitted to
dispense narcotic drugs in this manner, the CARA now temporarily permits
certain nurse practitioners and physician assistants to qualify to do so.
Timing of buprenorphine induction
Pt should be in mild to moderate withdrawal at time of induction. Use COWS
assessment (Clinical Opiate Withdrawal Scale)
-COWS ≥ 8 , 11 or 12 not unreasonable
, -COWS< 8 ok if UDS is neg and no self-reported opioid use in past 3 days
-Write Buprenorphine prescription ahead of time so pt can bring it to office and avoid
prior-authorization issues
How many mg can pt get on day 1 of buprenorphine induction?
12 mg
how long is induction phase with buprenorphine/naloxone ?
1-3 days
addiction
a chronic, relapsing brain disease that is characterized by compulsive drug seeking and
use, despite harmful consequences
Why is addiciton considered a brain dz?
Drugs change the brain, they change its structure and how it works. Those brain
changes can be long lasting and lead to many harmful, often self-destructive, behaviors
brain areas affected
amygdala: emotional responses
nucleus accumbens: reward center
cortex: our understanding of drug
denial vs. lying
denial: your perception is off and you act in accordance with your perception
lying: you know something is wrong and fabricate story to clear you of guilt
DSM criteria for SUD
1. Loss of control
2. Physiological changes
3. Consequences of use
SUD= ≥ 2/3 in past year resulting in distress or impairment
1&2 were formerly termed "dependence"
3 was formerly termed "abuse"
Are tolerance and withdrawal diagnostic for SUD?
no, anyone could experience those after a course of therapy
smoking vs injecting cocaine, which gets to the brain first?
same rate
1914 Harrison Act
Illegal to sell or give away opium or coca or derivatives without written order on an IRS
form
What year methadone approved by FDA for detox? maintenance?
1970, 1973
Why were early Opioid treatment programs (OTPs) limited in success?
people had to drive long ways to get to a methadone maintenance site. Started in 1974.
Office based opioid treatment (OBOT) legal in 2000 via Drug Addiction Treatment Act of
2000
Buprenorphine approved what year
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