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Chapter 36. Substance-Related Disorders

Student Questions

Which neurotransmitter is associated with neurotransmission in the mesocorticolimbic reward pathway?

A. Dopamine

B. Glutamate

C. Norepinephrine

D. Serotonin

Answer: A

Option A: Correct. The mesocorticolimbic tract is a dopaminergic pathway that originates in the ventral tegmental area and projects to the nucleus accumbens and prefrontal cortex. Dopamine is involved in natural rewards and drug reinforcement.

Option B: Incorrect. The mesocorticolimbic reward pathway is a dopaminergic tract, not a glutamatergic tract.

Option C: Incorrect. The mesocorticolimbic reward pathway is a dopaminergic tract, not a noradrenergic tract.

Option D: Incorrect. The mesocorticolimbic reward pathway is a dopaminergic tract, not a serotonergic tract.

A 45-year-old man is admitted to the hospital for major depressive disorder. He states that his alcohol consumption has steadily increased over the past several months. Which instrument would be the most appropriate to quickly screen for alcohol use disorder?

A. Addiction Severity Index

B. CAGE Questionnaire

C. Clinical Institute Withdrawal Assessment—Alcohol, Revised

D. Clinical Opiate Withdrawal Scale

Answer: B

Option A: Incorrect. The Addiction Severity Index is an assessment tool and, with 200 items, would not be a quick screening instrument. It is not specific to alcohol use disorders.

Option B: Correct. The CAGE Questionnaire screens for alcohol use disorders. CAGE stands for cut down, annoyed, guilty, and eye-opener. A score of 2 or more is positive and suggests problem drinking.

Option C: Incorrect. The Clinical Institute Withdrawal Assessment—Alcohol, Revised measures alcohol withdrawal symptoms. It is not an alcohol use disorders screening instrument.

Option D: Incorrect. The Clinical Opiate Withdrawal Scale measures opioid withdrawal symptoms. It is not an alcohol use disorders screening instrument.

Which medication induces the metabolism of methadone, decreases methadone levels, and potentially results in methadone withdrawal symptoms?

A. Conivaptan

B. Efavirenz

C. Tamoxifen

D. Ziprasidone

Answer: B

Option A: Incorrect. Conivaptan does not induce the metabolism of methadone. On the contrary, conivaptan is a strong CYP3A4 inhibitor that will inhibit the metabolism of methadone, increase methadone levels, and potentially result in toxicity.

Option B: Correct. Efavirenz is ...

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