Drug misuse, intoxication and withdrawal Quiz: Ace Your Exams

A 44-year-old woman comes to her primary care physician's clinic for evaluation of irritability, reduced concentration, and persistent headache. The headache is frontal, dull, and is not associated with nausea, vomiting, photophobia or phonophobia. She has noticed that she has gained 5 lbs (2.27 kg) over the last two weeks due to an increased appetite. Prior to a week ago, the patient smoked 2-3 packs of cigarettes daily but stopped abruptly. She also stopped using several illicit substances and alcohol at this time when she found out her daughter was pregnant. The patient has a history of major depressive disorder and chronic back pain. Her current medications include escitalopram and oxycodone as needed. Temperature is 98 °F (36.6 °C), pulse is 110 bpm, and blood pressure is 150/90 mmHg. The patient appears irritable. Oral mucosa appears moist. Pupils are equal and reactive to light. The patient moves all four extremities to commands with normal deep tendon reflexes. Withdrawal from which of the following substances is responsible for the constellation of symptoms observed in this patient?