Substance misuse and addiction: Clinical

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Substance misuse and addiction: Clinical

USMLE® Step 2 questions

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USMLE® Step 2 style questions USMLE

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A 26-year-old woman comes to the clinic due to a week of reduced concentration at work and a persistent headache. The patient recently quit smoking cigarettes and is requesting medication to assist in her abstinence. The patient has a history of major depressive disorder, generalized anxiety disorder, gastroesophageal reflux disease and allergic rhinitis. Her current medication regimen includes pantoprazole and over-the-counter nasal decongestants. She smoked two packs of cigarettes daily for ten years. The patient appears irritable. Temperature is 98 °F (36.6 °C), pulse is 96 bpm, and blood pressure is 150/90 mmHg. Administration of which of the following medications is the best next step of management in this patient?


People use substances or recreational drugs for various reasons. Initially it’s usually for fun or curiosity or to treat pain, but over time people can become reliant on them and it can lead to a substance-related and addictive disorders.

Addictive disorders are uniquely challenging to treat because they’re medical conditions that cause social support networks to fall apart.

In addition, an individual craves and seeks out substances, despite facing harmful consequences.

The addictive potential from substances come from their effect on the brain's reward system and their ability to affect emotion, mood, and perception.

They typically cause a dramatic increase in dopamine levels, which results in euphoria or a so-called “high.”

Individuals typically make repeated attempts to quit and often relapse.

Substance-related and addictive disorders are linked to biological factors - which is why individuals with a family history of substance use are at higher risk.

There are also psychological factors, like using substances to self-medicate for mental health problems like PTSD and depression.

Finally, there are environmental factors like neglect and abuse that put individuals at higher risk.

So substance-related and addictive disorders includes substance use disorders and substance-induced disorders which comprise three conditions: intoxication, withdrawal, and other substance or medication-induced mental disorders.

There are 10 classes of drugs that can lead to substance-related disorders, each with its own particular presentation: alcohol; opioids; stimulants which includes amphetamine-type substances and cocaine; cannabis; caffeine; hallucinogens - which includes phencyclidine (PCP) as well as other hallucinogens; inhalants; one category for sedatives, hypnotics, and anxiolytics; tobacco; and a category for other substances.



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