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Course 4H - The Quiz



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This publication applies only to Substance Abuse Treatment for persons with co-occurring disorders.
True False
Among other issues, this publication addresses psychotherapeutic medications which have the potential for abuse and/or physical dependence, serious side-effects, and special issues for pregnant women.
True False
Which of the statements below is NOT TRUE?
When the patent on a prescription medication expires, the drug may be made as a generic.
The generic name of a medication is the actual name of the medication and never changes.
Manufacturers can make several forms of a single generic medication with only slight variations in the color, size, or shape of the medication.
We do not need to be concerned if a person says his or her medication “looks different” and he is experiencing new side effects.
ANTIPSYCHOTICS: Antipsychotics must not be used to treat brief psychotic episodes CAUSED BY drugs of abuse.
True False
Which are the side affects associated with Tardive Dyskinesia?
Excessive thirst and hunger, slow healing cuts, frequent urination
difficulty breathing, blood pressure up and down, sweating and shakiness, dazed and confused, muscle stiffness
Involuntary movements of the tongue or mouth, and jerky, purposeless movements of legs, arms or entire body
Tardive Dyskinesia [a serious side effect of antipsychotic medication] _________________ with atypical (i.e., 'new generation' or 'novel') antipsychotic medications such as Risperdal, Pyrex, Sequel, Gordon, and Ability.
occurs frequently
occurs rarely
never occurs
Some of the new atypical antipsychotic medications are effective for relieving ANXIETY in low doses. The FDA has approved their use in small doses for treatment of anxiety.
True False
Risperdal Consta (Risperidone long-acting injections) is usually given
once monthly
every three weeks
every two weeks
Symmetrel, Symadine, Cogentin, Benadryl, and Artane are used
for treatment of major depression
for treatment of psychosis
to control the side effects of antipsychotic medications
The first and second answers above
none of the above
Which statement is true about 'Neuroleptic Malignant Syndrome'?
It's a type of adverse reaction which may occur when people who have malignancy (i.e., cancer) take antipsychotic medications.
It's a very rare but life-threatening neurological disorder most often caused by a reaction to antipsychotic/neuroleptic medications.
It can also occur in people taking antiparkinsonian medications if discontinued.
It typically develops within the first 2 weeks of treatment; but can develop at any time.
All except the first answer above
With pregnant women, the use of antipsychotic medications should generally be avoided _________________ unless the mother poses a danger to herself, to others, or to the unborn child, or if the mother shows signs of profound psychosis (Cohen 1989).
in the last trimester
in the first trimester
ANTIPARKINSONIAN MEDICATIONS: The risk of birth defects associated with [the antiparkinsonian medications] Cogentin, Artane, and Benadryl is not clear, although there is some evidence to suggest that the antiparkinsonian medications SYMMETREL and SYMADINE may produce a deformed baby.
True False
ANTIMANIC MEDICATIONS: Bipolar cycles that occur more often than 3 times a year are considered _________________ .... a condition often found in people with higher rates of substance abuse.
'atypical cycling'
'intermittent cycling'
'rapid cycling'
Bipolar II conditions, by definition, don't include full mania, but are characterized more as depression plus a low level of mania (hypomania).
True False
Bipolar I conditions include full manic episodes. Which medications below qualify as evidence-based treatments (EBT) for Bipolar I disorder? (select best answer).
All of the lithium products, Tegretol, Depakote, and those products listed under atypical antipsychotics
Valproic acid
By leveling mood swings with antimanic medications, some of the suicidal and other self-harming behaviors can be decreased, and can reduce a person’s violent outbursts toward others or property.
True False
Signs of lithium toxicity may include (select best answer) ....
nausea, vomiting, diarrhea,
drowsiness, mental dullness, slurred speech, confusion, dizziness
muscle twitching, irregular heartbeat and blurred vision.
all of t he above
only the first and second options above
The concurrent use of alcohol or street drugs with ANTIMANIC medications does NOT make such persons more vulnerable to ADVERSE MEDICAL consequences.
True False
Some antimanic medications, such as _________________ are associated with several birth defects if taken during pregnancy. If this type of medication must be used during pregnancy, the woman must be told that there is substantial risk of malformations.
Fluoxetine (Prozac)
Depakene (valproic acid),
ANTIDEPRESSANTS: The full therapeutic effect of an antidepressant medication may not be present for several
Antidepressants are the first line medications for certain anxiety disorders such as panic disorder, social phobia, generalized anxiety disorder, and obsessive-compulsive disorders.
True False
SSRIs, Tricyclics and quatracyclics (such as Elavil, Sinequan, Tofranil, and Nopramin), and other antidepressants (such as Wellbutrin, Desyrel, and Effexor) are prescribed for what? _________________
manic states
SSRIs are what type of drug? _________________ the most frequently prescribed class of antidepressants because of their broad effectiveness, low side effects, and safety - thought to affect serotonin (a type of neurotransmitter in the brain). Examples are Celexa, Lexapro, Prozac, Prozac Weekly, Sarafem, Luvox, Paxil, Paxil CR, and Zoloft.
Selective Street-Drug Replacement Indicators,
Selective Serotonin Reuptake Inhibitors,
Seratonin Substitute Reactive Insulators,
The most troubling SSRI side effect is
sedation and agitation
decreased sexual performance
Untreated depression may result in suicide, especially with co-occurring substance use disorders. Therefore, treatment for depression must be taken as seriously as treatment for any other major life-threatening illness.
True False
An overdose of any of the MAO inhibitors, tricyclics, quatracyclics, or other antidepressants is serious and potentially life threatening and must be reported to a physician immediately. Symptoms of tricyclic and quatracyclic overdose may include:
rapid heartbeat, dilated pupils, flushed face
agitation, loss of consciousness, seizures,
irregular heart rhythm, stoppage of heart and breathing, leading to death
all of the above
paranoid delusions, thought disorders, hallucinations
People taking MAO inhibitors must avoid high levels of caffeine and all foods with high levels of tryptophan or tyramine (e.g., aged cheese, wine, beer, chicken liver, chocolate, bananas, soy sauce, meat tenderizers, salami, bologna, and pickled fish). If eaten, these foods may react with the MAO inhibitors to
cause delusions and hallucinations.
raise blood pressure to dangerous levels.
cause unexpected somnambulism.
ANTIANXIETY MEDICATIONS: Which type of drug below is NOT used for treatment of generalized anxiety disorder, posttraumatic stress disorder (PTSD), panic, phobias, and obsessive-compulsive disorders (OCD)?
Low doses of risperidone (Risperdal), quetiapine fumarate (Seroquel), olanzapine (Zyprexa), or other atypical antipsychotics
SSRI antidepressants
atomoxetine hydrochloride (Strattera)
Which statement is true of Benzodiazepines, which are used in treatment for anxiety-related disorders?
They have a depressant effect on the central nervous system, and thus positive treatment response occurs rapidly, within days.
With co-occurring substance use disorders, the response may be short-lived and tolerance develops leading to the need for increased doses.
Benzodiazepines are cross tolerant with alcohol and have a market as street drugs.
They are one of the most common antianxiety medications.
All of the above.
Most addiction medicine physicians use Benzodiazepines only for a short time as .....
alcohol withdrawal medicines
sedatives in acute psychotic or manic episodes
both of the above
Benzodiazepines may cause _________________ IN ALMOST EVERYONE who uses the medication for longer than 6 months.
psychological dependence
at least mild physical dependence (i.e., blood pressure increase, fast heart rate if abruptly stopped)
addiction to the medication
Withdrawal from regular use of any of the benzodiazepines and similar medications must be done slowly _________________ because abrupt withdrawal from these medications can cause hallucinations, delusions and delirium, disorientation, difficulty breathing, hyperactivity, and grand mal seizures.
over a 48 hour period,
over a month’s time,
over a week's time,
There is a documented withdrawal syndrome in newborns exposed to benzodiazepines in utero.
True False
STIMULANTS: Stimulant medications are used to treat attention deficit/hyperactivity disorder (AD/HD), but are also used to treat narcolepsy, obesity, and sometimes depression.
True False
Most addiction medicine doctors use _________________ to treat AD/HD in adults with co-occurring substance use disorders.
stimulants such as Ritalin, Concerta, Metadate ER, and Focalin
antidepressants or non-stimulants such as Strattera
antianxiety drugs such as Librium, Libritabs, and Librax
Using stimulant medications to treat AD/HD in children has been shown to _________________ the potential for development of substance use disorders.
have no effect upon
NARCOTIC AND OPIOID ANALGESICS: Natural opioids are opium, morphine and codeine products. Pure, semi or totally synthetic derivatives include:
Heroin and Methadone
Percodan and Darvon
Oxycodone and Demerol
All of the above.
Only the first and third answers
Longer-term use of OPIOIDS is indicated to alleviate the chronic pain associated with cancer and certain other conditions, and research has shown that abuse or addiction to these medications
is unavoidable in such patients.
rarely occurs in such patients.
occurs in approximately 60% of such patients.
HYPNOTICS (SLEEP AIDS): Those with addiction disorders can become rapidly tolerant and dependent on the most commonly used hypnotic(s), i.e.,
the benzodiazepines such as Valium, Ativan, Restoril, and Halcion
one of the non-benzodiazepines — zolpidem ((Ambien).
Both of the above
Neither of the above
Neither of the above, unless the individual also has ADHD.
ADDICTION TREATMENT MEDICATIONS: For alcohol withdrawal, anticonvulsants such as Tegretol, Depakote, and Neurontin
are ineffective beyond 4 to 5 days.
have the advantage over benzodiazepines, in that they can be prescribed for weeks and months, versus only days with benzodiazepines.
The approach WHEN TALKING WITH CLIENTS ABOUT PSYCHIATRIC MEDICATIONS is exactly the same as when talking about their substance abuse decisions.
True False
Talking with Clients about their Medication - Which answer below is NOT recommended according to this section of the publication?
Take 5-10 minutes every few sessions to go over ... [medication issues]
Ask how their psychiatric medication is helpful.
Ask if they have missed any doses of their medication.
Ask, 'How many doses have you missed?'
Ask if they felt or acted different on days when they missed their medication.
For clients who admit to choosing NOT to take their medication: Which answer below is NOT recommended as an approach?
Don’t accept “I just don’t like pills.” Tell them you are sure they wouldn’t make such an important decision without having a reason.
Offer as examples reasons others might choose not to take medication.
Ask their reason for choosing not to take the medication.
Review why the undesired behavior seemed like a good idea at the time, and review the actual outcome resulting from their choice..
Remind them that if they want to participate in the program, they must take the prescribed medication.
Which is NOT one of ATTC's Brief Counselor Strategies for Tobacco Users — The Five A’s?
ASK about tobacco use and past quit efforts
ASSESS willingness for a quit attempt during next 30 days using a scale of 1-10, and discuss effective treatments available, such as nicotine replacement therapies (NRTs), medications, self-help resources
ASSIST quit attempt effort through developing a quit plan (STAR), and provide problem-solving strategies and skills training.
Recommend use of NRTs, tobacco cessation medications: Explain how these products increase smoking cessation rates and reduce withdrawal symptoms and cravings, provide materials on dosages, contraindications, side effects, etc.
ADAPT to the client's need to smoke during treatment sessions so long as he claims abstinence outside of sessions.
Re ATTC's Brief Counselor Strategies for Tobacco Users Unwilling to Quit — the Five R’s .... which is NOT a recommended strategy?
RELEVANCE: Write down personal incentives for quitting, rank order reasons, focus on them as often as possible, carry around on card in cigarette pack.
RISK: Inform him/her that reducing number of cigarettes, using alternative tobacco products (cigars), or switching brands will eliminate some but not all risks.
REWARDS: Discuss the financial and other benefits (Improved sleep, reduced anxiety, reduced depression, and improved sexual functioning after period of abstinence) and the physical changes (some immediate) as a result of quitting .... and highlight those most relevant.
ROADBLOCKS to quitting: Encourage each individual to discuss his/her perceived barriers to quitting and offer strategies that address these challenges.
Use REPETITION: Use motivational interventions each session. Repeat the Relevance, Risks, and Rewards


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