Day # 172: Substance Use Disorders Review Quiz

Today will be our review quiz on the substance use disorders theme. Take a few minutes to check your learning.

1) A 52-year-old man with alcohol use disorder presents 48 hours after his last drink with confusion, visual hallucinations, fever, and hypertension. What is the most appropriate next step in management?

a) Start haloperidol

b) Begin CIWA protocol with symptom-triggered benzodiazepines

c) Start loading dose IV benzodiazepines and transfer to ICU

d) Start propranolol

2) Which of the following medications is a partial opioid agonist commonly used for opioid use disorder?

a) Methadone

b) Buprenorphine

c) Naltrexone

d) Naloxone

3) A 28-year-old man presents with agitation, chest pain, paranoia, and mydriasis after substance use. Vitals show HR 130, BP 180/100. What is the most appropriate initial treatment?

a) Haloperidol

b) Lorazepam

c) Propranolol

d) Labetalol

4) A hospitalized patient with nicotine dependence becomes irritable, anxious, and unable to concentrate after admission. What is the best initial management?

a) Start varenicline

b) Start bupropion

c) Initiate nicotine replacement therapy

d) Provide reassurance only

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Answers

Question 1:

From day #161

Answer: c

Start loading dose IV benzodiazepines and transfer to ICU

Explanation:

• This is delirium tremens (DTs):

  • 48–96 hours after last drink

  • Confusion + autonomic instability +/- hallucinations

  • Potentially life-threatening condition.

• Requires:

  • ICU-level care

  • high-dose IV benzodiazepines or phenobarbital

• Haloperidol = adjunct only (lowers seizure threshold)

Question 2:

From day #163

Answer: b

Buprenorphine

Explanation:

• Buprenorphine = partial opioid agonist

• Methadone = full agonist

• Naltrexone = antagonist (requires detox first)

• Naloxone = acute overdose reversal

Question 3:

From day #164

Answer: b

Lorazepam

Explanation:

• Stimulant / Sympathomimetic toxidrome (e.g., cocaine, amphetamines):

  • ↑ Energy, euphoria

  • ↓ Appetite

  • Tachycardia, hypertension, hyperthermia

  • Possible paranoia/psychosis

  • Mydriasis

  • Complications can include aggression, seizures, chest pain, arrhythmias, or stroke

• First-line for stimulant toxicity = benzodiazepines

  • Treats: agitation, hypertension, tachycardia

• Avoid:

  • Pure beta-blockers (propranolol) → unopposed alpha stimulation

  • Antipsychotics = second-line if severe agitation/psychosis

Question 4:

From day #169

Answer: c

Initiate nicotine replacement therapy

Explanation:

• Inpatient setting → treat withdrawal immediately

• Nicotine replacement (patch ± gum/lozenge) = first-line

• Varenicline and bupropion = good outpatient options, slower onset

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Conclusion

Great job. We have completed the substance use disorders lessons. To view all the subject quizzes, click here.

If you are looking for more reading materials then check out our recommended resources.