NBME 21 Heroin (NBME Answers)

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NBME 21 Answers

nbme21/Block 4/Question#12 (reveal difficulty score)
A 24-year-old man with a history of drug ...
Heroin 🔍 / 📺 / 🌳 / 📖
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+8 upvote downvote
submitted by ∗hungrybox(1277)

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Great video I used to learn this material.

There are 3 major types of drugs: uppers (stimulants), downers (depressants), and hallucinogens.
Heroin is an opioid. Opioids are downers.*
Downers do what it sounds like. They cause "down" symptoms: sedation/decreased anxiety (and thus behavorial disinhibition), respiratory depression.
Thus withdrawal will cause the opposite: hypertension/tachycardia, anxiety.

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hungrybox *other downers: alcohol, benzodiazepines, barbiturates +2

nwinkelmann THANK YOU! for the link to the video. this is one thing I've ALWAYS struggled with. +

qball I get that this is a good rule of thumb to help narrow down between alcohol and heroin, BUT is still not enough to answer this question. Some key features for depressants (downer) is alcohol (if we are talking mild withdraw) - tremors , diaphoresis and delirium (heavy withdraw) . For Heroin - Dilated pupils, yawning and lacrimation are key exam findings. +4

l0ud_minority Also Rhinorrhea and flu-like symptoms are big flags for Heroin withdrawal. +

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submitted by ∗usmleuser007(464)

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Can someone please explain why can't alcohol be correct in this setting?

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niboonsh rhinorrhea is specific to withdrawal from opioids (aka heroin). Look at page 554 in FA2018 +12

dr_jan_itor what if the alcoholic just has a concurrent rhinovirus infection ;) +6

lovebug and FA2019 page 538. +1

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submitted by ∗divya(75)

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Why is there rhinorrhea in opioid withdrawal? And also, if stimulants like cocaine cause nasal vasoconstriction, shouldn't opioid withdrawal do the same?

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the_enigma28 Mechanism of opioid-induced rhinorrhoea, lacrimation, stomach cramps and diarrhoea is actually muscarinic receptor effects, rather than alpha adrenergic blockade caused by cocaine, causing nasal vasoconstriction. +1

baja_blast Symptoms of Opioid Withdrawal can be remembered with the phrase "anxious, hot, and moist" per SketchyPharm Opiods. Rhinorrhea is one way people can be "moist" during opioid withdrawal, but they can also sweat excessively and lacrimate too. +1

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