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NBME 21 Answers

nbme21/Block 4/Question#12

A 24-year-old man with a history of drug abuse has ...

Heroin

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 +3  upvote downvote
submitted by hungrybox(255),

Great video I used to learn this material.

  1. There are 3 major types of drugs: uppers (stimulants), downers (depressants), and hallucinogens.
  2. Heroin is an opioid. Opioids are downers.*
  3. Downers do what it sounds like. They cause "down" symptoms: sedation/decreased anxiety (and thus behavorial disinhibition), respiratory depression.
  4. Thus withdrawal will cause the opposite: hypertension/tachycardia, anxiety.
hungrybox  *other downers: alcohol, benzodiazepines, barbiturates +  
nwinkelmann  THANK YOU! for the link to the video. this is one thing I've ALWAYS struggled with. +  




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

niboonsh  rhinorrhea is specific to withdrawal from opioids (aka heroin). Look at page 554 in FA2018 +5  
dr_jan_itor  what if the alcoholic just has a concurrent rhinovirus infection ;) +1  




 +0  upvote downvote
submitted by divya(1),

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