ADDICTION MEDICINE BOARDS EXAM
2025 QUESTIONS AND CORRECT
ANSWERS | A+ GRADED STUDY GUIDE
RESOURCES
Name 4 smoking biomarkers and amount of time they can
detect smoking Correct Answer 1) Serum/urine cotinine: 7
days
2) CO: 12 hours
3) Thiocyanate: found in cigarette smoke, can remain
elevated for weeks but won't pick up low level smoking
4) Anabasine: tobacco alakaloid (not in NRT) so useful for
picking up on smoking if someone is on NRT
How does nicotine interact with antipsychotics? Correct
Answer It induces metabolism of antipsychotics (especially
clozapine, haloperidol, olanzapine) by upregulating
cyp1a2 enzyme
If someone stops smoking, their antipsychotic dose may
need to be reduced. If someone starts smoking, their
antipsychotic medicine may not work as well.
True or False: If you have a reduced function variant of
CYP2A6 you are more likely to smoke fewer cigarettes
and you have a lower risk of lung ca. Correct Answer
True: If your CYP2A6 enzyme sucks and can't metabolize
that rapidly, you end up smoking fewer cigarettes to
,achieve the same level of nicotine. Fewer cigarettes = less
cancer.
What 3 mental illnesses are a/w smoking? Correct Answer
Schizophrenia
ADHD
Depression
What test most accurately assesses tobacco
dependence? Correct Answer Fagerstrom test for nicotine
dependence. Most useful ? is how soon after waking do
you smoke AND # of cigs/day
What receptor does nicotine act on? Correct Answer
Nicotinic Acetylcholine Receptors. Binds acetylocholine
and nicotine among other things. Receptor is made of 5
polypeptide subunits (2 alphas and 3 betas). The
alpha4beta2 nAChR receptor is found in certain areas of
the brain. This is the receptor variant most involved in
addiction and this is where varenicline acts.
Why might cigarettes help with depression? Correct
Answer MAO-I activity
Smoking during pregnancy effects Correct Answer
Preterm birth
IUGR
Low birth weight
SIDS
Neurodev/behavioral issues
obesity
,HTN
T2DM
Impaired lung functions
What other substance use d/o is tobacco most closely
linked to? Correct Answer AUD. Pts with AUD are less
likely to quit smoking.
Most smokers want to quit and 40% make a quit attempt
each year. what % are successful? (unaided) Correct
Answer 2-3%
5 FDA approved forms of NRT Correct Answer patch,
gum, lozenge, inhaler, nasal spray
Dosing nicotine patch Correct Answer Patients smoking
>10 cigarettes/day: Begin with step 1 (21 mg/day) for 6
weeks, followed by step 2 (14 mg/day) for 2 weeks; finish
with step 3 (7 mg/day) for 2 weeks
Patients smoking ≤10 cigarettes/day: Begin with step 2 (14
mg/day) for 6 weeks, followed by step 3 (7 mg/day) for 2
weeks
This is per up to date but there's actually a cochrane
review that didn't show issues with not tapering patches
If smoking 1, 2, or more packs per day can do high dose
42mg patch therapy
, Dosing nicotine gum Correct Answer Patients who smoke
their first cigarette within 30 minutes of waking should use
the 4 mg strength; otherwise the 2 mg strength is
recommended
dosing nicotine lozenge Correct Answer Patients who
smoke their first cigarette within 30 minutes of waking
should use the 4 mg strength; otherwise the 2 mg strength
is recommended.
dosing nicotine inhaler Correct Answer 6 to 16
cartridges/day (at least 6 cartridges/day for the first 3 to 6
weeks) for up to 12 weeks; maximum: 16 cartridges/day.
Note: Best effect achieved with frequent continuous
puffing (20 minutes).
Mechanism bupropion Correct Answer NE and dopamine
reuptake inhibitor
Acts on reward pathways AND is an antagonist at the
nAChR
Dosing bupropion Correct Answer 150mg SR qday for 3
days, then 150 SR BID
SE bupropion Correct Answer seizures, insomnia, dry
mouth (if insomnia take qday)
Varenicline mechanism Correct Answer blocks nicotine
from binding NAChR at alpha4beta2
AND
2025 QUESTIONS AND CORRECT
ANSWERS | A+ GRADED STUDY GUIDE
RESOURCES
Name 4 smoking biomarkers and amount of time they can
detect smoking Correct Answer 1) Serum/urine cotinine: 7
days
2) CO: 12 hours
3) Thiocyanate: found in cigarette smoke, can remain
elevated for weeks but won't pick up low level smoking
4) Anabasine: tobacco alakaloid (not in NRT) so useful for
picking up on smoking if someone is on NRT
How does nicotine interact with antipsychotics? Correct
Answer It induces metabolism of antipsychotics (especially
clozapine, haloperidol, olanzapine) by upregulating
cyp1a2 enzyme
If someone stops smoking, their antipsychotic dose may
need to be reduced. If someone starts smoking, their
antipsychotic medicine may not work as well.
True or False: If you have a reduced function variant of
CYP2A6 you are more likely to smoke fewer cigarettes
and you have a lower risk of lung ca. Correct Answer
True: If your CYP2A6 enzyme sucks and can't metabolize
that rapidly, you end up smoking fewer cigarettes to
,achieve the same level of nicotine. Fewer cigarettes = less
cancer.
What 3 mental illnesses are a/w smoking? Correct Answer
Schizophrenia
ADHD
Depression
What test most accurately assesses tobacco
dependence? Correct Answer Fagerstrom test for nicotine
dependence. Most useful ? is how soon after waking do
you smoke AND # of cigs/day
What receptor does nicotine act on? Correct Answer
Nicotinic Acetylcholine Receptors. Binds acetylocholine
and nicotine among other things. Receptor is made of 5
polypeptide subunits (2 alphas and 3 betas). The
alpha4beta2 nAChR receptor is found in certain areas of
the brain. This is the receptor variant most involved in
addiction and this is where varenicline acts.
Why might cigarettes help with depression? Correct
Answer MAO-I activity
Smoking during pregnancy effects Correct Answer
Preterm birth
IUGR
Low birth weight
SIDS
Neurodev/behavioral issues
obesity
,HTN
T2DM
Impaired lung functions
What other substance use d/o is tobacco most closely
linked to? Correct Answer AUD. Pts with AUD are less
likely to quit smoking.
Most smokers want to quit and 40% make a quit attempt
each year. what % are successful? (unaided) Correct
Answer 2-3%
5 FDA approved forms of NRT Correct Answer patch,
gum, lozenge, inhaler, nasal spray
Dosing nicotine patch Correct Answer Patients smoking
>10 cigarettes/day: Begin with step 1 (21 mg/day) for 6
weeks, followed by step 2 (14 mg/day) for 2 weeks; finish
with step 3 (7 mg/day) for 2 weeks
Patients smoking ≤10 cigarettes/day: Begin with step 2 (14
mg/day) for 6 weeks, followed by step 3 (7 mg/day) for 2
weeks
This is per up to date but there's actually a cochrane
review that didn't show issues with not tapering patches
If smoking 1, 2, or more packs per day can do high dose
42mg patch therapy
, Dosing nicotine gum Correct Answer Patients who smoke
their first cigarette within 30 minutes of waking should use
the 4 mg strength; otherwise the 2 mg strength is
recommended
dosing nicotine lozenge Correct Answer Patients who
smoke their first cigarette within 30 minutes of waking
should use the 4 mg strength; otherwise the 2 mg strength
is recommended.
dosing nicotine inhaler Correct Answer 6 to 16
cartridges/day (at least 6 cartridges/day for the first 3 to 6
weeks) for up to 12 weeks; maximum: 16 cartridges/day.
Note: Best effect achieved with frequent continuous
puffing (20 minutes).
Mechanism bupropion Correct Answer NE and dopamine
reuptake inhibitor
Acts on reward pathways AND is an antagonist at the
nAChR
Dosing bupropion Correct Answer 150mg SR qday for 3
days, then 150 SR BID
SE bupropion Correct Answer seizures, insomnia, dry
mouth (if insomnia take qday)
Varenicline mechanism Correct Answer blocks nicotine
from binding NAChR at alpha4beta2
AND
