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These symptoms may be a result of cocaine dependence D cheap 50 mg imipramine. This patient has a risk factor for cocaine addiction Key Concept/Objective: To understand the characteristics of cocaine addiction Addiction can be understood as a chronic medical illness purchase imipramine 25 mg line. Addiction has identifiable risk factors, including genetic factors. The most well-established risk factors for addic- tion are family history and male sex. Serum and urine tests are useful when they are positive, but they are of limited utility when they are negative because of the short duration of detectability of cocaine (6 to 8 hours) and cocaine metabolites (2 to 4 days). Cocaine does not produce compensatory adaptations in brain regions that control somatic functions and therefore does not produce dependence. Dependence and, there- fore, withdrawal are not produced by highly addictive compounds such as cocaine. A 45-year-old woman presents with complaints of back pain. She requests "something strong" for pain and states that various NSAIDs and nonnarcotic pain medications do not help her when she has pain. A review of her medical record shows a pattern of various musculoskeletal complaints, for which she has been given opiate-derivative pain medications on several occasions. For this patient, which of the following statements is false? Opiates function by blocking norepinephrine reuptake D. Pharmacologic therapy is available for treatment of opiate addiction Key Concept/Objective: To understand opiate abuse All addictive drugs share the property of activating a subcortical brain circuit that nor- mally functions to motivate the pursuit of goals with positive survival value, such as obtaining food and sexual partners.

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Ask about living arrangements because close quarters 50mg imipramine otc, such as class- rooms and college dormitories purchase 25 mg imipramine with mastercard, can predispose the patient to a variety of infections. Inquire about family history, especially thyroid disease. The symptoms will vary depending on the underlying cause. In thyroid disease, patients may describe a feeling of having something in their throat. The complaint is more likely to be one of fullness rather than of pain or dysphagia. The history should inquire about signs and symptoms of hyper- or hypothyroidism, such as weight loss or gain, nervousness or fatigue, diarrhea or constipation, intolerance to heat or cold, insomnia or lethargy, men- strual irregularities, and skin or hair changes. Laboratory studies and thyroid scanning can diagnose most problems. Lymphadenopathy has numerous causes but can generally be placed into two categories: infection or malignancy. Infection often presents with fever, sore throat, runny nose, cough, and malaise. A history of an upper respiratory infection is common. Symptoms of malignancies are more likely to be fatigue, weakness, anorexia, weight loss, fever, night sweats, bleeding, and easy bruisability. A history of tobacco and/or EtOH abuse may be present in neoplasms of the head and neck. Physical Examination The physical exam includes palpation of the thyroid for enlargement, asymmetry, or nod- ules.

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