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Detoxification of Chemically Dependent Inmates

Introduction

1. Any substance that alters perception, mood, or cognition can be abused.

A. True

B. False


Detection of Substance Abuse and Treatment of Withdrawal

2. Generally, the most addictive substances are those that are all of the following, except for:

A. Have high-potency

B. Cross the blood-brain barrier quickly

C. Have a long half-life

D. Produce a significant change in the neurochemistry of the brain


3. Which of the following is a sign or symptom of a condition requiring immediate medical attention?

A. Increasing anxiety

B. Insomnia

C. Abdominal pain

D. All of the above


Management of Inmates with Complicating Medical and Psychiatric Conditions

4. Inmates with pre-existing psychiatric conditions may suffer an exacerbation of their illness during detoxification, therefore a careful assessment of the inmate’s mental status, with particular attention to thoughts of self-harm, should be part of every inmate evaluation during detoxification.

A. True

B. False


Alcohol Withdrawal

5. Withdrawal delirium, “delirium tremens,” usually begins _____ after the last drink, and if allowed to progress, delirium can result in changes in consciousness, marked autonomic instability, electrolyte imbalances, hallucinations, and death.

A. 48 - 72 hours

B. 24 - 48 hours

C. 12 - 24 hours

D. 6 - 12 hours


6. All inmates with suspected alcohol use disorder should be treated with:

A. Folate

B. Thiamine

C. Riboflavin

D. All of the above


7. Which benzodiazepine is recommended for managing alcohol withdrawal in most inmates?

A. Chlordiazepoxide

B. Lorazepam

C. Diazepam

D. Clonazepam


8. Which of the following has been used successfully to attenuate the many symptoms of alcohol withdrawal that are caused by increased sympathetic activity?

A. Clonidine

B. Lorazepam

C. Diazepam

D. Clonazepam


9. Anti-seizure medications replace the need for benzodiazepines in the treatment of alcohol withdrawal and will prevent the development of delirium tremens.

A. True

B. False


Benzodiazepine Withdrawal

10. Because of the high risk of _____, benzodiazepine withdrawal should always be treated.

A. Delirium

B. Seizures

C. Death

D. All of the above


11. The general principle of substituting a short-acting medication for a long-acting one is especially important in the treatment of benzodiazepine withdrawal.

A. True

B. False


Barbiturate Withdrawal

12. Discontinuation of barbiturates produces a withdrawal syndrome essentially identical to that of _____, and can similarly result in significant morbidity and mortality if left untreated.

A. Alcohol

B. Benzodiazepines

C. Both (A) and (B)

D. None of the above


13. Phenobarbital should be administered on a _____ schedule for barbiturate withdrawal treatment.

A. Four-times-a-day

B. Three-times-a-day

C. Two-times-a-day

D. One-time-a-day


Opiate Withdrawal

14. Methadone can be provided without an institutional license for up to three days while arranging for an appropriate referral of the patient to a licensed facility, and if need, the three-day allowance can be renewed or extended.

A. True

B. False


15. Because methadone has a long half-life, accumulation can occur over the first few days while a steady state is reached, which can result in an iatrogenic overdose and death due to respiratory depression.

A. True

B. False


16. Which of the following is an acceptable alternative for opiate detoxification and should be considered if the institution does not have a methadone license or when otherwise medically indicated?

A. Buprenorphine

B. Clonidine

C. Benzodiazepines

D. Buspirone


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