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Physical Detoxification from Substances

Psycosocial and Biomedical Screening

1. A biomedical screening without the use of a psychosocial assessment is likely to lead to the patient failing to successfully complete a detoxification regimen.

A. True

B. False


2. According to this paper, biomedical screening is used for different purposes in the diagnosis and treatment of substance abuse. Which of the following is NOT a use for this kind of assessment?

A. To support a proper diagnosis, assessment, and management of detoxification.

B. For forensic purposes, such as evaluating a driver after an automobile accident.

C. As a basis for reporting to law enforcement authorities

D. In detecting secret use of alcohol and other substances in therapeutic settings where abstinence, rehabilitation, and treatment are being promoted


Alcohol Intoxication and Withdrawal

3. The signs and symptoms of acute alcohol withdrawal generally start ________ after the patient takes his last drink

A. 6 to 24 hours

B. 2 to 12 hours

C. 24 to 48 hours


4. The primary goals for treatment of alcohol intoxication are:

A. To preserve respiration until alcohol levels fall into a safe range

B. Preserve cardiovascular function until alcohol levels fall into a safe range

C. To successfully manage the patient's agitation until alcohol levels fall into a safe range

D. All of the above

E. A and B above


5. Signs and symptoms of alcohol withdrawal include:

A. Restlessness, irritability, anxiety, agitation

B. Anorexia (lack of appetite), nausea, vomiting

C. Tremor (shakiness), elevated heart rate, increased blood pressure

D. All of the above

E. A and C above


6. Which of the following statements regarding alcohol withdrawal is true?

A. Some people may progress partially through some of symptoms and then have a slow improvement

B. Some people may have mild to moderate symptoms with almost abrupt resolution

C. Some people may present with a grand mal seizure or with hallucinations

D. Some people with alcohol dependence, regardless of their pattern of drinking or the extent of drinking, appear to develop only minor symptoms or show no symptoms of withdrawal

E. All of the above


7. Seizures, delirium tremens (severe delirium with trembling), and dysregulation of body temperature, pulse, and blood pressure in severe alcohol dependence can lead to fatal consequences.

A. True

B. False


8. For alcohol, sedative-hypnotic, and opioid withdrawal syndromes, hospitalization or some form of 24-hour medical care is generally the best setting for detoxification.

A. True

B. False


9. Short-term, nonmedical treatment services for individuals with substance use disorders, often called social detoxification programs, should generally be avoided.

A. True

B. False


10. Research indicates that many individuals in alcohol withdrawal can be managed successfully without medications in a social detoxification setting.

A. True

B. False


11. In order to best decide whether to use medications for the treatment of alcohol withdrawal requires that patients be separated into three groups. Which does NOT describe one of these groups?

A. People who have a previous history of the most extreme forms of withdrawal that include seizures and/or delirium

B. People who are already in withdrawal and demonstrating moderate symptoms of withdrawal

C. People who may still be intoxicated and have not had time to develop withdrawal symptoms

D. People who show symptoms of mild alcohol withdrawal


12. Benzodiazepines are the medication class of choice for treating alcohol withdrawal.

A. True

B. False


13. Benzodiazepines have some problems when used for alcohol detoxification in outpatient settings, including:

A. Potential interactions with alcohol that can lead to coma and respiratory suppression, motor incoordination, and abuse of the medications.

B. As alcohol withdrawals increase the severity of withdrawal (e.g., seizures and delirium tremens) increases while responsiveness to benzodiazepines decreases.

C. Studies have shown that benzodiazepine may “prime” or reinstate alcohol use during their use to treat outpatients in alcohol withdrawal.

D. A and B above

E. A, B and C above


14. The major goal of medical management is to avoid seizures and a special state of delirium called delirium tremens (DTs).

A. True

B. False


15. Someone experiencing DTs as part of an alcohol withdrawal is very likely to progress to having a seizure.

A. True

B. False


Opioids

16. Opioid withdrawal is both highly unpleasant and medically dangerous.

A. True

B. False


17. Which of the following statements is true according to this paper?

A. Heroin withdrawal typically begins 8 to 12 hours after the last heroin dose and subsides within a period of 3 to 5 days.

B. Methadone withdrawal typically begins 36 to 48 hours after the last dose, peaks after about 3 days, and gradually subsides over a period of 3 weeks or longer.

C. Physiological, genetic, and psychological factors can significantly affect intoxication and withdrawal severity.

D. All of the above.

E. A and B above.


18. If an intravenous user withdrawing from opioids has a fever it should be evaluated because:

A. Fevers during opioid withdrawal can become medically dangerous.

B. A fever can indicate dangerous interactions between multiple drugs.

C. A fever may indicate presence of HIV, viral hepatitis, abscesses, infected injection sites, or pneumonia that will require medical attention.


19. Management of opioid withdrawal symptoms without medication is not recommended because:

A. Withdrawal can easily become medically dangerous.

B. People withdrawing from opioids can become violent and harm themselves or others.

C. Opioid withdrawal can produce needless suffering in a population that tends to have limited tolerance for physical pain.


20. The MOST common medication used to manage opioid withdrawal symptoms is:

A. Buprenorphin

B. Clonidine

C. Methadone


21. Methadone can only be dispensed at a physician's office.

A. True

B. False


22. The detoxification process for withdrawal from methadone is much longer than the process prescribed for detoxification from heroin.

A. True

B. False


23. Which of the following statements are true?

A. Clonidine detoxification is best conducted on an inpatient basis to ensure appropriate vital sign monitoring.

B. The final 2 to 3 weeks of methadone detoxification is when relapsing is most likely.

C. Inpatient treatment can provide additional support, medical supervision, and rehabilitative treatment that serve as disincentives to relapse.

D. All of the above

E. A and C above


24. "Rapid detoxification" from opioid dependence is desirable for many reasons, but methods to accomplish fast detox are limited and/or controversial.

A. True

B. False


25. Patients undergoing treatment for dependence on substances taken intravenously should be screened for several conditions. Which of the following is NOT something to screen for?

A. HIV/AIDS other sexually transmitted diseases,

B. Viral hepatitis (particularly B and C)

C. Tuberculosis

D. Hantavirus

E. Infections or abscess at injection sites


Benzodiazepines and Other Sedative-Hypnotics

26. Patients intoxicated with sedative-hypnotics exhibit symptoms similar to that of alcohol intoxication. Which is NOT one of these symptoms?

A. Slurred speech

B. Rapid pulse

C. Ataxia

D. Poor physical coordination


27. Flumazenil, which is sometimes used to reverse the sedative and overdose effects of benzodiazepines, is not an effective antidote against other sedative-hypnotics or alcohol.

A. True

B. False


28. Medical complications of withdrawal from benzodiazepines are similar to those of withdrawal from stimulants.

A. True

B. False


29. The best candidates for outpatient detoxification from benzodiazepines are patients:

A. Whose doses of benzodiazepines were mainly in therapeutic ranges

B. Who are not dependent on multiple substances

C. Who are reliable and have reliable significant others to aid in monitoring and supervising their progress

D. All of the above

E. A and C above


Stimulants

30. Which of the following statements is true?

A. Stimulants are associated with withdrawal symptoms that are similar to those seen with opioid, alcohol, and sedative dependence.

B. There has been little emphasis on treating symptoms of stimulant withdrawal.

C. No medications have been developed for this purpose.

D. All of the above

E. B and C above


31. The period of depression experienced by amphetamine users is more prolonged and may be more intense than that of cocaine users.

A. True

B. False


32. Stimulant withdrawal is not usually associated with medical complications.

A. True

B. False


Inhalants/Solvents

33. Which of the following statements about inhalants are true?

A. Dependence on inhalants and subsequent withdrawal symptoms are both relatively uncommon.

B. In rare instances symptoms similar to sedative withdrawal have been described, including “fine tremors, irritability, anxiety, insomnia, tingling sensations, seizures and muscle cramps”.

C. Toluene withdrawal has been reported to cause delirium tremens.

D. All of the above.


Nicotine

34. As many as 90 percent of patients entering treatment for substance abuse are current nicotine users.

A. True

B. False


35. Trying to get patients to quit smoking at the same time they are in detoxification for other substances is very difficult, for many reasons. Which of the following is NOT one of the reasons for this?

A. Patients are ambivalent or lack interest in quitting smoking

B. Physicians are ambivalent about the importance of getting patients to quit smoking at the same time they are detoxifying from another substance

C. It is very easy for patients to get cigarettes from friends, family, visitors, staff, and at 12-step meetings

D. Staff are resistant to patients quitting smoking because withdrawal symptoms, including irritability, anxiety, and depression, can make patients more difficult to manage.

E. Physicians and staff themselves often smoke.


Marijuana and Other Drugs Containing THC

36. Most experts now believe that a THC-specific withdrawal syndrome does occur in some patients who are heavy users.

A. True

B. False


Anabolic Steroids

37. Symptoms of withdrawal from anabolic steroids include:

A. Craving for more steroids

B. Fatigue

C. Restlessness

D. Anorexia

E. All of the above


38. There is no recommended detoxification protocol for anabolic steroids.

A. True

B. False


Club Drugs

39. Withdrawal syndromes have been reported with some of these drugs, but the more common clinical problems are intoxication and severe intoxication with overdose.

A. True

B. False


40. Clinicians need to be constantly aware that a patient may be abusing multiple substances. The LEAST effective way to determine this is:

A. By interviewing family and/or friends

B. Patient self-reports

C. Performing a urine screening


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