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Medically Supervised Withdrawal for Inmates with Substance Use Disorders

1. Which of the following best represents a sign/symptom of withdrawal that requires immediate medical attention?

A. Glossitis

B. Hallucinations

C. Weight gain

D. Hyperhidrosis


2. Which of the following statements is most accurate?

A. Inmates with a history of any brain injury are more likely to suffer seizures and/or delirium during withdrawal.

B. Inmates with a history of any brain injury are less likely to suffer seizures and/or delirium during withdrawal.

C. Inmates with cardiac disease are less sensitive to sympathetic hyperactivity.

D. Cardiac disease does not impact sympathetic hyperactivity.


3. Which of the following best represents a primary treatment option for the management of alcohol withdrawal?

A. Phenobarbital

B. Buprenorphine

C. Bupropion

D. Lorazepam


4. A health care professional has questions regarding the CIWA-Ar. Which of the following informational points of interest should be communicated to the health care professional?

A. The CIWA-Ar is an evidence-based scoring system that should be used to objectively assess the severity and progression of opioid withdrawal symptoms.

B. The CIWA-Ar is an evidence-based scoring system that should be used to objectively assess the severity and progression of alcohol withdrawal symptoms.

C. The CIWA-Ar should not be used on individuals over the age of 21.

D. The CIWA-Ar should not be used on individuals under the age of 21.


5. When does alcohol withdrawal delirium typically occur?

A. 6 hours after the last drink

B. 12 hours after the last drink

C. 24 hours after the last drink

D. 48 -72 hours after the last drink


6. A 28-year-old patient suffering from alcohol withdrawal is being treated with thiamine. Which of the following thiamine doses should be administered to the aforementioned patient?

A. 25 mg daily

B. 50 mg daily

C. 100 mg daily

D. 150 mg daily


7. Which of the following best represents a treatment recommendation for a patient with a CIWA-Ar score between 16 - 20?

A. Supportive care and close monitoring are indicated. Avoid medications.

B. Supportive care and close monitoring are indicated. Medication may beindicated based on clinical judgment.

C. Supportive care and close monitoring are indicated. Medication is usually indicated to reduce symptoms and the risk of major complications.

D. The patient should be hospitalized for a minimum period of 48 hours.


8. A 29-year-old male patient is started on gabapentin for the treatment of mild alcohol withdrawal. Which of the following best represents the recommended gabapentin Day 1 dose for the patient?

A. 300mg every 6 hours

B. 600mg every 6 hours

C. 900mg every 6 hours

D. 1200mg every 6 hours


9. A health care professional has questions regarding benzodiazepine withdrawal. Which of the following informational points of interest should be communicated to the health care professional?

A. Physiological dependence develops within 3 - 4 weeks of regular use.

B. Physiological dependence does not typically develop when individuals use benzodiazepines as prescribed.

C. Health care professionals should use the CIWA-Ar for assessing benzodiazepine withdrawal.

D. Inmates with suspected benzodiazepine withdrawal should not be given a targeted physical examination.


10. Which of the following best represents an early stage benzodiazepine withdrawal symptom?

A. Anxiety

B. Anorexia

C. Diarrhea

D. Hallucinations


11. Which of the following medications should be used for benzodiazepine withdrawal treatment?

A. Methadone

B. Buprenorphine

C. Bupropion

D. Clonazepam


12. Which of the following medications should be used for barbiturate withdrawal treatment?

A. Phenobarbital

B. Bupropion

C. Methadone

D. Buprenorphine


13. When do untreated opioid withdrawal symptoms typically peak?

A. Within 2 hours of onset

B. Within 8 hours of onset

C. Within 12 hours of onset

D. Within 72 hours of onset


14. Which of the following best represents an early sign of opioid withdrawal?

A. Vomiting

B. Diarrhea

C. Tenesmus

D. Diaphoresis


15. Which of the following statements is most accurate?

A. Methadone can be provided without an OTP license for up to three days.

B. Methadone can be provided without an OTP license for up to five days.

C. Methadone can be provided without an OTP license for up to 10 days.

D. Methadone cannot be provided without an OTP license.


16. A health care professional has questions regarding methadone treatment for opioid withdrawal. Which of the following informational points of interest should be communicated to the health care professional?

A. Once a patient is in mild to moderate withdrawal with a COWS score of 5 - 24 or above, the initial dose of methadone should be 5 mg.

B. Once a patient is in mild to moderate withdrawal with a COWS score of 5 - 24 or above, the initial dose of methadone should be 20 mg.

C. Once a patient is in mild to moderate withdrawal with a COWS score of 5 - 24 or above, the initial dose of methadone should be 40 mg.

D. Once a patient is in mild to moderate withdrawal with a COWS score of 5 - 24 or above, the initial dose of methadone should be 80 mg.


17. Which of the following statements regarding buprenorphine is most accurate?

A. Buprenorphine is a pure mu receptor agonist.

B. Buprenorphine is a pure mu receptor antagonist.

C. Buprenorphine is a partial mu α-receptor agonist.

D. Buprenorphine is a partial mu receptor agonist/antagonist


18. A health care professional measures the blood pressure of a patient receiving clonidine for opioid withdrawal. The health care professional observes that the patient's systolic blood pressure is below 90 mm Hg. Which of the following opioid treatment recommendations should the health care professional follow?

A. Withhold clonidine if systolic blood pressure drops below 90 mm Hg or if bradycardia develops.

B. Administer half of the clonidine dose if systolic blood pressure drops below 90 mm Hg or if bradycardia develops.

C. Administer the full clonidine dose, and monitor the patient for 24 hours.

D. Administer the full clonidine dose, and monitor the patient for 48 hours.


19. Which of the following statements is most accurate?

A. SAMHSA recommends that patients withdrawing from stimulants should be monitored closely for complications of stimulant withdrawal, depression, and suicidality; an ECG is not recommended during cocaine withdrawal.

B. SAMHSA recommends that patients withdrawing from stimulants should be monitored closely for complications of stimulant withdrawal, depression, and suicidality, as well as prolonged QTc intervals and seizures; an ECG is recommended during cocaine withdrawal to monitor for cardiac complications.

C. Individuals presenting to a health care facility suffering from cocaine withdrawal should be reported to local law enforcement within one hour of entry.

D. Individuals presenting to a health care facility suffering from cocaine withdrawal should be reported to federal law enforcement within 2 hours of entry.


20. Which of the following statements best defines the term "huffing?"

A. Huffing may refer to the act of breathing in cocaine fumes after it is burned.

B. Huffing may refer to the act of breathing in methadone fumes after it is burned.

C. Huffing may refer to the act of breathing in smoke after drinking alcohol.

D. Huffing may refer to the act of breathing substances, such as paint thinner, cleaners, and glue, through the nose.


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