_ch. 19 Addiction Flashcards
Five most addictive substances
Most addictive substance
+ Alcohol, opioids, methamphetamine, marijuana, cocaine
+ alcohol by 200%
One standard drink
+ Beer - 12 ounce of 5% alcohol
+ Wine – 5 ounce glass, 12% alcohol
+ Hard liquor – shot – 1.5 ounces 40% alcohol.
Low risk drinking limits
+ Women: > 3 drinks per day, > 7 drinks per week
+ men: > 4 drinks per day, > 14 drinks per week
Tips for cutting down alcohol use – 7 total
+ Measure and count
+ set goals
+ pace/space
+ EAT
+ avoid triggers
+ plan for urges
+ know your NO
4 C’s of addiction
+ Chronic
+ cognitive issues
+ cravings
+ compulsive
Signs of intoxication – CNS depressants
+ Slurred speech + in coordination/staggering + drowsiness
+ lowered inhibitions = impulsivity for sex / aggression
+ impaired judgment
+ social/occupational problems
Physical problems – alcohol related
+ Cirrhosis of the liver
+ pancreatitis
+ ulcers
+ esophageal varices
+ malabsorption of vitamins: folic acid, vitamin B1/thiamine, vitamin B 12
+ cardiomyopathy
+ myopathies
Blood tests to determine alcohol misuse
+ ALT/AST
+ lipase/amylase
+ tox screen
+ BAL – blood alcohol level
How does alcohol dull the “awake” centers?
+ By blocking neurotransmission
Existing health problems that worsen with alcohol abuse
+ Liver disease
+ heart disease and hypertension
+ diabetes
+ ulcers/stomach issues
+ depression/anxiety
+ sleep problems 
Alcohol withdrawal symptoms
+ ⬆️ BP/pulse
+ anxiety
+ insomnia
+ tremors
+ illusions/confusion
+ nausea/vomiting/anorexia
Alcohol withdrawal timeline
+ Symptoms begin 6 hours after last drink
+ symptoms peak/disappear 24 to 48 hours after last drink
+ delirium tremens begins 48 to 72 hours – medical emergencies
Mild symptoms of alcohol withdrawal – 6 to 24 hours
+ mild excitation, mild tremors
+ diaphoresis, nausea
+ anxiety
+ rapid heart rate
+ increase BP
2nd cluster of alcohol withdrawal symptoms and timing
+12 to 48 hours post abstinence
+ excessive neuronal excitation
+ gross tremors, anxiety, agitation
+ insomnia, disorientation
+ anorexia, weakness
+ visual/auditory hallucinations
+ headache
+ possibly seizures – tonic clonic
+ hallucinations begin
3rd cluster symptoms - alcohol withdrawal
+ Symptoms characterized by delirium tremens
+ Medical emergency – 20% mortality
+ death due to heart problems, aspiration, pneumonia, hyperpyrexia
+ delirium, disorientation, visual, and tactile hallucinations, illusions, paranoid delusions, agitation, raise vital signs
Medication for alcohol withdrawal
+ short acting / immediate help - Benzo - ATIVAN
+ Long acting benzodiazepine – chlordiazepoxide/Librium is common
+ MedSurg setting — benzo often ordered PRN then tapered
+ Clonidine = anti-hypertensive agent – to reduce blood, pressure and withdrawal, reduce acuity of symptoms
Other medication’s given for alcohol abuse recovery
+ Naltrexone – reduces alcohol craving (also treats opioid use disorder) – blocks effects/feelings of alcohol, reduces alcohol cravings/alcohol consumption — helps patients maintain sobriety 3 to 4 months of treatment
+ Antabuse/disulfiram – cause a strong reaction when alcohol ingested to promote abstinence – must avoid all alcohol products: nausea/vomiting, facial, flushing, sweating, throbbing, headache, tachycardia, hypotension
Wernicke’s Korsakov Syndrome - Wet brain
+ Thiamine B1 deficiency
+ Warnicke’s encephalopathy🟰 * eye paralysis, nystagmus, ataxia, acute confusion, underdiagnosed
+ Korsakoff Psychosis 🟰 **permanent loss of ability to remember — learning/memory amnesia!!*
+ Confabulation (KP) – can’t remember so fills in the blanks
CIWA scores — implementation
+ < = 7 Q2
+ 8-16 Qhr
+ 17+ Q30min
+ > than 17 for more than 4 hours – contact provider, consider critical care, infusion of Ativan 
Medication’s used with benzodiazepines
1. hypertension, 180/100
2. Agitation
+ Clonidine, metoprolol
+ Haloperidol
Supplements given for alcohol abuse, withdrawal, detox
+ Multivitamin
+ B1 – thiamine and other B vitamins
Opiate intoxication signs and symptoms
+ Constricted pupils
+ decreased respiration & BP
+ euphoric feeling
+ drowsiness, slurred, speech, impaired memory and judgment
Life-saving medication for opiate overdose?
What is its ‘action?’
Naloxone/Narcan
- opioid antagonist
– takes over opioid, receptors, and knocks opiate off
Opiate withdrawal
+ Flu like: runny nose, aches, chills, fever
+ cramps, diarrhea, insomnia, diaphoresis, irritability
Medication’s that support opiate withdrawal and detox
+ Naloxone/Narcan
+ methadone to replace high - controlled substitution management
+ naltrexone – opioid antagonist
+ Buphrenorphine
Signs and symptoms of marijuana intoxication
+ Increased appetite
+ red eyes
+ detachment, relaxation
+ euphoria
+ impaired memory & judgment, apathy
Withdrawal symptoms of marijuana
+ Anxiety
+ cravings
+ trouble sleeping
+ appetite loss
Signs and symptoms of stimulant intoxication
+ Pupils dilated
+ tachycardia, increased BP
+ excessive motor activity
+ euphoria & paranoia
Signs and symptoms of stimulant withdrawal
+ Depression 🟰 poss. suicidality
+ anergia
+ anhedonia
+ avolition
Disorders that CAN co-occur with substance abuse
+ Mental health disorders
+ suicide
+ homelessness
+ incarceration
+ HIV/STDs
Substance-abuse coping styles - 6 total
+ denial
+ rationalization
+ all or nothing thinking
+ selective attention
+ conflict minimization
+ manipulation
* Addicts have trouble giving up these coping styles, which interfere with their recovery – or behaviors, reinforce addictive lifestyle
