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Abuse Disorders Flashcards

1
Q

Smoking Cessation: What is it?

A

Cigarette smoking (tobacco dependency) is a chronic disease that often requires repeated intervention and multiple attempts to quit. Withdrawal from nicotine produces anxiety, craving, hunger, irritability, drowsiness, tremors, diaphoresis, insomnia, dizziness, and headaches. Smoking cessation is defined as abstaining from cigarette smoking for at least 1 year.
** Although quitting smoking at any age is beneficial, smokers who quit between the ages of 35 and 44 avoid the greatest risk of dying from a smoking-related

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2
Q

Smoking Cessation: Etiology

A
  • Psychosocial stress and nicotine dependence are two primary reasons people smoke
  • Reasons for smoking and motivation to quit are age related
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3
Q

Smoking Cessation: Why do teenagers start and quit smoking?

A
  • Teenagers smoke to appear older, due to peer pressure, and are influenced by media and marketing
  • Teenagers may be motivated to quit by recognizing the immediate undesirable effects of cigarette smoking (e.g., bad odor, expense, decreased exercise capacity, relationship between smoking a acute respiratory illness)
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4
Q

Smoking Cessation: Why do adults start and quit smoking?

A
  • Adults smoke due to physical dependence
  • Adults tend to quit smoking when they are provided with healthy alternatives, if psychosocial issues are addressed, and when they recognize the relationship between smoking and acute illness
  • Financial issues can influence adherence to smoking cessation
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5
Q

Smoking Cessation: Why do older adults start and quit smoking?

A
  • Older adults continue to smoke because they feel it is too late to undo damage that is already done
  • Older adults tend to quit smoking to receive immediate benefits (e.g., fewer upper respiratory infections, improved taste sensation, less coughing, money savings) and because they believe that quitting can prevent further damage
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6
Q

Smoking Cessation: Assessment Findings

A
  • Use the theoretical model of change to assess a patient’s readiness to act on a new healthier behavior. Consider use of motivational interviewing
  • Chronic cough
  • Inflammation of oropharynx, sinuses, nose
  • Cigarette odor on breath, hair, clothing
  • Nicotine-stained teeth and fingers
  • Prematurely aged skin
  • Frequent upper respiratory infections
  • COPD
  • Past attempts at quitting
  • Smokeless tobacco including vaping/e-cigarettes
    1. Erythema of isolated areas of intraoral soft tissue
    2. Leukoplakia (white patches) on gums
    3. Bronchiolitis obliterans (popcorn lung syndrome)
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7
Q

Smoking Cessation: Non-Pharmacologic Management

A

Advise all smokers to quit; repeat at every visit

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8
Q

Smoking Cessation: Pharmacologic Management

A

Focuses on nicotine replacement and non-nicotine-based therapy. Patients should quit smoking before using nicotine replacement (do not use concurrently)

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9
Q

Smoking Cessation: Nicotine Replacement Therapies

A
  • Help relieve withdrawal symptoms while quitting
  • Should be used in conjunction with counseling
  • Transdermal patch releases a constant dose of nicotine through the skin
  • Not recommended for patients <18 years, but recent studies indicate can be used safely in adolescents
  • Nicotine gum/lozenge helps reduce urge to smoke
  • Nicotine nasal spray highly effective but carries dependence risk due to rapid absorption of nicotine
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10
Q

Smoking Cessation: Non-Nicotine-Based Therapy

A
  • Bupropion theorized to block noradrenergic and dopaminergic pathways (addiction receptors in the brain), resulting in a reduction in urge to smoke and reduction in withdrawal symptoms
  • Patients should start taking bupropion before they stop smoking, and should stop smoking during the second week of therapy
  • Continue therapy for 7 to 12 weeks
  • If used in conjunction with nicotine replacement therapy, nicotine replacement should be started only after patient has stopped smoking
    ** Varenicline (Chantix)
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11
Q

Alcohol Use Disorder: What is it?

A

A pattern of alcohol use that results in psychological and physiologic problems. The severity of alcohol use disorder is determined based on the number of symptoms present
* Mild: 2-3 symptoms
* Moderate: 4-5 symptoms
* Severe: greater than 6 symptoms

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12
Q

Alcohol Use Disorder: Etiology

A
  • Combination of social, cultural, biological, and emotional factors
  • Probable genetic influence
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13
Q

Alcohol Use Disorder: Incidence

A
  • Men affected at twice the rate of women
  • Predominant age 18-25 years
  • 88% of people > 18 years old report alcohol use
  • 88,000 people (62,000 men/26,000 women) die from alcohol-related causes annually
  • Third leading preventable cause of death in U.S.
  • Accounts for 31% of all vehicle fatalities
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14
Q

Alcohol Use Disorder: Criteria for Determining Severity

A
  1. Consuming alcohol in larger amount or for longer than intended
  2. Persistent desire or unsuccessful effort to reduce or control use
  3. Spending significant time getting or using alcohol, or recovering from alcohol use
  4. Cravings and urges to consume alcohol
  5. Recurrent use resulting in failure to fulfill obligations at work, school, or home
  6. Continued alcohol use despite persistent or recurrent social/interpersonal problems caused/exacerbated by consumption
  7. Giving up/reducing social, occupational, or recreational activities due to alcohol use
  8. Recurrent use even if physically hazardous
  9. Continuing use despite knowledge of having problems caused/exacerbated by alcohol
  10. Tolerance
  11. Withdrawal
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15
Q

Alcohol Use Disorder: How is tolerance defined?

A
  • Markedly increased amounts to achieve intoxication or desired effect
  • Markedly diminished effect with continued use of the same amount
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16
Q

Alcohol Use Disorder: How can withdrawal manifest?

A
  • Characteristic withdrawal syndrome
  • Alcohol (or substance such as benzodiazepine) is consumed to relieve/avoid withdrawal symptoms
  • Withdrawal can be life-threatening so must treat
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17
Q

Alcohol Use Disorder: Assessment Findings - Medical Problems Associated with Alcohol Dependence

A

** Reliability of patient reporting is highly variable
1. Psychosis, dementia, memory impairment, blackouts, insomnia
2. Nausea, vomiting, peptic ulcer, abd pain
3. Hepatitis, cirrhosis, pancreatitis
4. Thiamine deficiency: anorexia, weight loss, peripheral neuropathy, irritability, tremors
5. Cardiomyopathy, HTN, arrhythmias
6. Aspiration pneumonia, bronchitis
7. Cancer of oropharynx, larynx, esophagus, liver
8. Erectile dysfunction
9. Cushingoid appearance, gynecomastia
10. Signs of accidents (fractures, bruises, burns)
11. Poor hygiene, plethoric facies (reddened face)

18
Q

Alcohol Use Disorder: Assessment Findings - Psychosocial Consequences

A
  1. Divorce
  2. Depression
  3. Suicide
  4. Domestic violence
  5. Arrests, legal problems
  6. Unemployment, employment problems
  7. Poverty
  8. Unsafe sexual behavior, STDs
  9. Children may experience abnormal psychosocial development related to parental alcohol abuse
    ** Delays in maturation and sexual development are common in adolescents who abuse alcohol
19
Q

Alcohol Use Disorder: Non-Pharmacologic Management

A
  • Substance abuse counseling
  • Balanced diet: common deficiencies are folate, thiamine, magnesium, phosphate, and zinc
  • Provide education about 12-step group meetings
  • Treatment for adolescent should be developmentally appropriate, peer oriented, and involve the family
  • Develop relapse prevention plan
20
Q

Alcohol Use Disorder: Substance Abuse Counseling

A
  • Screening Brief Intervention and Referral to Treatment (SBIRT) useful to identify, reduce, and prevent use, abuse, and dependence on alcohol
  • Establish a therapeutic relationship
  • Make medical office off limits for substance abuse
  • With permission of patient:
    1. Present information about negative health
    2. Involve family and other support
    3. Set goals
    4. Involve community treatment services
21
Q

Alcohol Use Disorder: Pharmacologic Management

A
  • Withdrawal from alcohol dependence can be life threatening (delirium tremens)
  • Detoxification: symptoms of withdrawal (seizures, hallucinations, delirium) typically begin within 12 hours of cessation of alcohol use and resolve within 5 days.
22
Q

Substance Use Disorder (SUD): What is it?

A

A maladaptive pattern of substance use that leads to impairment or distress. Commonly abused substances are alcohol, caffeine, cannabis, hallucinogens, inhalants, opioids, sedatives, hypnotics and anxiolytics, stimulants, tobacco, and anabolic steroids.
- Manifestations of SUD often include difficulties with school, work, family, relationships, personal health, and the legal system. The severity of SUD is determined by the number of criteria symptoms present:
1. Mild (2-3)
2. Moderate (4-5)
3. Severe (greater than 6)

23
Q

Substance Use Disorder (SUD): Etiology

A
  1. Biological factors
  2. Psychological factors
  3. Social factors
    ** The dopamine system is stimulated by consumption or ingestion of mood-altering substances
24
Q

Substance Use Disorder (SUD): Etiology - Biological Factors

A
  • Intrinsic addictiveness of a drug coupled with inherited familial biologic markers
25
Q

Substance Use Disorder (SUD): Etiology - Psychological Factors

A
  • Increased prevalence of certain psychiatric problems (affective disorders, borderline personality, antisocial personality, trauma-related disorders)
26
Q

Substance Use Disorder (SUD): Etiology - Social Factors

A
  • Increased prevalence among the economically and culturally impoverished
27
Q

Substance Use Disorder (SUD): Assessment Findings

A
  1. Accidents, trauma
  2. Legal difficulties
  3. Physical signs
  4. Results of chronic use
    ** Patients with SUD are often malnourished
28
Q

Substance Use Disorder (SUD): Assessment Findings - Opioid Intoxication

A
  1. Somnolence
  2. Cognitive impairment
  3. Bradycardia
  4. Hypotension
  5. Hypoventilation
  6. Pupillary constriction
29
Q

Substance Use Disorder (SUD): Assessment Findings - Opioid Withdrawal

A
  1. Tearing
  2. Anxiety
  3. Disturbed sleep
  4. Nausea
  5. Vomiting
  6. Diarrhea
  7. Pain
  8. Restlessness
  9. Rhinorrhea
30
Q

Substance Use Disorder (SUD): Assessment Findings - Inhalant Intoxication

A
  1. Sedation
  2. Slurred speech
  3. Unsteady gait
  4. Irritation of the nasal and ocular tissues
  5. Foul breath odor
  6. Source of inhaled substance on body or clothing
  7. Excitation
  8. Depression
  9. Impulsiveness
  10. Exhilaration
  11. Diminished reflexes
31
Q

Substance Use Disorder (SUD): Assessment Findings - Sedative Intoxication

A
  1. Sedation
  2. Somnolence
  3. Disinhibition
  4. Staggering gail
  5. Slurred speech
  6. Depressed respirations
  7. Slowed pulse
  8. Diminished reflexes
32
Q

Substance Use Disorder (SUD): Assessment Findings - Sedative Withdrawal

A
  1. Insomnia
  2. Restlessness
  3. Tremor
  4. Anxiety
  5. Poor sleep
  6. Poor appetite
  7. Limb twitching
  8. Agitation
  9. Seizures
  10. Fever
  11. Tachycardia
  12. Elevated BP
33
Q

Substance Use Disorder (SUD): Assessment Findings - Cannabis Reactions

A

** Marijuana or hashish synthetic methylcannabinoids
1. Distortion of time, space, sound, and color
2. Paranoia
3. Disorientation

34
Q

Substance Use Disorder (SUD): Assessment Findings - Stimulant Intoxication

A

** Cocaine, amphetamine, MDMA, synthetic cathinones (bath salts)
1. Confusion
2. Paranoia
3. Restlessness
4. Irritability
5. Delusions
6. Hallucinations
7. Tremor
8. Anxiety
9. Tachycardia
10. HTN
11. High fever
12. Convulsions
13. Coma

35
Q

Substance Use Disorder (SUD): Assessment Findings - Stimulant Withdrawal

A
  1. Somnolence
  2. Depressed mood
  3. Fatigue
  4. Vivid, unpleasant dreams
  5. Strong desire to obtain more stimulants
36
Q

Substance Use Disorder (SUD): Assessment Findings - Hallucinogens Intoxication

A
  1. Panic reaction
  2. Hallucinations
  3. Loss of contact with reality
  4. Disturbed behavior
  5. Increased pulse
  6. Elevated BP
  7. Perspiration
  8. Blurred vision
37
Q

Substance Use Disorder (SUD): Non-Pharmacologic Management

A
  1. Consider that denial is often an integral problem and anticipate defenses
  2. Screening, Brief Intervention, Referral and Treatment (SBIRT) using motivation interviewing and patient education
  3. Behavioral therapies
  4. Self-help groups 12-step programs
  5. Self-help groups for families
  6. Nutrition education
  7. Detoxification in appropriate environment, if needed
  8. Fundamental requirement is abstinence from use of mood-altering substances
  9. A caring, nonjudgemental attitude is essential to patient’s acceptance of treatment
38
Q

Substance Use Disorder (SUD): Pharmacologic Management - Opiate Withdrawal

A
  1. Decreasing doses of methadone
  2. Methadone or Subutex (buprenorphine) maintenance is the usual treatment for opiate addiction in pregnancy
  3. Medically supported detoxification with comfort medications
  4. Clonidine ameliorates abstinence-related withdrawal symptoms
  5. Naltrexone orally or monthly IM injection
39
Q

Substance Use Disorder (SUD): Pharmacologic Management - Opioid Chronic Use/Maintenance

A
  1. Universal monitoring of all patients on opioids by screening for other substance use and/or deferment of medications with routine substance use screening
    - review of pharmacy monitoring programs
    - random/routine urine drug screens
    - unscheduled pill counts
    - following state/clinical guidelines for prescribing opioid medications
  2. Monitor patient’s morphine equivalent; overdose risk increases when > 50-100
  3. Combination of opioid and sedative/anxiolytic/hypnotic medications contraindicated due to overdose/sudden death risk
  4. Greater risk of drug interactions/overdose with long-acting opioid medications, especially methadone and Suboxone
  5. Preventative coprescribing of naloxone to reverse life-threatening respiratory depression in patients at high risk of unintentional overdose
40
Q

Substance Use Disorder (SUD): Pharmacologic Management

A
  1. Use of sedative is discouraged. Short-term use of benzodiazepines may be necessary for physical withdrawal from stimulant drugs if patient is severely agitated
  2. IV diazepam is the drug of choice for treatment of cocaine toxicity characterized by agitation, seizures, and dysrhythmias. Beta blockers are not recommended
  3. Sedative withdrawal accomplished by gradually decreasing amount of drug available to avoid precipitating CNS rebound or hyperactivity; with phenobarbital or benzodiazepine, taper dose detoxification in an inpatient setting
  4. Medications to treat comorbid psychiatric conditions
  5. Treatment for SUD should continue long term and include group and individual therapy
  6. Ketamine therapy is a new and emerging treatment

Adult Health (21 decks)

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