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NUR 215: Mental Health > Addiction > Flashcards

Addiction Flashcards

1
Q

Addiction

A

a chronic, relapsing brain disease characterized by compulsive drug seeking behavior motivated by cravings, despite harmful consequences; causes long term changes to brain chemistry

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2
Q

Role of Dopamine in Addiction

A
  1. Most psychoactive drugs flood the brain with dopamine; produces the high feeling; targets the brains reward system
  2. activation of the dopamine system leads to learned behaviors and increased likelihood of repeating the behavior
  3. overstimulation of this hormone leads to an enhanced euphoric effect which causes a strong desire for repeated use of the drug
  4. with repeated use, the brain adapts to the surges of dopamine by synthesizing less dopamine and reducing the number of receptors; leads to limited ability to experience pleasure without drug, they’re need to feel normal; tolerance
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3
Q

blackouts

A

amnesia for the events of any part of a drinking episode

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4
Q

intoxication

A

disturbances in the level of consciousness, cognition, perception, and or behavior after using a substance

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5
Q

cross-tolerance

A

tolerance of a certain drug produces tolerance to another drug in the same class/category

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6
Q

withdrawal

A

symptoms that occur after a substance is stopped or reduced after a long term period of use

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7
Q

antagonistic effects

A

occur when one drug is taken to weaken or inhibit the effects of another drug

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8
Q

codependency

A

a type of dysfunctional helping relationship where one person supports or enables another person’s addictive behaviors continue

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9
Q

s/s of CNS Depressant Intoxication

A

“slow”
slurred speech, unsteady gate, drowsiness, decreased vitals, disinhibition, impaired judgement, irritability, impaired attention/memory

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10
Q

CNS Depressant Overdose

A

cause: cardiovascular and respiratory depression, shock, convulsions, coma, and/or death
tx: clear airway, IV fluids, seizure precautions, activated charcoal, dialysis, flumazenil if barbiturates or benzos

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11
Q

barbiturate and benzo withdrawal

A

opposite of intoxication, b/c of loss of drug
ex. elevated vitals, n/v, tremors, paroxysmal sweats, insomnia, anxiety and agitation, tactile, auditory or visual disturbances, seizures, disorientation and delirium

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12
Q

alcohol related medical problems

A

Gasto: gastritis, esophagitis, pancreatitis, hepatitis, cirrhosis of the liver
Neuro: effects cerebral cortex, hippocampus, and cerebellum, Wernicke’s encephalopathy, Korsakoff’s psychosis, peripheral neuropathy

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13
Q

Wernicke’s Encephalopathy

A

Alcohol related medical problem: (neuro)
caused by thiamine (b1) deficiency
acute/subacute confusion, nystagmus (rapid, repetitive, uncontrolled eye movements), ataxia (poor muscle control)

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14
Q

Korsakoff’s Psychosis

A

Alcohol related Medical problem (neuro)
difficulty/inability to learn new information and/or remember recent events
also affects thinking and social skills

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15
Q

Four Blood Alcohol concentration levels

A

0.02-0.06 “buzzed feeling”
0.07-0.14 “drunk”
0.15-0.24 “dangerous intoxication”
>0.24 medical emergency

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16
Q

Measuring alcohol intolerance level;
how and why

A

blood alcohol concentration level
determines the level of intoxication based on weight and size; assess level of tolerance; verify patients report of recent drinking

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17
Q

Manifestations of alcohol withdrawal; most dangerous?; timeline

A

autonomic: elevated HR, BP, and temp. diaphoresis, n/v, diarrhea

motor: hand tremor, hyperreflexia, ataxia, seizures, dysarthria (trouble speaking), insomnia, irritability

awareness: disorientation, delirium, agitation

psychiatric: hallucinations, illusions, paranoia, combativeness

most dangerous: delirium tremors- fatal form of alcohol withdrawal

sx peak 24-48 h ours after last drink, can continue 5-7 days

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18
Q

10 Categories of CIWA scale; ranges of scores

A
  1. n/v
  2. tremor
  3. paroxysmal sweats
  4. anxiety
  5. agitation
  6. tactile disturbances
  7. auditory disturbances
  8. visual disturbances
  9. headache
  10. orientation/clouding of sensorium

all score from 0-7 except orientation which is 0-4

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19
Q

Medications used for Alcohol Withdrawal

A

administer meds with a cross tolerance to alcohol and gradually decrease the dose
- most common: benzos
IV ativan for high scores, PO chlordiazepoxide for low scores
can be scheduled or score based
provides sedation, decreases anxiety, and decreases risk of seizures

clonidine for cardiovascular effects

thiamine and vitamin replacement (Rally Pack)

anti-convulsant for seizures and anxiety

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20
Q

Meds used for Sobriety (alcohol)

A

Disulfiram (anatabuse): helps with impulse drinking d/t long lasting effects, when mixed with alcohol patient will have violent physical reactions; takes 14 days to leave body

Naltrexone (vivitrol): reduces the desired pleasant feelings by blocking the release of endorphins, also blocks cravings; inj. given once a month or daily orally (ReVia)

Acamprosate (campral): reduces unpleasant symptoms of abstinence and decreases cravings

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21
Q

principles of meds for alcohol sobriety

A

making alcohol unpleasant
reducing psychophysiological symptoms of withdrawal, reducing the reinforced qualities of use

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22
Q

s/s of Opiate intoxication

A

constricted pupils, drowsiness, slurred speech, psychomotor slowing, initial euphoria followed by dysphoria (sadness, dissatisfied)

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23
Q

Associated Medical Problems with Opiate Use

A

“super slow”
chronic constipation, respiratory depression and failure, pneumonia, neonatal abstinence syndrome, complications from IV drug use

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24
Q

Possible medical complications of IV drug use

A

endocarditis, hep c, hiv/aids, tb, infection and abscesses

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25
signs of opiate overdose
"opioid overdose triad" 1. pinpoint pupils 2. respiratory depression 3. decreased LOC
26
treating opiate overdose
administer narcan, preserve airway, ensure adequate oxygenation
27
s/s of opiate withdrawal; when does it start
"parasympathetic nervous system "wakes up"- wet, gi, etc. yawning, low energy, irritability, insomnia, agitation, flu like symptoms, runny nose, teary eyes, goose bumps, hot/cold sweats, severe muscle aches and pains, abdominal cramping, diarrhea, n/v can begin within 1 hour but usually 12 hours after last use; peaks at 3-5 days and lasts 1-4 weeks
28
Clinical Opiate Withdrawal Scale (COW) categories, scores
resting pulse, GI upset, Sweating, Tremor, Restlessness, yawning, pupil size, anxiety or irritability, bone or joint aches, goose/flesh skin, runny nose or tearing mild: 5-12 moderate:13-24 moderately severe: 25-36 severe: >36
29
Meds used for opiate withdrawal
methadone for staged abstinence clonidine: can assist with withdrawal effects related to autonomic instability; anxiety, chills, insomnia symptom management: - ibuprofen -dicyclomine - baclofen (yawning, muscle spasms) - zofran - loperamide (diarrhea) -trazadone - hydroxyzine (anxiety)
30
Meds used for opioid sobriety
methadone: long term to decrease cravings and relapses related to urges; does NOT produce a "high", given once a day usually in a supervised setting buprenorphine: opioid used to support abstinence that is a partial agonist, longer acting with milder withdrawal sx, only required to take 1-3x week instead of every day naltrexone: opioid antagonist that blocks the euphoric effects of opiates; will cause withdrawal in pts currently taking opioids suboxone: combo of buprenorphine and naltrexone
31
s/s of CNS stimulant intoxication
"fast!" increased alertness, sexual arousal, behavioral excitement, well-being and energy, diminished fatigue, extreme energy, anorexia, rambling/incoherent speech, increased violence, delusions of grandeur, anxiety/fear, pupil dilation, dryness of nasal cavity, excessive motor activity
32
s/s of CNS stimulant overdose
exaggerated responses of the drug: respiratory distress, ataxia, hyperpyrexia (temp goes to above 106.7F due to changes in hypothalamus), convulsions. stroke, MI, hypertension, tachycardia, coma, death
33
tx for CNS Stimulant overdose
supportive: - benzos to prevent seizure and sedation - cooling blanket for fever - IV antihypertensives for tachycardia and hypertension - supplemental oxygen - monitor glucose levels (rapid shifts)
34
s/s CNS stimulant withdrawal
fatigue/lethargy/sleepiness (most common) OR anxiety/agitation/insomnia also apathy, suicidal ideation, depression, cravings, and disorientation
35
tx for CNS stimulant withdrawal
modafinil (for excessive lethargy) OR Diphenhydramine or Trazadone for insomnia and agitation antidepressants may be needed for depression, apathy, and suicidal ideation
36
use of modafinil
less intense stimulant that does not produce the high associated with traditional stimulants narcolepsy or other sleep disturbances monitor for hyperglycemia
37
Associated Medical Problems with Nicotine
increased risk for cancer smoking tobacco can cause pulmonary and cardiac complications (COPD, CAD, stroke, MI)
38
meds for nicotine withdrawal
nicotine based: patches, gum, lozenges, nasal sprays, inhalers - used as substitute for smoking and is gradually tapered no nicotine (atypical antidepressants) verenicline (chantix) bupropion (zyban)
39
s/s of marijuana use
euphoria, detachment, relaxation, increased appetite, talkativeness, slowed perception of time, inappropriate laughter, heightened sensitivity to stimuli, anxiety and paranoia
40
Associated Medical Problems with Marijuana
osteoporosis, respiratory problems, impaired immune system, gynecomastia (increased breast gland tissue), cannabinoid hyperemesis syndrome, increased risk for heart attack and testicular cancer
41
Psychoactive Drugs- "club drugs" examples; feeling; how do they work
ecstasy, GHB, rohypnol -produce a euphoric feeling - increased serotonin and norepi
42
Psychoactive Drugs- "dissociative drugs" examples; feeling
ketamine, salvia, pcp -dissociative feeling
43
s/s of ecstasy use
hyperthermia, heart failure, kidney failure, hypertensive crisis, serotonin syndrome, and hyponatremia, dehydration, sleep disorders, depression, anxiety
44
why are rohypnol and ghb used?
sexual assault due to rapid disinhibition and alteration in voluntary muscle control; lasting anterograde amnesia and is easily mixed with drinks
45
s/s of dissociate drugs
acute psychosis, aggression, volatile mood swings, bizarre behavior, violence pcp: makes you impervious to pain and can cause belligerence
46
s/s of ecstasy overdose
seizures, hypertensive crisis, serotonin syndrome
47
s/s of GBH and rohypnol overdose
cheyne-stokes respirations (abnormal breathing pattern; fast and shallow, slow and deep, apea), seizures, low body temp
48
s/s of pcp overdose
stroke, psychosis, hypertensive crisis, hyperthermia, seizures
49
s/s of ketamine and salvia overdose
amnesia, respiratory failure, hypertension
50
tx for psychoactive drug overdose; pcp overdose tx
no antidote can use: - activated charcoal to prevent further absorption - treat symptomatically - quiet environment pcp - haldol or benzos - acidify urine to facilitate excretion of pcp
51
s/s of psychoactive drug withdrawal; ecstasy, GHB and rohypnol
ecstasy: cravings that last for weeks, profound depression, confusion, anxiety, sleep problems GHB and rohypnol: tremors, sweating, anxiety and muscle pain
52
tx of psychoactive drug withdrawal
no specific tx- offer symptomatic support
53
what are anabolic-androgenic steroids; what do they include; how do they work?
often used in sports to enhance athletic performance synthetic derivatives related to male sex hormones, testosterone (androgens) include: DHEA, THG, and Androstenedione function in a similar way to testosterone by binding with special receptor sites on muscle and tissue to promote protein synthesis in skeletal muscle (anabolic effects) and the development of male sexual characteristics (adrenergic effects)
54
Associated Medical Problems of Anabolic-Androgenic Steroids; general; male specific; female specific
liver damage, renal failure, elevated cholesterol levels, MI, endocrine dysfunction, depression, stunted growth, paranoia, jealousy, delusions, and violent mood swings males: infertility, increased risk of prostate cancer, growth of facial hair, breast development female: male pattern baldness, changes in menstrual cycle, growth of facial hair and deepening of the voice
55
examples of hallucinogens; feelings produced
LSD, Psilocybin (magic mushrooms) and mescaline (petoye) dreamlike state of unreality and hallucinations
56
dissociative sx of salvia
depersonalization, sense of unreality, loss of bodily awareness
57
s/s of hallucinogen intoxication
pupil dilation, diaphoresis, tremors, incoordination, paranoia, synesthesia (colors are heard and sounds are seen), distorted sense of space and time, hallucinations, delusions of grandeur
58
s/s of hallucinogen overdose
psychosis, permanent brain damage, death
59
tx for hallucinogen overdose
low stimuli environment, stay with patient and offer reassurance, speak slowly and softly, give benzos for extreme anxiety or tension
60
Classes of inhalants
volatile solvents (paint thinner, glue, gasoline) gases (butane, propane, nitrous oxide) nitrates (isobutyl, isoamyl) aerosols (spray paint, etc.)
61
s/s of inhalant use
slurred speech, lack of inhibition, euphoria, dizziness, drunkenness, sometimes violent behavior
62
associated medical problems with inhalants
loss of sense of smell, hearing loss, tachycardia, neurotoxic symptoms, nose bleeds, lung, live and kidney problems, muscle wasting and reduced muscle tone, accidental suffocation, cardiac dysrhythmias
63
two main parts of the assessment of a patient with an addictive disorder
1. history of substance abuse: hx of sobriety, triggers, toxicology screen 2.standardized screenings
64
types of standardized screenings for clients with an addictive disorder
CAGE (alcohol and/or drug use) B-DAST (brief drug abuse screening test) AUDIT (alcohol use disorders identification test)
65
questions asked during CAGE screening; results
C: cut down A: annoyed G: guilty E: eye opener 1. have you ever felt like you should cut down on your drinking or drug problem? 2. have people ever annoyed you by criticizing you about your drinking or drug use? 3. have you ever felt bad or guilty about your drinking or drug use? 4. have you ever had a drink or use a drug the first thing in the morning to steady your nerves or get rid of a hangover? (eye opener) results: positive responses are given one point and a score of two or more is clinically significant
66
underreporting
individual doesn't report full amount of substance abuse
67
minimizing
individuals belief that the pattern of use is not problematic when compared to others
68
potential triggers to relapse
people who remind them of using places that remind them of using thoughts that lead to use
69
examples of physical, emotional and mental cues that often precede relapse
physical: stopping counseling/meetings, hanging out with old friends/going old places where substance abuse took place emotional: increases in anxiety, depression, mood swings, feelings of restlessness and boredom, poor eating and sleeping mental: glamorizing past drug use, keeping secrets or lying, thinking about using
70
what is the Recovery Model?
established to define recovery as a process of change through which an individual improves their health and wellness, lives a self-directed life, and strives to reach their full potential
71
four dimensions of past substance abuse
1. health- overcoming or managing ones disease 2. home- having a safe and stable place to live 3. purpose- conducting meaningful activities 4. community- having relationships and social networks that provide support
72
12 step programs are based on what principles and concepts
individuals with addictive disorders are powerless over their addiction and their lives are unmanageable although individuals with addictive disorders are not responsible for their disease, they are responsible for their recovery individuals can no longer blame people, places, and things for their addiction- they must face their problems and their feelings

NUR 215: Mental Health (11 decks)

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