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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
Q

signs of opiate overdose

A

“opioid overdose triad”
1. pinpoint pupils
2. respiratory depression
3. decreased LOC

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26
Q

treating opiate overdose

A

administer narcan, preserve airway, ensure adequate oxygenation

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27
Q

s/s of opiate withdrawal; when does it start

A

“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

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28
Q

Clinical Opiate Withdrawal Scale (COW)
categories, scores

A

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

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29
Q

Meds used for opiate withdrawal

A

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
Q

Meds used for opioid sobriety

A

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
Q

s/s of CNS stimulant intoxication

A

“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
Q

s/s of CNS stimulant overdose

A

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
Q

tx for CNS Stimulant overdose

A

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
Q

s/s CNS stimulant withdrawal

A

fatigue/lethargy/sleepiness (most common)
OR anxiety/agitation/insomnia
also
apathy, suicidal ideation, depression, cravings, and disorientation

35
Q

tx for CNS stimulant withdrawal

A

modafinil (for excessive lethargy)
OR
Diphenhydramine or Trazadone for insomnia and agitation

antidepressants may be needed for depression, apathy, and suicidal ideation

36
Q

use of modafinil

A

less intense stimulant that does not produce the high associated with traditional stimulants

narcolepsy or other sleep disturbances

monitor for hyperglycemia

37
Q

Associated Medical Problems with Nicotine

A

increased risk for cancer
smoking tobacco can cause pulmonary and cardiac complications (COPD, CAD, stroke, MI)

38
Q

meds for nicotine withdrawal

A

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
Q

s/s of marijuana use

A

euphoria, detachment, relaxation, increased appetite, talkativeness, slowed perception of time, inappropriate laughter, heightened sensitivity to stimuli, anxiety and paranoia

40
Q

Associated Medical Problems with Marijuana

A

osteoporosis, respiratory problems, impaired immune system, gynecomastia (increased breast gland tissue), cannabinoid hyperemesis syndrome, increased risk for heart attack and testicular cancer

41
Q

Psychoactive Drugs- “club drugs” examples; feeling; how do they work

A

ecstasy, GHB, rohypnol
-produce a euphoric feeling
- increased serotonin and norepi

42
Q

Psychoactive Drugs-
“dissociative drugs” examples; feeling

A

ketamine, salvia, pcp
-dissociative feeling

43
Q

s/s of ecstasy use

A

hyperthermia, heart failure, kidney failure, hypertensive crisis, serotonin syndrome, and hyponatremia, dehydration, sleep disorders, depression, anxiety

44
Q

why are rohypnol and ghb used?

A

sexual assault due to rapid disinhibition and alteration in voluntary muscle control; lasting anterograde amnesia and is easily mixed with drinks

45
Q

s/s of dissociate drugs

A

acute psychosis, aggression, volatile mood swings, bizarre behavior, violence

pcp: makes you impervious to pain and can cause belligerence

46
Q

s/s of ecstasy overdose

A

seizures, hypertensive crisis, serotonin syndrome

47
Q

s/s of GBH and rohypnol overdose

A

cheyne-stokes respirations (abnormal breathing pattern; fast and shallow, slow and deep, apea), seizures, low body temp

48
Q

s/s of pcp overdose

A

stroke, psychosis, hypertensive crisis, hyperthermia, seizures

49
Q

s/s of ketamine and salvia overdose

A

amnesia, respiratory failure, hypertension

50
Q

tx for psychoactive drug overdose; pcp overdose tx

A

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
Q

s/s of psychoactive drug withdrawal; ecstasy, GHB and rohypnol

A

ecstasy: cravings that last for weeks, profound depression, confusion, anxiety, sleep problems

GHB and rohypnol: tremors, sweating, anxiety and muscle pain

52
Q

tx of psychoactive drug withdrawal

A

no specific tx- offer symptomatic support

53
Q

what are anabolic-androgenic steroids; what do they include; how do they work?

A

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
Q

Associated Medical Problems of Anabolic-Androgenic Steroids; general; male specific; female specific

A

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
Q

examples of hallucinogens; feelings produced

A

LSD, Psilocybin (magic mushrooms) and mescaline (petoye)

dreamlike state of unreality and hallucinations

56
Q

dissociative sx of salvia

A

depersonalization, sense of unreality, loss of bodily awareness

57
Q

s/s of hallucinogen intoxication

A

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
Q

s/s of hallucinogen overdose

A

psychosis, permanent brain damage, death

59
Q

tx for hallucinogen overdose

A

low stimuli environment, stay with patient and offer reassurance, speak slowly and softly, give benzos for extreme anxiety or tension

60
Q

Classes of inhalants

A

volatile solvents (paint thinner, glue, gasoline)

gases (butane, propane, nitrous oxide)

nitrates (isobutyl, isoamyl)

aerosols (spray paint, etc.)

61
Q

s/s of inhalant use

A

slurred speech, lack of inhibition, euphoria, dizziness, drunkenness, sometimes violent behavior

62
Q

associated medical problems with inhalants

A

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
Q

two main parts of the assessment of a patient with an addictive disorder

A
  1. history of substance abuse:
    hx of sobriety, triggers, toxicology screen

2.standardized screenings

64
Q

types of standardized screenings for clients with an addictive disorder

A

CAGE (alcohol and/or drug use)

B-DAST (brief drug abuse screening test)

AUDIT (alcohol use disorders identification test)

65
Q

questions asked during CAGE screening; results

A

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
Q

underreporting

A

individual doesn’t report full amount of substance abuse

67
Q

minimizing

A

individuals belief that the pattern of use is not problematic when compared to others

68
Q

potential triggers to relapse

A

people who remind them of using
places that remind them of using
thoughts that lead to use

69
Q

examples of physical, emotional and mental cues that often precede relapse

A

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
Q

what is the Recovery Model?

A

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
Q

four dimensions of past substance abuse

A
  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
Q

12 step programs are based on what principles and concepts

A

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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