Addictive Disorders Flashcards
At the synapse Cocaine _______ _______ of dopamine while Heroin and Morphine ______ _______ __ _________________.
blocks reuptake
blocks release of inhibitory neurotransmitters
18.7 Million people or 7.7% of population are dependent on _______ and 12,000 more try it for the first time every day.
Alcohol
3.6 Million are dependent on _______. 700,000 are in treatment and 8,000 try it for first time every day in which over half are female under 18 years old.
Drugs
71.5 million people use _______ with 23.4% men and 18.5% women. Young adults age 18 - 25 are the highest rate for any age group.
Tobacco
Its the most widely used mood altering drug in the world being ingested by 80 to 90% of Americans.
Caffeine
An addiction to ______ effects as many as 4 million adults strongly linked to Depression. About 15% of ______ _______ people are compulsive _______.
food
mildly obese
eaters
2 million American adults or 0.67% of the population are compulsive __________, an additional 4 to 8 million people are considered problem ________.
gambling
gamblers
At least 1 in 20 Americans is a compulsive ________. This condition affects both genders equally.
shopper
About 16 million Americans suffer from compulsive _______ _______. This is the least understood of all addictions. One third are women and about 60% of all were abused in childhood.
sexual behavior
Like compulsive ________, _______ addiction is thought to be an impulse control disorder that can disrupt social relationships. There’s a disagreement as to whether should be formally considered disorder. Though substance abusers strive for abstinence it’s goal is to attain moderation.
gambling
internet
Define binge
Episodic overuse
Define substance abuse criteria which involves one or more of the following in a 12 month period.
Functional role impairment
Participation in hazardous situations while impaired
Recurrent legal or interpersonal problems
Continued use despite the above
Substance dependence = __________.
Significant impairment or distress with ___ or more of the criteria within ____ months.
Addiction
3, 12
Criteria for substance dependence includes
- presence of _______.
- presence of _______ if removed
- takes _______ or for ______ than intended
- inability to ______ ______.
- increased ______ ______ getting, taking, recovering from.
- ______ or ______ of social, job, recreational activities.
- ______ _____ despite knowledge of physical or other problems caused by substance.
tolerance withdrawal more, longer cut down time spent reduction, absence continued use
Define intoxication
Substance specific symptoms due to recent ingestion, behaviors, and/or psychological changes
Define substance withdrawal (aka Detoxification)
Development of an uncomfortable, substance specific syndrome due to cessation or reduction in use of the substance.
Define cross tolerance
Tolerance developed to other drugs in the same class
Define synergistic
Drugs taken together, with more than the expected effects of each drug
Define antagonist
Decreases the effects of each drug
What is a pseudo-addiction
A person who has chronic pain and has developed tolerance. Seeks more med for pain relief, different from med seeking patient
Theories of why some people get addicted
- Socio-cultural theories: risk factors are known to include
- Psychodynamic theories: Freud oral stage includes
- Behavioral/learning theory
- Biologic theories, Genetics
- Social, conditioning, mental illness
- Developmental, personality
- If it feels good, do it… Stops the “pain”, numbs “feelings”
- Study showed some people have lower levels of DA receptors
A normal person converts alcohol to ____ + _____ while an alcoholic converts alcohol to ___________ which is “morphine-like”
CO2, H2O
Tetrahydroisoquinoline (THIQ) alkaloid
What are the screening methods for possible substance use
Blood Breath Urine Hair Saliva
How would you interview a patient for possible substance use
Do not say do you use, ask how much do you use, ALWAYS ask, Denial is prominent and pt may not disclose
Identify the CAGE questionnaire criteria
2 yes = possible, 3 yes = probable, 4 yes = definitive
Have you ever thought you should CUT down on your drinking?
Do you get ANNOYED or ANGRY when people say you should cut back on your drinking?
Have you ever felt GUILTY about drinking?
Have you ever had an EYE-OPENER in the morning to get rid of a hangover or to study your nerves?
The body to metabolize one drink in approximately one hour. One drink equals
1 ounce liquor, 5 ounces wine, 12 ounces beer
Alcohol
- Risk groups
- Men versus women
- Legal intoxication
- Commercial license legal intoxification
- teens and people > 65
- Women = Men
- 0.08%
- 0.04%
Pharmacokinetics of alcohol
- Absorption
- Distribution
- Elimination
- Metabolism
- Mostly in small intestine
- Hydrophylic > BRAIN first
- Lungs/Skin/Kidneys
- Approximately 10 ML every 20 minutes in a normal liver, males faster, time is the only way to metabolize
In the physiologic effect of each blood alcohol level
- 05
- 10-0.15
- 15-0.20
- 25
- 30
- 35
- 40
- 40-0.50
- 05 Euphoria, decreased inhibitions
- 10-0.15 Labile mood, talkative, impaired judgement
- 15-0.20 Decreased motor skills, slurred speech, double vision
- 25 Altered perceptions
- 30 Altered equilibrium
- 35 Apathy, inertia
- 40 Stupor, Coma
- 40-0.50 Severe respiratory depression, death
When do you early withdrawal symptoms for alcohol occur and what do they include
Around hours to three days after last drink
Increase all vital signs, anxious, tremulous, nausea, vomiting, diarrhea, diaphoresis, illusions
When do you later life-threatening withdrawal symptoms for alcohol occur and what are they
Up to five days after last drink
Delirium tremens or DTs which are characterized by global confusion, coarse tremors even seizures, psychosis, great fear, sympathetic crisis in all vital signs
With chronic alcohol use what can happen to these systems
- CNS
- PNS
- Liver
- GI
- Hematapoetic
- Other
- CNS - Wernicke-Korsakoff syndrome - (neurological disorder, encephalopathy) characterized by amnesia, memory loss, confabulation, nystagmus, due to B1 and B9 deficiency
- PNS - Peripheral neuritis, ATAXIA
- Liver - Cirrhosis
- GI - gastritis, ulcers, bleeds, impaired absorption, pancreatitis
- Hematapoetic - anemias, low platelets
- Other - Myopathy, cardiac, vision, gonads, decreased immune function, increases lipids
Treatment for ETOH withdrawal includes (meds)
Benzodiazepine - Librium/Ativan Thiamine Folic Acid K+ and Mg+ Anti-convulsant - Dilantin
What is the rationale for using benzodiazepine?
Replacing ETOH w another CNS depressant (cross-tolerant drug) to prevent major withdrawal Sx. Titrate down, ATC and PRN best for Sx of AWS. Often have protocols for how to measure and treat AWS Sx.
After detoxification what medication can be used for treatment of alcoholism
Antabuse (disulfirim) - Makes etOH painful, and it’s the breakdown of alcohol the toxic stage, vasodilation, severe hypotension, nausea vomiting, circulatory collapse. Need to take every day, need informed consent and lots of teaching.
Topamax (Topiramate) - An antiepileptic drugs, works on impulsivity areas in the brain, as well as increases GABA
Name some psychostimulants and chemical alterations they induce
Cocaine, methamphetamine, many others
Most increase dopamine and norepinephrine
Clinical manifestations of stimulants during intoxication include
Increased heart rate, pupils, blood pressure, nausea vomiting, wait, psychomotor, confusion
Clinical manifestations of withdrawal symptoms in regards to stimulants include
Dysphoric, fatigue, dreams, sleep/vegetative state, nausea vomiting, appetite, psychomotor, confusion
Major complications that stimulants can cause include
Strokes, myocardial infarction, seizures
Psychostimulants with other junk also known as
Rave drugs, ecstasy
Hyperthermia and dehydration are often big issues, combined with animal tranquilizers like ketamine
What is DMX and what are its effects and possible side effects
Dextromethorphan (aka Dex, Robotripping, Skittles, etc) ask as a hallucinogen with stimulant effects. Side effects include hallucinations, slurred speech, uncoordinated, drowsiness, and/V, increased vital signs, agitation, psychosis, seizures, cardiac irregularities.
Signs of opioid intoxication
Pinpoint pupils, vital signs decreased, drowsy
Signs of opiate withdrawal
Severe flulike symptoms, yawning, G.I. cramps, N/V/D, muscle/joint pains, insomnia, runny nose, diaphoresis, anxiety/panic, pupils dilate, lots of cravings
Common opioid detoxification medications
Methadone, Patrick Sullivan, clonidine, also treat other symptoms as they occur
Buprenorphine (Suboxone, Subutex) partial agonist, helps w Sx of withdrawal and cravings
General nursing interventions during detox for withdrawal include
Quiet know you, decreased stimulation, monitor for drugs being brought in, change in status after visitors
Food and fluids monitoring and supplement, maintain electrolytes
Focus on physical needs initially REST, treat physical symptoms
Communication with chemically dependent patients
Expect denial, projection, rationalization, manipulation
Use supportive confrontation after establishing some relationship, call attention to minimizing, manipulation
Set limits and boundaries with empathy and respect
Be concrete with examples of problems
How to develop personal responsibility
Reinforce delayed gratification and other coping skills
Maintain self-awareness and be nonjudgmental, use empathy
Name the common group therapies
AA, Al-Anon, Ala-Teen, Nar-Anon
Name the philosophies group therapies
90 meetings in 90 days, sponsor, one day at a time, 12-step, relapse prevention, HALTS: don’t get too hungry, angry, lonely, tired, sick
The IMPAIRED nurse
Up to 20% of active nurses, accounts 460 to 70% of license revocations, any of us are adult children of alcoholics which increases risk for substance abuse
Symptoms to look forward alcohol include
Irritable, Moodswings, unpredictable, excuses for being late, unkempt, blackouts, excessive errors, Breath purifiers, symptoms of withdrawal, flushed face
Things to look for in drug addicted nurses
Moodswings, suddenly calm, content, isolated, long sleeves, medication errors, volunteers to care for certain patients, spills drugs, discrepancies, patient reports still in pain
What to do if you expect to abuse
Eventually there carelessness and poor judgment get them caught, do not confront, go to supervisor, continue to collect data, California BRN diversion program can keep license for strict provisions as long as nurse stays in treatment
