Ch 14: Drug Abuse Flashcards
Need for increasing amounts to produce the desired effects
physical dependence
Overwhelming desire to repeat the use of a particular drug to produce pleasure or avoid discomfort
psychological dependence
describe substance abuse disorder
Use of the substance interferes with ability to fulfill role obligations
Attempts to cut down or control use fail
Intense craving for the substance
Excessive amount of time spent trying to procure the substance or recover from its use
Development of a reversible syndrome of symptoms following excessive use of a substance
Direct effect on the central nervous system
Disruption in physical and psychological functioning
Judgment is disturbed and social and occupational functioning is impaired.
substance intoxication
Development of symptoms that occurs upon abrupt reduction or discontinuation of a substance that has been used
Symptoms are specific to the substance that has been used.
Disruption in physical and psychological functioning
substance withdrawal
Classes of Psychoactive Substances
Alcohol, Caffeine, Cannabis, Hallucinogens, Inhalants, Opioids, Sedatives/hypnotics, Stimulants, Tobacco
biochemical factor of alcohol addiction
Alcohol may produce morphine-like substances in the brain that are responsible for alcohol addiction.
is alcoholism genetic
yes
psychological factors for addiction/alcoholism
Punitive superego
Fixation in the oral stage of psychosexual development
sociocultural factors of addiction
social learning, conditioning, cultural influences
phase one of alcohol use disorder
Prealcoholic phase: Characterized by use of alcohol to relieve everyday stress and tensions of life
phase two of alcohol use disorder
Early alcoholic phase: Begins with blackouts—brief periods of amnesia that occur during or immediately following a period of drinking; alcohol is now required by the person.
phase three of alcohol use disorder
The crucial phase: Person has lost control; physiological dependence is clearly evident.
phase four of alcohol use disorder
The chronic phase: Characterized by emotional and physical disintegration. The person is usually intoxicated more often than sober
Peripheral neuropathy, characterized by
Peripheral nerve damage Pain Burning Tingling Prickly sensations of the extremities
Thought to result from same B vitamin deficiency that contributes to peripheral neuropathy
alcoholic myopathy
Sudden onset of muscle pain, swelling, and weakness; reddish tinge to the urine; rapid rise in muscle enzymes in the blood
acute myopathy
Gradual wasting and weakness in skeletal muscles
chronic myopathy
Most serious form of thiamine deficiency in alcoholic patients
Wernicke’s encephalopathy
Syndrome of confusion, loss of recent memory, and confabulation in alcoholic patients
Korsakoff’s psychosis
Effect of alcohol on the heart is an accumulation of lipids in the myocardial cells, resulting in enlargement and a weakened condition.
alcoholic cardiomyopathy
Inflammation and pain in the esophagus
esophagitis
Effects of alcohol on the stomach include inflammation of the stomach lining characterized by epigastric distress, nausea, vomiting, and distention
gastritis
Usually occurs 1 or 2 days after a binge of excessive alcohol consumption. Symptoms include constant, severe epigastric pain; nausea and vomiting; and abdominal distention.
acute pancreatitis
Leads to pancreatic insufficiency resulting in steatorrhea, malnutrition, weight loss, and diabetes mellitus
chronic pancreatitis
Caused by long-term heavy alcohol use
Symptoms: Enlarged, tender liver; nausea and vomiting; lethargy; anorexia; elevated white blood cell count; fever; and jaundice. Also ascites and weight loss in severe cases
alcoholic hepatitis
end-stage of alcoholic liver disease and is believed to be caused by chronic heavy alcohol use. There is widespread destruction of liver cells, which are replaced by fibrous (scar) tissue
Cirrhosis of the liver
Complications of cirrhosis of the liver can include
Portal hypertension
Ascites
Esophageal varices
Hepatic encephalopathy
Impaired production, function, and movement of white blood cells
leukopenia
Platelet production and survival are impaired as a result of the toxic effects of alcohol
thrombocytopenia
Alcohol use during pregnancy can result in
fetal alcohol spectrum disorders (FASDs)
what can fetal alcohol syndrome cause
Problems with learning, memory, attention span, communication, vision, and hearing
Alcohol-related neurodevelopmental disorder
Alcohol-related birth defects
Alcohol intoxication
Occurs at blood alcohol levels between 100 and 200 mg/dL
when does alcoholic withdrawal occur
Occurs within 4 to 12 hours of cessation of or reduction in heavy and prolonged alcohol use
what substances are used in Sedative/hypnotic use disorder
Barbiturates
Nonbarbiturate hypnotics
Antianxiety agents
Club drugs
effects of sedative/hypnotic use disorder
Effects on sleep and dreaming Respiratory depression Cardiovascular effects Renal function Hepatic effects Body temperature Sexual functioning
With these central nervous system (CNS) depressants, effects can range from disinhibition and aggressiveness to coma and death (with increasing dosages of the drug).
intoxication
Severe withdrawal from CNS depressants…
can be life threatening
substances used in stimulant use disorder
Amphetamines Synthetic stimulants Non-amphetamine stimulants Cocaine Caffeine Nicotine
stimulant use disorder effects
CNS, cardiovascular, pulmonary, renal/GI, sexual
Amphetamine and cocaine intoxication produce
euphoria, impaired judgment, confusion, and changes in vital signs (even coma or death, depending on amount consumed).
Caffeine intoxication usually occurs following
consumption in excess of 250 mg (causes restlessness and insomnia)
Amphetamine and cocaine withdrawal may result in
dysphoria, fatigue, sleep disturbances, and increased appetite.
Withdrawal from caffeine may include
headache, fatigue, drowsiness, irritability, muscle pain and stiffness, and nausea and vomiting
Withdrawal from nicotine may include
dysphoria, anxiety, difficulty concentrating, irritability, restlessness, and increased appetite
symptoms of inhalant disorder
Dizziness, ataxia, muscle weakness
Euphoria, excitation, disinhibition, slurred speech
Nystagmus, blurred or double vision
Psychomotor retardation, hypoactive reflexes
Stupor or coma
when does intoxication of inhalants occur
shortly after use of or exposure to inhalant
Severe opioid intoxication can lead to
respiratory depression, coma, and death
withdrawal From short-acting drugs (e.g., heroin)
Symptoms occur within 6 to 8 hours, peak within 1 to 3 days, and gradually subside in 5 to 10 days
withdrawal From long-acting drugs (e.g., methadone)
Symptoms occur within 1 to 3 days, peak between days 4 and 6, and subside in 14 to 21 days.
withdrawal From ultra-short-acting meperidine
Symptoms begin quickly, peak in 8 to 12 hours, and subside in 4 to 5 days
symptoms of opiod withdrawal
Dysphoria, muscle aches, nausea/vomiting, lacrimation or rhinorrhea, pupillary dilation, piloerection, sweating, abdominal cramping, diarrhea, yawning, fever, and insomnia
physiological effects of hallucinogens
NV, pupil dilation, increased BP and pulse, loss of appetite, insomnia, increased blood sugar, decreased respirations
Symptoms of phencyclidine intoxication
belligerence and assaultiveness, and may proceed to seizures or coma.
how long does impairment of motor skills following cannabis last
8-12 hrs
symptoms of cannabis intoxication
conjunctival injection, increased appetite, dry mouth, tachycardia
what is the legally intoxicated level
0.08 % BAL
when does alcohol withdrawal occur
4-12 hours after cessation
this is an excellent tool that is used by many hospitals to assess risk and severity of withdrawal from alcohol
used for initial assessment as well as ongoing monitoring of alcohol withdrawal symptoms
Clinical Institute Withdrawal Assessment of Alcohol Scale (CIWA)
these are another screening tool to determine if an individual has problem with substances
some psychiatric units administer this to all clients to determine if there is a dual diagnosis
CAGE Questionnaire and Michigan Alcoholism Screening Test (MAST)
what are the four main parts of the CAGE
Cut down?
Annoyed you?
Guilty?
Eye opener?
Clients with a coexisting substance disorder and mental disorder may be assigned to a special program that targets the dual diagnosis.
Program combines special therapies that target both problems.
dual diagnosis
It is estimated that 10 to 15 percent of nurses suffer from
disease of chemical dependency
_______ is the most widely abused drug, followed closely by ________
alcohol; narcotics
state board response to chemically impaired nurse
May deny, suspend, or revoke a license based on a report of chemical abuse by a nurse
allow impaired nurses to avoid disciplinary action by agreeing to seek treatment.
diversionary laws
Defined by dysfunctional behaviors that are evident among members of the family of a chemically dependent person, or among family members who harbor secrets of physical or emotional abuse, other cruelties, or pathological conditions
codependency
Keeps feelings in control, and often releases anxiety in the form of stress-related illnesses, or compulsive behaviors such as eating, spending, working, or use of substances
codependency
classic characteristics of codependent nurse
Caretaking
Perfectionism
Denial
Poor communication
recovery process of codependence
Survival stage
Re-identification stage
Core issues stage
Reintegration stage
A major self-help organization for the treatment of alcoholism
alcoholics anyonymous
what is AA based on
Peer support
Acceptance
Understanding from others who have experienced the same problem
pharmacology for alcoholism
Disulfiram (Antabuse) * Acamprosate (Campral) * Naltrexone (ReVia) Nalmefene (Revex) Selective serotonin reuptake inhibitors (SSRIs)
what is used in substitution therapy
activan and valium
psychopharmacology for alcohol
Benzodiazepines
Anticonvulsants
Multivitamin therapy
Thiamine
pharmacology for opiods
Narcan and Clonidine and Methadone
psychopharmacolgy for stimulants
Minor tranquilizers
Major tranquilizers
Anticonvulsants
Antidepressants
