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Nursing 2100H > Ch. 31 Addiction and Substance Related Disorders > Flashcards

Ch. 31 Addiction and Substance Related Disorders Flashcards

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1
Q

CAGE Questionnaire

A

Have you ever felt you should Cut down your drinking?

  • Have people Annoyed you by criticizing your drinking?
  • Have you ever felt bad or Guilty about your drinking?
  • Have you ever had a drink first thing in the morning (an “Eye-opener”) to steady your nerves or to get rid of a hangover?

Scoring: Two “yes” answers indicate probably alcohol abuse and warrant further assessment

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2
Q

Risky Substance Use Limits

A

For men up to age 65: more than 4 drinks/day and/or more than 14 drinks/week

For women and men who are over 65: more than 3 drinks in one day and/or more than 7 drinks/week

Prescription misuse and illicit drugs: Any Rx misuse or illicit drugs use at any age by men or women

Any tobacco use

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3
Q

Diagnostic Criteria

A

Substance-related disorders are disorders related to taking a drug of abuse, including alcohol, stimulants, cannabis (marijuana), hallucinogens, inhalants, tobacco, opioids, sedatives-hypnotics and anxiolytics, caffeine, other unknown substances

These disorders are further categorized as:

  • Substance Use Disorder
  • Substance Induced Disorder

There are 10 classes of drugs that are abused

All of the drugs of abuse cause direct activation of the reward centers of the brain

Gambling does also, so it was included in the DSM 5.

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4
Q

Substance Use Disorder has how many criteria? How many categories?

A

11 criteria grouped into 4 categories

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5
Q

Substance Use Disorder: A. Impaired Control

A
  1. Taking in larger amounts than intended.
  2. Unsuccessful attempts to cut down.
  3. Excessive time spent obtaining, using, and recovering the substance.
  4. Craving
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6
Q

Substance Use Disorder: B. Social Impairment

A
  1. Not meeting work, home, or school obligations
  2. Continued use despite persistent problems
  3. Withdrawing from important family, social, occupation, recreational activities to use
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7
Q

Substance Use Disorder: C. Risky Use

A
  1. Recurrent use in physically hazardous situations

9. Continued use despite recurrent physical or psychological problems

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8
Q

Substance Use Disorder: D. Pharmacological

A
  1. Tolerance - needing increasing amounts of a substance to produce desired effect
  2. Withdrawal - the adverse physical and psychological symptoms that occur when a person ceases using a substance
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9
Q

How many categories of Substance-Induced Disorders are there?

A

3

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10
Q

Substance-Induced Disorders: A. Substance Intoxication

A

behavioral/psychological changes due to recent ingestion of the substance

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11
Q

Substance-Induced Disorders: B. Substance Withdrawal

A

behavioral/cognitive/psychological changes due to cessation or reduction in use after heavy prolonged use

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12
Q

Substance-Induced Disorders: C. Substance Induced Mental Disorder

A
  1. Temporary examples - Methamphetamine induced psychotic disorder and Cocaine withdrawal induced depression
  2. Potentially permanent neurocognitive changes from alcohol, inhalants, and sedative-hypnotic anxiolytic drugs
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13
Q

Epidemiology

A

Over 50% of Americans over 12 years old drink alcohol

15 million are dependent on alcohol

16% of the population has alcoholism, 80% or more of the alcohol consumed in the United States is consumed by people w/ alcoholism

Rates of binge drinking and heavy alcohol use are highest among young adults ages 18 to 25 years

14 million Americans (6.3% of the population 12 years and older) are current illicit drug users

Marijuana is the most commonly used illicit drug (used by 76.4%)

New epidemic of heroin abuse (locally as well)

Nonmedical use of oxycodone

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14
Q

Cultural Issues

A

Alcohol is the drug most widely used by African American youth

African American youth use both licit and illicit substances at lower rates than do Caucasians, but experience more associated health and legal problems

Drug use is high among Mexican American and Puerto Rican adolescent boys

Mexican American men and Native Americans report the most frequent, heavy drinking and alcohol-related problems

Cuban Americans report the lowest percentage of problems

Use is lowest among Asian and Pacific Islanders

Men more than women

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15
Q

Etiology: Biologic Components

A

Genetic predisposition

Children of alcoholics (COA) are 3-4 times more likely to have alcohol/drug problems

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16
Q

Etiology: Psychological Components

A

Temperament (impulsivity)

Feelings about self

Mood

Inability to cope w/ feelings

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17
Q

Etiology: Social Components

A

Parental and family relationships

Family history can cause less sensitivity to effects of alcohol (high tolerance)

Environmental factors

Peer pressure

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18
Q

Alcohol

A

Intoxication is determined by blood alcohol level (0.08% in MO)

People who abuse alcohol can exhibit various patterns of use

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19
Q

Medical Complications of Alcohol Dependence: Cardiovascular System

A

Congestive heart failure, cardiomyopathy, and high BP

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20
Q

Medical Complications of Alcohol Dependence: Respiratory System

A

pneumonia and other infections

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21
Q

Medical Complications of Alcohol Dependence: Hematologic System

A

anemia, leukemia, hematoma

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22
Q

Medical Complications of Alcohol Dependence: Nervous System

A

paranoia, anxiety, depression, irritability, dementia, gait disturbances, sleep, and vision problems

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23
Q

Medical Complications of Alcohol Dependence: Nutritional Deficiencies

A

scurvy (vitamin C), Pellagra (vitamin B3, niacin), Cheilosis (B vitamins)

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24
Q

Medical Complications of Alcohol Dependence: Digestive

A

GI bleeding, esophageal varices and pancreatitis

jaundice, ascites, spider angioma, and liver cirrhosis

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25
Q

Medical Complications of Alcohol Dependence: Endocrine and Metabolic

A

gout, diabetes, neuropathies, hyperlipidemia

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26
Q

Medical Complications of Alcohol Dependence: Immune System

A

TB, STIs

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27
Q

Medical Complications of Alcohol Dependence: Integumentary System

A

abscesses

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28
Q

Medical Complications of Alcohol Dependence: Musculoskeletal

A

osteoporosis, myopathy (disease of muscle tissue)

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29
Q

Medical Complications of Alcohol Dependence: Genitourinary

A

incontinence, hypogonads, Hypokalemia (low K+), men and women develop secondary sex characteristics of the opposite sex

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30
Q

Medical Complications of Alcohol Dependence: Reproductive System

A

Fetal Alcohol Syndrome (FAS)

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31
Q

Wernicke’s Syndrome

A

Thiamine deficiency (B1):

  • -Oculomotor dysfunctions (eyes), ataxia (unsteady gait), and confusion
  • -Treat w/ Thiamine

Associated w/ chronic alcohol use/abuse

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32
Q

Korsakoff’s Syndrome

A

If Wernicke’s is not treated then Korsakoff’s psychosis occurs (alcohol amnestic disorder).

Symptoms are retrograde and anterograde amnesia, lack of insight, paucity of speech (won’t say much), confabulation (makes up answers), apathy (lack of interest in much anything).

Treat w/ Thiamine

Associated w/ chronic alcohol use/abuse

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33
Q

Biologic Responses to Alcohol

A

Tolerance (initial rapid metabolism increases)

Alcohol intoxication

Alcohol withdrawal syndrome
changes in vital signs, diaphoresis, and GI and CNS adverse effects

Delirium tremens - short term mental status changes - life threatening

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34
Q

Principles of Alcohol Detoxification (detox)

A

The long-acting benzodiazepines are the drugs of choice because they effectively reduce signs and symptoms of withdrawal, prevent seizures, and have a better margin of safety than other drugs

A symptom-triggering closed regimen is preferred over fixed-schedule closing because it is effective, requires less medication, and appears to prevent seizures as well as fixed schemes

The use of a withdrawal assessment tool is recommended for medication determinations b/c it reduces overmedication caused by patient over-reporting of symptoms or fixed regimes, and under-medication resulting from staff reluctance to treat

35
Q

Pharmacologic Treatment of Alcohol Withdrawal

A

Benzodiazepines - Diazepam (Valium), Chlordiazepoxide (Librium)

  • -Given for elevations in HR, BP, and temperature, and in the presence of tremors
  • -When given early in withdrawal and in sufficient dosages, can prevent delirium tremens

Long-acting CNS depressants
–Produce sedation and reduce anxiety symptoms

Antipsychotic medications

Also give vitamins and folic acid (folate) for vitamin deficiencies, thiamine (vitamin B1), and magnesium sulfate to reduce seizures

36
Q

Alcohol Withdrawal

A

Early Signs:
1-2 hours following cessation of the drug, peak after 24-48 hours, and then rapidly disappear unless the withdrawal progresses to delirium tremens (DT)

Delirium Tremens:
A medical emergency that usually occurs 2 to 5 days following alcohol withdrawal and persists 2 to 3 days

37
Q

Alcohol Withdrawal Symptoms

A
  1. Tremor - mild to severe
  2. Tachycardia (fast HR)
  3. Hypertension (HTN)
  4. Sweating - mild to soaking the bed
  5. Nausea, vomiting
  6. Fever
  7. Agitation
  8. Confusion, out of contact w/ reality
  9. Sleeplessness
  10. Hallucinations (small animals and bugs on bed common)
  11. Convulsions (emergency situation)
38
Q

Pharmacologic Treatment of Alcohol Use Disorder

A

Disulfiram (Antabuse)

  • Use adjunctively for aversion therapy
  • Disulfiram plus even small amounts of alcohol produces adverse effects

Naltrexone (Trexan)
-Can reduce cravings, can help maintain abstinence, and can interfere w/ wanting to drink more if a recovering patient relapses

Multivitamin, thiamine, folic acid (folate)

39
Q

Cocaine

A

CNS stimulant

Produces a sudden burst of mental alertness and energy and feelings of self-confidence, being in control, and sociability

“Cocaine rush” lasts 10-20 minutes

High is followed by an intense let-down effect in which the person feels irritable, depressed, and tired, and craves more of the drug

40
Q

Biologic Responses to Cocaine

A

Increase the release and blockage of the reuptake of neurotransmitter

Increases dopamine: euphoria and psychotic symptoms

Increase norepinephrine: tachycardia, HTN, dilated pupils, and rising body temperature

Increase serotonin: sleep disturbances, anorexia

Long-term use: depletion of dopamine

41
Q

Cocaine Intoxication

A

CNS stimulation followed by depression

Increasing doses: restlessness —> tremors and agitation —> convulsions —> CNS depression

Death: respiratory failure

42
Q

Cocaine Withdrawal

A

Norepinephrine depletion causes person to sleep 12-18 hours

Then, sleep disturbances w/ rebound REM, anergia (lack of physical activity/energy), decreased libido (sex drive), depression, suicidality, anhedonia (lack of enjoyment), poor concentration and cocaine craving may last for weeks

Respiratory depression can cause unconsciousness and intubation so a machine is breathing for the patient

43
Q

Other Stimulants: Amphetamines

A

Block reuptake of norepinephrine and dopamine, not as strong effect on serotonin (as cocaine does)

Effects on PNS

44
Q

Other Stimulants: Methamphetamine

A

Releases excess dopamine, the “rush” damages nerve terminals

Highly addictive - used in a “binge and crash” pattern

MO meth capital of the world - a woman lives an average of 10 years after addiction

5.2% of the population has tried meth

45
Q

Other Stimulants: MDMA (Ecstasy)

A

Causes hallucinations, confusion, depression, sleep problems, drug cravings, severe anxiety, and paranoia

46
Q

Other Stimulants: Nicotine

A

Addiction at least as strong as heroin or cocaine, 70% relapse w/in a year

Stimulates the CNS, PNS, and autonomic nervous systems, causing increased alertness, concentration, attention, and appetite suppression

47
Q

Nicotine Withdrawal

A

Nicotine withdrawal is marked by mood changes (craving, anxiety, irritability, depression) and physiologic changes (difficulty in concentrating, sleep disturbances, headaches, gastric distress, and increased appetite)

48
Q

Nicotine Treatment

A

Treated w/ replacements such as transdermal patches, nicotine gum, nasal spray, and inhalers, Varenicline (Chantix) is medication to help stop but does increase suicidal thoughts

49
Q

Other Stimulants: Caffeine

A

Stimulates cerebral cortex and increase mental acuity

At a dose of 300 mg (a little over 3 cups) caffeine can cause tremors, poor motor performance, and insomnia

Doses exceeding 500 mg increase HR; stimulate respiratory, vasomotor, and vagal centers and cardiac muscles; dilate pulmonary and coronary blood vessels; and constrict blood flow to the cerebral vascular system

50
Q

Caffeine Withdrawal

A

Withdrawal syndrome includes headache, drowsiness, and fatigue, sometimes w/ impaired psychomotor performance, difficulty concentrating, craving, and yawning or nausea

51
Q

Cannabis (Marijuana)

A

Binds w/ an opioid receptor in the brain to block dopamine reuptake

Can be stored for weeks in fat tissue in the brain

Impairs the ability to form memories, recall events, and shift attention from one thing to another

Long-term marijuana use produces anti-motivational syndrome

52
Q

Hallucinogens

A

More than 100 different hallucinogens:

  • Psilocybin (mushroom)
  • D-lysergic acid diethylamide (LSD)
  • Mescaline
  • Numerous amphetamine derivatives

Produce euphoria or dysphoria, altered body image, distorted or sharpened visual auditory perception, confusion, incoordination, and impaired judgement and memory

53
Q

Benzodiazepines (substance abuse)

A

Cause CNS depression

Although benzodiazepines increase total sleep time, they decrease duration of REM sleep

Withdrawal symptoms may begin as long as 8 days after cessation depending on half-life

54
Q

Benzodiazepines (substance abuse): Withdrawal Symptoms

A

Anxiety rebound

Autonomic rebound

Sensory excitement

Motor excitation

Cognitive excitation

55
Q

Dissociative Anesthetics

A

Reduce (or block) signals to the conscious mind from other parts of the brain

Ketamine, PCP (angel dust)

Intoxication can last 4-6 hours

Interventions to reduce stimuli, maintain a safe environment for the patient and others, manage behavior, and observe for medical and psychiatric complications

56
Q

Opiates and Morphine Derivatives

A

Codeine, fentanyl, heroin, morphine, oxycodone, and hydrocodone

Effects are pleasure (or reward) and pain relief

Physical dependence can develop rapidly

Withdrawal syndrome includes rebound hyper-excitability

57
Q

Pharmacologic Treatment of Opiate Use Disorder: Suboxone

A

combination of Buprenorphrine and Naloxone - used for easier, safer opiate withdrawal and long term replacement therapy

58
Q

Pharmacologic Treatment of Opiate Use Disorder: Suboxone: Buprenorphrine

A

semi-synthetic opioid - used to treat opioid addiction. It is a long term replacement therapy w/o so many side-effects

59
Q

Pharmacologic Treatment of Opiate Use Disorder: Suboxone: Naloxone (Narcan)

A

given in emergency treatment of opiate intoxication - IV in 2 minutes reverses respiratory depression, sedation, and HTN

60
Q

Pharmacologic Treatment of Opiate Use Disorder: Methadone

A

daily use, a substitute w/ less side effects

61
Q

Pharmacologic Treatment of Opiate Use Disorder: Naltrexone (Revia-daily, Vivitrol-monthly injection)

A

blocks the euphoric effects of opioids, has little effect on opioid cravings (unlike alcohol)

62
Q

Inhalants

A

CNS depression

Common household products - glue, aerosols, paint, dust-off

Cause euphoria, sedation, emotional lability, and impaired judgement

Intoxication can result in respiratory depression, stupor, and coma

Risk for sudden sniffing death

Chronic neurologic syndromes can result from long-term use

63
Q

Steroids

A

Increase irritability and aggression

Behavioral effects include euphoria, increased energy, sexual arousal, mood swings, distractibility, forgetfulness, and confusion

Increased risk for heart attacks and strokes, blood clotting, cholesterol changes, HTN, depressed mood, fatigue, restlessness, loss of appetite, insomnia, reduced libido, muscle and joint pain, and severe liver problems

Reduced sperm production, shrinking of testes, and difficulty or pain in urinating

Breast enlargement in men and masculinization in women

64
Q

Nursing Assessment

A

Denial of a problem

Motivation for change

Countertransference

Codependence

65
Q

Nursing Diagnosis

A

Ineffective denial

Others based on type of substance

66
Q

Goal Setting: Long Term goals

A

Total abstinence/reduced relapse, improved functioning

67
Q

Goal Setting: Short Term goals

A

Attend AA 90 meetings in 90 days

Talk w/ sponsor daily

Written contract - patient to sign

ODAAT - one day at a time, stay away from substances

68
Q

Nursing Interventions and Treatment Modalities

A

Pharmacologic modalities

12-step-program-focused groups

Cognitive or psycho-educational groups

Behavioral therapy

Group psychotherapy

Individual and family therapy

Discharge planning

Relapse therapy

69
Q

12 Step Self Help Groups

A

AA (alcoholics anonymous)
–Dr. Bob Smith and Bill Wilson are AA founders

NA (narcotics anonymous)

Al-Anon/Ala-Teen- groups for families who have an addicted member

Overeaters anonymous

Gamblers anonymous

70
Q

Therapeutic Interactions

A
  • Encourage honest expression of feelings
  • Listen to what the individual is really saying
  • Express caring for the individual
  • Hold the individual responsible for behavior
  • Provide consequences for negative behavior that are fair and consistent
  • Talk about specific actions that are objectionable
  • Do not compromise your own values or nursing practice
  • Communicate the treatment plan to the patient and to others on the treatment team
  • Monitor your own reactions to the patient
71
Q

Nursing Interventions and Treatment Modalities: Brief Interventions

A

Advising how to reduce client’s drug use

Providing self-help manuals that are relevant to the client

Giving the client information about:

  • The consequences of drug conviction on travel and employment
  • The consequences of further or heavier drug charges

Offering and arranging a follow-up visit

72
Q

Nursing Interventions and Treatment Modalities: Brief Interventions - Discussing harm reduction strategies, especially those relating to:

A

Overdose

Violence

Driving under the influence

Safe practices (e.g. safe injecting, safe sex)

73
Q

Nursing Interventions and Treatment Modalities: Brief Interventions - Relapse Prevention could mean things like?

A
  • Avoiding people who encourage use of substances
  • Avoiding bars or substance abuse hangouts
  • ->Driving a different way home if needed
  • Finding recreation that they enjoy
  • Joining groups that do not use
  • Making new friends
  • Repairing relationships
  • New employment, job training
  • Moving out the apartment shared w/ other addicts
74
Q

Nursing Interventions and Treatment Modalities: Brief Interventions - Therapies

A

Cognitive and cognitive behavioral interventions and psycho-education

Enhancing coping therapies

Group therapy

Individual therapy

Family therapy

12-step programs

Multifamily groups

75
Q

Decisional Balance Worksheet: Old Behavior

A

Pros/Benefits:

  1. Like taste of alcohol
  2. Helps me to relax

Cons/Costs:

  1. Costs a lot of money
  2. Led to DWI - costly, embarrassing, and inconvenient
76
Q

Decisional Balance Worksheet: New Behavior

A

Pros/Benefits:

  1. Better relationship w/ spouse
  2. No more DWIs

Cons/Costs:

  1. Will miss my drinking friends
  2. Don’t know how to have fun w/o it
77
Q

Substance Use Disorder and Professional Nurses

A

Estimated prevalence of chemical dependency for nursing professionals of approximately 10-15%

Nursing licenses can be suspended as a result of addictions

Some states have mandatory reporting laws

Any nurse who knows of any health care provider’s incompetent, unethical, or illegal practice must report that information through proper channels

Peer assistance programs

Impaired nurses may wear long sleeves to hide tracks (from drug use)

78
Q

Signs of Substance Use Disorder in Nurses (Be able to know some of them, this is a long list)

A
  1. Mood swings
  2. Inappropriate behavior at work
  3. Frequent days off
  4. Noncompliance w/ acceptable policies and procedures
  5. Deteriorating appearance
  6. Deteriorating job performance
  7. Sloppy, illegible charting
  8. Errors in charting
  9. Alcohol on breath
  10. Forgetfulness
  11. Poor judgment and concentration
  12. Lying
  13. Volunteering to be the med nurse
  14. High achievement, both as a student and a nurse
  15. Volunteering for overtime and extra duties
  16. No drug use until prescribed following surgery or a chronic illness
  17. Family history of alcoholism or addiction
79
Q

Cocaine affects what 2 organs?

A

Brain

Heart

80
Q

What is Eosinophilia?

A

Increased WBCs

Indicates possible infection or inflammation

Occurs w/ chronic cocaine use

81
Q

List some long term effects of Cannabis.

A
  1. several types of cancer
  2. birth defects if used during pregnancy
  3. circulatory system problems
  4. lack of motivation
  5. short term memory loss
  6. panic attacks
  7. exacerbations of schizophrenia and psychosis
82
Q

List side effects of Oxycodone.

A

CNS:

  • hallucination
  • fainting
  • dizziness
  • confusion

Skin:

  • hives
  • rash

Respiratory:

  • difficulty breathing
  • slowed breathing

Face/Eyes:
-swelling

Throat:

  • hoarseness
  • swelling
  • difficulty swallowing

Heart:
-fast/slow heartbeat

Muscular:
-seizures

83
Q

What are the long term effects of heroin?

A
  • neurochemical/molecular changes in the brain

- profound degrees of tolerance/physical dependence –> abuse

84
Q

What are the side effects of codeine?

A

Very constipating - given for pain relief after surgery frequently. Constipation can be very painful for patient if that happens, and it’s preventable.

Nursing 2100H (28 decks)

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