Chapter 17 Substance Abuse Flashcards
Physical Dependence
A condition characterized by physiologic reliance on a substance, usually indicated by tolerance to the effects of the substance and development of withdrawal symptoms when use of the substance is terminated
Psychologic Dependence
A condition characterized by strong desires to obtain and use a substance
Habituation
Development of tolerance to a substance following prolonged medical use but without psychologic or physical dependence(addiction)
Addicition
Psychologic or physical dependence on a drug or psychoactive substance
Opioids
examples
- heroin
- codeine
- hydrocodone
- hydromorphone
- meperidine
- morphine
- oxycodone
Stimulants
examples
- racemic amphetamine
- dextroamphetamine
- methamphetamine
- cocaine, methylphenidate, dextroamphetamine, phenmetrazine, and methamphetamine
Depressants
- Benzodiazepines
- Barbiturates
- Marijuana
Opioids
-Also known as narcotics
-Intended drug effects: relieve pain, reduce cough, relieve diarrhea, and induce anesthesia
-Abuse and psychological dependency: opioids promote relaxation and euphoria
-Affect areas outside the central nervous system (CNS)
Skin, gastrointestinal tract, genitourinary tract
Methadone
- Used to treat opioid dependence
- Goal: reduce the patient’s dosage gradually so that eventually the patient can live permanently drug free
- Relapse rates are often high; the drug can be abused.
Opioids: Adverse Effects
Central Nervous System
- Diuresis
- Miosis
- Convulsions
- Nausea, vomiting
- Respiratory depression
Opioids: Adverse Effects
Non–central nervous system
- Hypotension
- Constipation
- Urinary retention
- Flushing of the face, neck, and upper thorax
- Sweating, urticaria, and pruritus
Opioid Drug Withdrawal
Peak Period
1 to 3 days
Opioid Drug Withdrawal
Duration
5 to 7 days
Opioid Drug Withdrawal Signs
Drug seeking, mydriasis, diaphoresis, rhinorrhea, lacrimation, diarrhea, elevated blood pressure (BP) and pulse
Opioid Drug Withdrawal Symptoms
Intense desire for drug, muscle cramps, arthralgia, anxiety, nausea, vomiting, malaise
Opioid Drug Withdrawal: Treatment
- Block opioid receptors so that use of opioid drugs does not produce euphoria
- Naltrexone—an opioid antagonist
- Vivitrol—injectable form of naltrexone
- Naloxone combined with buprenorphine (Subutrex) or used alone (Suboxone)
Stimulants
- Elevation of mood
- Reduction of fatigue
- Increased alertness
- Invigorated aggressiveness
Stimulants: Adverse Effects Gastrointestinal
Gastrointestinal Dry mouth Metallic taste Anorexia Nausea Vomiting Diarrhea Abdominal cramps
Stimulant Overdose
-Death results from:
Convulsions
Coma
Cerebral hemorrhage
-May occur during periods of intoxication or withdrawalStimulant Withdrawal Peak Period
1 to 3 days
Stimulant Withdrawal Duration
5 to 7 days
Stimulant Withdrawal Signs
Social withdrawal, psychomotor retardation, hypersomnia, hyperphagia
Stimulant Withdrawal Symptoms
Depression, suicidal thoughts and behavior, paranoid delusions
Depressants
-Drugs that relieve anxiety, irritability, and tension when used as intended
-Also used to treat seizure disorders and induce anesthesia
-Two main pharmacologic classes
Benzodiazepines
Barbiturates
-Marijuana (“pot,” “grass,” “weed”)
-Flunitrazepam (“roofies”)
Benzodiazepines and barbiturates
increase the action of GABA an amino acid in the brain, which inhibits nerve transmission in the CNS
Benzodiazepines
reduce anxiety, induce sleep, to sedate, and prevent seizures
Barbiturates
sedatives and anticonvulsants and to induce anesthesia
Depressants: Adverse Effects
-CNS: Drowsiness, sedation, loss of coordination,
dizziness, blurred vision, headaches, and
paradoxical reactions
-Gastrointestinal: Nausea, vomiting, constipation, dry mouth, and abdominal cramping
-Pruritus and skin rash
-Marijuana: “amotivational” syndrome
Depressants Withdrawal Peak Period
- 2 to 4 days for short-acting drugs
- 4 to 7 days for long-acting drugs
Depressants Withdrawal Duration
- 4 to 7 days for short-acting drugs
- 7 to 12 days for long-acting drug
Depressants Withdrawal signs
Increased psychomotor activity; agitation; hyperthermia; diaphoresis; delirium; convulsions; elevated BP, pulse rate, and temperature; others
Depressants Withdrawal Symptoms
Anxiety, depression, euphoria, incoherent thoughts, hostility, grandiosity, disorientation, hallucinations, suicidal thoughts
Depressant Withdrawal treatment
involves tapering of the drug over a course of a 7 to 10 or 10 to 14 days
Alcohol (Ethanol)
- More accurately known as ethanol (ETOH)
- Causes CNS depression by dissolving in lipid membranes in the CNS
- Few legitimate uses of ethanol and alcoholic beverages
- Used as a solvent for many drugs
- Systemic uses of ethanol: treatment of methyl alcohol and ethylene glycol intoxication (e.g., from drinking automotive antifreeze solution).
Ethanol: Drug Effects
- CNS depression
- Respiratory stimulation or depression
- Vasodilation, producing warm, flushed skin
- Increased sweating
- Diuretic effects
Effects of Chronic Ethanol Ingestion
-Nutritional and vitamin deficiencies (especially B vitamins):Wernicke’s encephalopathy
Korsakoff’s psychosis
Polyneuritis
Nicotinic acid deficiency encephalopathy
-Seizures
-Alcoholic hepatitis, progressing to cirrhosis
-Cardiomyopathy
-Fetal alcohol syndrome (FAS)
Ethanol Withdrawal Signs and Symptoms
- Elevated blood pressure, pulse rate, and temperature
- Insomnia
- Tremors
- Agitation
Ethanol Withdrawal Treatment
-Benzodiazepines are the treatment of choice
-Diazepam (Valium), lorazepam (Ativan), or
chlordiazepoxide (Korsakoff’s psychosis)
-Dosage and frequency depend on severity
-For severe withdrawal, monitoring in an intensive care unit is recommended
Treatment for Alcoholism
-disulfiram (Antabuse)
Acetaldehyde syndrome
-naltrexone
-acamprosate (Campral)
Newest treatment
-Counseling
Individual
Alcoholics AnonymousNicotine: Drug Effects
- Transient stimulation of autonomic ganglia
- Followed by more persistent depression of all autonomic ganglia
- CNS and respiratory stimulation followed by CNS depression
- Increased heart rate and BP
- Increased bowel activity
Nicotine Withdrawal
-Manifested by cigarette craving
Irritability, restlessness, decreased heart rate and BP
-Cardiac symptoms resolve in 3 to 4 weeks, but cigarette craving may persist for months or years
Nicotine Withdrawal Treatment
-Treatments provide nicotine without the carcinogens in tobacco
Nicotine transdermal system (patch)
Nicotine polacrilex (gum)
Inhalers
Nasal spray
-bupropion (Zyban): may be prescribed to aid in smoking cessation
-varenicline (Chantix): Stimulates nicotine receptors
