Chapter 17 Substance Abuse

Question 1

Physical Dependence

Answer 1

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

Question 2

Psychologic Dependence

Answer 2

A condition characterized by strong desires to obtain and use a substance

Question 3

Habituation

Answer 3

Development of tolerance to a substance following prolonged medical use but without psychologic or physical dependence(addiction)

Question 4

Addicition

Answer 4

Psychologic or physical dependence on a drug or psychoactive substance

Question 5

Opioids

examples

Answer 5

• heroin
• codeine
• hydrocodone
• hydromorphone
• meperidine
• morphine
• oxycodone

Question 6

Stimulants

examples

Answer 6

• racemic amphetamine
• dextroamphetamine
• methamphetamine
• cocaine, methylphenidate, dextroamphetamine, phenmetrazine, and methamphetamine

Question 7

Depressants

Answer 7

• Benzodiazepines
• Barbiturates
• Marijuana

Question 8

Opioids

Answer 8

-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

Question 9

Methadone

Answer 9

• 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.

Question 10

Opioids: Adverse Effects

Central Nervous System

Answer 10

• Diuresis
• Miosis
• Convulsions
• Nausea, vomiting
• Respiratory depression

Question 11

Opioids: Adverse Effects

Non–central nervous system

Answer 11

• Hypotension
• Constipation
• Urinary retention
• Flushing of the face, neck, and upper thorax
• Sweating, urticaria, and pruritus

Question 12

Opioid Drug Withdrawal

Peak Period

Answer 12

1 to 3 days

Question 13

Opioid Drug Withdrawal

Duration

Answer 13

5 to 7 days

Question 14

Opioid Drug Withdrawal Signs

Answer 14

Drug seeking, mydriasis, diaphoresis, rhinorrhea, lacrimation, diarrhea, elevated blood pressure (BP) and pulse

Question 15

Opioid Drug Withdrawal Symptoms

Answer 15

Intense desire for drug, muscle cramps, arthralgia, anxiety, nausea, vomiting, malaise

Question 16

Opioid Drug Withdrawal: Treatment

Answer 16

• 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)

Question 17

Stimulants

Answer 17

• Elevation of mood
• Reduction of fatigue
• Increased alertness
• Invigorated aggressiveness

Question 18

Stimulants: Adverse Effects Gastrointestinal

Answer 18

Gastrointestinal
Dry mouth
Metallic taste
Anorexia
Nausea
Vomiting
Diarrhea
Abdominal cramps

Question 19

Stimulant Overdose

Answer 19

-Death results from:
       Convulsions
       Coma
       Cerebral hemorrhage
-May occur during periods of intoxication or withdrawal

Question 20

Stimulant Withdrawal Peak Period

Answer 20

1 to 3 days

Question 21

Stimulant Withdrawal Duration

Answer 21

5 to 7 days

Question 22

Stimulant Withdrawal Signs

Answer 22

Social withdrawal, psychomotor retardation, hypersomnia, hyperphagia

Question 23

Stimulant Withdrawal Symptoms

Answer 23

Depression, suicidal thoughts and behavior, paranoid delusions

Question 24

Depressants

Answer 24

-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”)

Question 25

Benzodiazepines and barbiturates

Answer 25

increase the action of GABA an amino acid in the brain, which inhibits nerve transmission in the CNS

Question 26

Benzodiazepines

Answer 26

reduce anxiety, induce sleep, to sedate, and prevent seizures

Question 27

Barbiturates

Answer 27

sedatives and anticonvulsants and to induce anesthesia

Question 28

Depressants: Adverse Effects

Answer 28

-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

Question 29

Depressants Withdrawal Peak Period

Answer 29

• 2 to 4 days for short-acting drugs

- 4 to 7 days for long-acting drugs

Question 30

Depressants Withdrawal Duration

Answer 30

• 4 to 7 days for short-acting drugs

- 7 to 12 days for long-acting drug

Question 31

Depressants Withdrawal signs

Answer 31

Increased psychomotor activity; agitation; hyperthermia; diaphoresis; delirium; convulsions; elevated BP, pulse rate, and temperature; others

Question 32

Depressants Withdrawal Symptoms

Answer 32

Anxiety, depression, euphoria, incoherent thoughts, hostility, grandiosity, disorientation, hallucinations, suicidal thoughts

Question 33

Depressant Withdrawal treatment

Answer 33

involves tapering of the drug over a course of a 7 to 10 or 10 to 14 days

Question 34

Alcohol (Ethanol)

Answer 34

• 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).

Question 35

Ethanol: Drug Effects

Answer 35

• CNS depression
• Respiratory stimulation or depression
• Vasodilation, producing warm, flushed skin
• Increased sweating
• Diuretic effects

Question 36

Effects of Chronic Ethanol Ingestion

Answer 36

-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)

Question 37

Ethanol Withdrawal Signs and Symptoms

Answer 37

• Elevated blood pressure, pulse rate, and temperature
• Insomnia
• Tremors
• Agitation

Question 38

Ethanol Withdrawal Treatment

Answer 38

-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

Question 39

Treatment for Alcoholism

Answer 39

-disulfiram (Antabuse)
      Acetaldehyde syndrome
-naltrexone
-acamprosate (Campral)
      Newest treatment 
-Counseling
      Individual
      Alcoholics Anonymous

Question 40

Nicotine: Drug Effects

Answer 40

• 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

Question 41

Nicotine Withdrawal

Answer 41

-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

Question 42

Nicotine Withdrawal Treatment

Answer 42

-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