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NURS3314 Mental Health Nursing > Chapter 19 Addiction > Flashcards

Chapter 19 Addiction Flashcards

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1
Q

Substance Abuse

A

Use of alcohol or drugs for intoxication or beyond intended use

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2
Q

Substance Tolerance

A

Decrease in the action of a drug at a given dose or concentration

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3
Q

What problems fall under substance abuse versus substance dependencs?

A

Substance Abuse: Denotes problems in social, vocational, or legal areas of the person’s life

Substance Tolerance: Also includes problems associated with addiction such as tolerance, withdrawal, and unsuccessful attempts to stop using the substance

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4
Q

Dependence

A

Psychological or physiological dependence on a drug

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5
Q

Substance Use Disorder

A

Continued use or reward-seeking behavior despite significant adverse consequences

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6
Q

Substance Induced Disorder

A

Intoxication
Withdrawal
Substance-induced mental disorder

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7
Q

Polysubstance Abuse

A

Abuse of more than one substance

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8
Q

What is the key symptom of addiction?

A

Inability to control addictive behavior

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9
Q

What drugs fall under the CNS depressants category?

A

Alcohol
Sedatives/hypnotics/anxiolytics
Antidepressants

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10
Q

What drugs fall under the CNS stimulants category?

A

Cocaine
Crack
Amphetamines
Caffeine
Methamphetamine
Nicotine

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11
Q

What drugs fall under the hallucinogens category?

A

LSD
Peyote
Psilocybin
Ecstasy: MDMA (3,4-Methylenedioxymethamphetamine)

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12
Q

What drugs fall under the dissociative anesthetics category?

A

PCP (Phencyclidine)
Ketamine (Usually used for pain in clinical practice)

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13
Q

What drugs fall under the narcotic analgesics (AKA opiods)?

A

Opium
Codeine
Heroin
Demerol (Meperidine)
Darvon (Dextropropxyphene)
Morphine
Methadone
Vicodin (Acetaminophen, Hydrocodone)
Oxycodone

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14
Q

What drugs fall under the inhalants category?

A

Wide variety of breathable substances that produce mind-altering effects

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15
Q

What drugs fall under the cannabis category?

A

Cannabis
Cannabinoids

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16
Q

Biologic Risk Factors for Substance Misuse

A

Genetics: Children of alcoholic parents are at higher risk for developing alcoholism and drug dependence than are children of nonalcoholic parents
- Increased risk is partly the result of environmental factors, but evidence points to the importance of genetic factors as well
- Adoption studies have shown higher rates of alcoholism in sons of biologic fathers with alcoholism than in those of nonalcoholic biologic fathers
->These studies led theorists to describe the genetic component of alcoholism as a genetic vulnerability that is then influenced by various social and environmental factors

Brain’s Reward Center Theory: Addictive substances or behaviors affect the brain’s reward system by flooding the nucleus accumbens with dopamine

  • Repeated exposure causes nerve cells in the nucleus accumbens and prefrontal cortex to couple liking something with wanting it
  • This motivates someone to seek the pleasure source
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17
Q

Psychosocial Risk Factors for Substance Misuse

A

Chronic stressors
PTSD
Mood disorders
Anxiety disorders
Abuse
Neglect
Poverty
Lack of parental involvement

Experimentation
Poor academic performance
Home environment that promotes substance abuse
Availability of drugs at school
Poor social skills
Use of drugs to self-medicate if mental or physical illness is present

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18
Q

Designer Drugs

A

AKA Club Drugs

Synthetic substances made by altering existing medications or formulating new ones not yet controlled by the FDA
- Amphetamine-like effects, some also have hallucinogenic effects

As attempts to make such drugs illegal are formulated, makers of the drugs alter the substance slightly so it once again falls outside the law.

They may also contain unknown compounds as a filler or additive, and the effects are unknown until the drug is ingested.

Some of these substances are known by generic terms such as bath salts or plant food, although the substances are never used for those purposes.
- Others have specific names, such as ecstasy (methylenedioxymethamphetamine), special K (Ketamine), or smiles (2C-1)

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19
Q

Intoxication

A

Use of a substance that results in maladaptive behavior

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20
Q

Withdrawal Syndrome

A

Refers to the negative psychological and physical reactions that occur when use of a substance ceases or dramatically decreases

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21
Q

What two drugs (categories) can cause death from withdrawal syndrome?

A

Alcohol & Benzodiazepines

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22
Q

Detoxification

A

The process of safely withdrawing from a substance

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23
Q

What are the initial effects of alcohol intoxication?

A

Relaxation & loss of inhibitions

Some people become aggressive or display inappropriate sexual behavior when intoxicated

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24
Q

Signs & Symptoms of Alcohol Intoxication

A

Slurred speech
Memory Impairment
Altered judgement
Decreased motor skills/ unsteady gait
Decreased LOC (stupor, coma)
RESPIRATORY ARREST
Peripheral collapse
Death (w/large doses)
May experience a blackout

25
Q

Early Onset of Alcohol Misuse

A

Prognosis: Unclear, only people with alcohol problems seeking treatment have been studied

In the United States, the average age for an initial alcohol intoxication episode is during adolescent years
- The 1st episode of intoxication between 12–14 years of age
- The 1st evidence of minor alcohol-related problems is seen in the late teens

Episodes of “sipping” alcohol may occur at age 8 years or even earlier

26
Q

“Middle” Clinical Course of Alcohol Use

A

A pattern of more severe difficulties for people with alcoholism begins to emerge in the mid-20s to the mid-30s

These difficulties can be:
- The alcohol-related breakup of a significant relationship
- An arrest for public intoxication or driving while intoxicated
- Evidence of alcohol withdrawal
- Early alcohol-related health problems, or significant interference w/ functioning at work or school

During this time, the person experiences their 1st blackout

As the person continues to drink, they often develop a tolerance for alcohol

After continued heavy drinking, the person experiences a tolerance break

27
Q

Blackout

A

An episode during which the person continues to function but has no conscious awareness of their behavior at the time or any later memory of the behavior

28
Q

Tolerance Break

A

Very small amounts of a substance will produce intoxication

29
Q

Later Course of Alcohol Misuse

A

The later course of alcoholism, when the person’s functioning is definitely affected, is often characterized by periods of abstinence or temporarily controlled drinking

Abstinence may occur after some legal, social, or interpersonal crisis, and the person may then set up rules about drinking, such as drinking only at certain times or drinking only beer

This period of temporarily controlled drinking soon leads to an escalation of alcohol intake, more problems, and a subsequent crisis

The cycle repeats continuously

30
Q

Signs & Symptoms of an Alcohol Overdose

A

Vomiting
Unconsciousness
Respiratory depression
Alcohol-induced hypotension: Can lead to CV shock & death

Combo of symptoms can cause aspiration pneumonia or pulmonary obstruction

31
Q

Treatment of Alcohol Overdose

A

Gastric lavage or dialysis to remove the drug and support of respiratory and cardiovascular functioning in an intensive care unit.

The administration of CNS stimulants is contraindicated

32
Q

What is the relapse range rate?

A

Range from 60% to 80%, with nearly half of individuals relapsing in the year after treatment

A minority of people remain sober after the first treatment experience

The highest rates for successful recovery are for people who:
- Abstain from substances
- Highly motivated to have a substance-free lifestyle
- Who actively work on relapse prevention

33
Q

Spontaneous Remission

A

Natural recovery that occurs without treatment of any kind

34
Q

Wernicke’s Encephalopathy

A

Degenerative brain disorder related to vitamin B1 deficiency

Acute & reversible

35
Q

Signs & Symptoms of Wernicke’s-Korsakoff Syndrome

A

Abnormal eye movement
Confusion
Confabulation
Hallucinations
Double vision
Memory loss
Inability to form new memories
Loss of muscle coordination

36
Q

Treatment for Wernicke’s Syndrome

A

Large doses of thiamine IV 2-3 X daily for 1-2 weeks

May progress into Korsakoff’s syndrome if untreated

37
Q

Korsakoff Syndrome

A

CHRONIC!!!

Memory disorder resulting from vitamin B1 deficiency

Treatment: Thiamine for 3-12 months

Recovery rate is 20%

38
Q

Alcohol Withdrawal

A

Classic Signs: Tremulousness

Mild to Moderate Withdrawal: Agitation, N/V, insomnia, impaired cognition
- Temp, pulse, & BP increase

Severe Withdrawal: MEDICAL EMERGENCY!!!
- Psychosis which can lead to unconsciousness, seizure (grand-mal = deadly), & delirium
- Alcohol w/drawal delirium or DT’s (Delirium Tremens) (Usually see bugs crawling around)

39
Q

If the client’s withdrawal symptoms are mild & they can abstain from alcohol…

A

…they can be treated safely at home (pg. 360)

40
Q

If the client’s withdrawal symptoms are severe or they cannot abstain during detoxification…

A

…short admission of 3-5 days is the more common setting

41
Q

Treatment for Alcohol Withdrawal

A

Treat w/ benzodiazepine PO or IM

42
Q

When does alcohol withdrawal start?

A

Between 3 hrs- 3 days after last drink

43
Q

Why is it important to obtain the client’s VS before each dose of benzodiazepine for alcohol withdrawal?

A

To watch for the response to treatment & signs of impending respiratory distress

Pay close attention to the patient’s respirations!!!

44
Q

Tapering

A

Administering decreasing doses of a medication, leading to discontinuation of the drug

45
Q

Symptom-Triggered Dosing

A

The presence and severity of withdrawal symptoms determine the amount of medication needed & the frequency of admin

46
Q

Alcohol Assessment Tools: CAGE

A

Have you ever…
Attempted to CUT back on your alcohol?
Been ANNOYED by comments made about your drinking?
Feel GUILTY about your drinking?
Had an EYE-OPENER in the morning to calm your nerves?

47
Q

Alcohol Assessment Tools: CIWA-Ar

A

More often used versus CAGE assessment tool

10-item scale to assess and manage alcohol withdrawal
- Sum indicates severity of withdrawal

Mild ≤ 15

Moderate = 16-20

Severe > 20

Score ranges prompt protocol decisions
- e.g., administration of benzodiazepines

48
Q

Which two types of CNS depressants are the most frequently abused?

A

Benzodiazepines & barbiturates

49
Q

Sedatives, Hypnotics, and Anxiolytics Intoxication Signs & Symptoms

A

Slurred speech
Lack of coordination
Unsteady gait
Labile mood
Impaired attention & memory
Stupor & coma
Disorientation
N/V

50
Q

Treatment for Benzodiazepine Toxicity

A

IV flumazenil

51
Q

Signs & Symptoms of Sedative, Hypnotic, & Anxiolytic Withdrawal

A

Anxiety
Insomnia
Diaphoresis, HTN
Possible psychotic reactions
Hand tremors
N/V
Hallucinations/ illusions
Psychomotor agitation, possible seizures

52
Q

Psychological Signs & Symptoms of Stimulant Intoxication

A

Develops rapidly!

High or euphoric feeling

Hyperactivity, hypervigilance, talkativeness

Anxiety

Grandiosity

Hallucinations

Stereotypic or repetitive behavior

Anger, fighting, and impaired judgment

53
Q

Physiological Signs & Symptoms of Stimulant Intoxication

A

Tachycardia
Elevated BP
Dilated pupils
Perspiration or chills
Nausea
Chest pain
Confusion
Cardiac dysrhythmias

54
Q

Stimulant Withdrawal Signs & Symptoms

A

Occurs w/in a few hours to several days after cessation of the drug and is NOT life-threatening

Marked dysphoria is the primary symptom and is accompanied by:
- Fatigue
- Vivid and unpleasant dreams
- Insomnia or hypersomnia,
- Increased appetite
- Psychomotor retardation or agitation

Marked withdrawal symptoms are referred to as “crashing”
- Person may experience depressive symptoms, including suicidal ideation, for several days

55
Q

Nicotine Intoxication

A

Highly toxic

Acute toxicity only in children or when exposure is to nicotine in pesticides

Contains other harmful highly toxic chemicals w/ long-term effects

56
Q

Long-term Effects of Nicotine

A

Cardiovascular disease (HTN, stroke)

Respiratory disease (emphysema, lung cancer)

Cancer and irritation to oral mucous membranes with smokeless tobacco (snuff)

57
Q

Signs & Symptoms of Caffeine Intoxication

A

With ingestion of > 250 mg

Tachycardia and arrhythmias

Flushed face

Muscle twitching

Restlessness

Diuresis

GI disturbances

Anxiety

Insomnia

58
Q

Signs & Symptoms of Caffeine Withdrawal

A

Can occur w/in 24 hrs of last consumption

Headache

N/V

Muscle pain

Irritability

Inability to focus

Drowsiness

59
Q
A

NURS3314 Mental Health Nursing (30 decks)

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