Chapter 22 - Substance-Related & Addictive Disorders Flashcards
Substances that lead to use disorders
- Alcohol
- Caffeine
- Cannabis
- Hallucinogens
- Inhalants
- Opioids
- Sedative-hypnotics
- Stimulants
- Tobacco
- Other (Process Addictions): gambling, sex, shopping, etc.
What is addiction?
KNOW THIS!!!
- Chronic medical condition
- Individual is dependent on something (toxic or chemical substance)
- Patient has a need for using the substance
What is intoxication?
KNOW THIS!!!
using a substance in excess
- causing physical, physiological, & psychological effects
What is tolerance?
KNOW THIS!!!
Takes higher doses to achieve the initial / desired level of response
What is withdrawal?
KNOW THIS!!!
Symptoms that occur when a person stops using a substance
Comorbidities with Subtance-Related & Addictive Disorders
Psychiatric (dual diagnosis)
* 6 out of 10 people
Medical
* EtOH-related medical problems are the most commonly seen comorbiditiy
* DM, Hepatitis C, Psoriasis
What is a dual diagnosis?
KNOW THIS!!!
Mental Health Disorder + Substance-Use Disorder
Risk factors of substance use disorders
KNOW THIS!!!
- Genetics
- Enviornmental (social & cultural norms; socioeconomics)
- Psychological Factors (lack of tolerance, success, or self-regard, low self-esteem, risk-taking propensity)
What is the most widely used psychoactive substance in the world?
Caffeine
List different types of inhalants
- Propellants (aerosol paint sprays, hair sprays, & shaking cream)
- Thinners (i.e. for pain products & correction fluids)
- Fuels (i.e. gasoline, propane)
- Solvents (for glues & adhesives)
Signs & Symptoms of Opioid Intoxication / Overdose
KNOW THIS!!!
- Coma
- Pinpoint Pupils
- Respiratory depression
- Hypothermia
- Hypotension
- Bradycardia
- Unresponsiveness
What is the antidote for opioid intoxication / overdose?
KNOW THIS!!!
naloxone (Narcan)
- Intranasal
- IM
- Subcutaneous
- IV
What medications are commonly used for opioid withdrawal?
KNOW THIS!!!
- methadone (Dolphine, Methadose)
- clonidine (Catapres)
- Buprenophine/naloxone
What substances are used in sedative, hypnotic, & anti-anxiety medication use disorder?
KNOW THIS!!!
Benzodiazepines
* alprazolam (Xanax)
* clonazepam (Klonopin)
* diazepam (Valium)
* lorazepam (Ativan)
Benzodiazepine-like drugs (Z-hypnotics)
* zolpidem (Ambien)
* zaleplon (Sonata)
* eszopiclone (Lunesta)
Carbamates
Barbituates
Barbituate-like hypnotics
What is the treatment for overdose on sedatives, hypnotics, or anti-anxiety medications?
Gastric lavage (pump stomach)
What types of drugs are abused / used in stimulant use disorder?
KNOW THIS!!!
- Amphetamine type drugs (amphetamine, methamphetamine, Adderall, Ritalin, etc.)
- Cocaine
- MDMA (ecstasy or molly)
What can be done for withdrawal in a patient with stimulant use disorder?
- Diazepam for agitation
- Group & individual therapy
How long does cocaine withdrawal take? What medications are often used after withdrawal is complete?
KNOW THIS!!!
1-2 weeks of withdrawal
- Antidepressants are often used once withdrawal is complete
A person requests help for cocaine withdrawal symptoms. Which is least likely to be part of the individual’s treatment plan?
a.) Diazepam
b.) Bupropion
c.) In-patient care
d.) Group therapy
c.) In-patient care
Cocaine withdrawal does NOT require in-patient treatment
- Can be a day program, check in regularly, etc.
A patient is admitted to the ED experiencing respiratory distress due to opioid overdose. As soon as his respiration is stabilized, which drug should be administered?
a.) Naloxone
b.) Bupropion
c.) Methadone
d.) Clonidine
a.) Naloxone
A patient is admitted to the ED experiencing respiratory distress due to opioid overdose. As soon as his respiration is stabilized, which drug should be administered?
a.) Naloxone
b.) Bupropion
c.) Methadone
d.) Clonidine
a.) Naloxone
Describe alcohol use disorder
KNOW THIS!!!
initial euphoria –> sedation
- 2x prevalence in men than women
- Most common in American Indians / Alaskan Natives
List comorbidities associated with alcohol use disorder
KNOW THIS!!!
- Bipolar disorder
- Schizophrenia
- Antisocial personality disorder
- Major depressive disorder
What is the difference in binge drinking & heavy drinking?
KNOW THIS!!!
Binge Drinking: drinking too much too quickly (large amount at once)
* Men = 5+ drinks in 2 hours
* Women = 4+ drinks in 2 hours
Heavy Drinking: drinking too much too often (too much for a long period of time / too often)
* Men = 14+ drinks in 1 week
* Women = 8+ drinks in 1 week
What is the legal definition of alcohol intoxication?
KNOW THIS!!!
Blood alcohol level of 0.08 - 0.10 g/dL
Systemic effects from EtOH Use Disorder
- Peripheral neuropathy
- EtOH myopathy & cardiomyopathy
- Esophagitis, gastritis, pancreatitis
- EtOH hepatitis
- Cirrhosis of the liver
- Leukopenia
- Thrombocytopenia
- Cancer (head & neck)
What is CAGE screening for alcohol use disorder?
What is the difference in CAGE & CAGE-AID Screening?
KNOW THIS!!!
Cutting down
Annoyed / criticized by others for your drinking
Guilty
Eye-opener (drink first thing in AM)
**CAGE-AID = **screening for EtOH & other drugs
**CAGE = **screening for EtOH
What is codependence?
KNOW THIS!!!
- Co-dependent person** feels they are responsible for the individual who is using**
- Define their worth by caring for others
- Put their own needs aside
Treatment for alcohol use disorder
KNOW THIS!!!
Medications:
* naltrexone
* benzodiazepines
* disulfiram (Antabuse) - will make patient sick if they use alcohol when taking this medication
- Therapy
- Motivational interviewing
What is the most common medication used for the treatment alcohol use disorder & how does it work?
KNOW THIS!!!
disulfiram (Antabuse): makes the patient feel sick if they use alcohol while taking it
- avoid mouthwash with EtOH in it
What are the transtheoretical stages of change theory?
KNOW THIS!!!
1.) Precontemplation (not ready to change)
2.) Contemplation (deciding if they need to change their habits; considering change)
3.) Preparation (preparing to change & start program)
4.) Action (doing the work in order to change, participating in therapy, AA, NA, etc.)
5.) Maintenance (continuing sobriety)
A nurse is assigned the care of 4 patients who are detoxifying from alcohol. The patient with which symptom would be the nurse’s highest priority?
a.) Fine motor tremor
b.) Diaphoresis
c.) Diarrhea
d.) Hallucinations & delusions
d.) Hallucinations & delusions
Individual is unpredictable
- they may act out, be aggressive or agitated or violent – need to take this seriously & prioritize their care
