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Psych NRSG EXAM 2 > Chapter 22- substance use and addictive disorder > Flashcards

Chapter 22- substance use and addictive disorder Flashcards

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1
Q

4 C’s of Addiction?

A

Addiction is a chronic dx that is categorized by:

  1. Cravings
  2. Loss of control
  3. Compulsion
  4. Use despite of consequences
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2
Q

3 C’s for Dealing With a Loved One w/ Addictions?

A
  • I did not cause it
  • I can not cure it
  • I can not control it
    • You can not love someone more than they love themselves…
      • What does this statement mean for the person helping someone with addiction?
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3
Q

How do people get addicted?

A
  • Dopamine…how does dopamine make us feel? happy- euphoric!
  • We ingest a substance that activates the reward center in the brain which releases dopamine
  • The more we use a substance, we build a tolerance to it and end up needing more of the substance to get a release of dopamine
  • This creates addiction
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4
Q

Intoxication or high ?

A

use of substance in excess

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5
Q

Tolerance:?

A

need more of the same substance in order to get the same high?

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6
Q

Withdrawal s/s?

A

Physiological s/s that presents due to stopping substance use

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7
Q

Addiction:?

A

Inability to abstain from substance or activity. (Think of the 4 C’s)

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8
Q

Codependent:?

A

Excessive emotional and psychological reliance on a partner. Important for the partner without the addiction to remember 3 C’s.

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9
Q

DSM 5 Categories of Drugs?

A
  1. Alchol
  2. caffeine
  3. cannabis
  4. hallucinogens
  5. inhalent
  6. opioid
  7. sedative hyponotic and antianxiety meds
  8. stimulant
  9. tabacco
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10
Q

Process Addictions?

A
  • Compulsive behaviors or the feelings brought on that activate the reward system of the brain (dopamine)
    • Gambling
    • Internet gaming
    • Use of social media
    • Shopping
    • Sexual activity
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11
Q

Gambling?

A
  • Regular or episodic in occurrences
  • May commit illegal acts to finance addiction
  • Preoccupied with behavior and try to conceal it.
  • May rely on others to pay off debt.
  • Develops usually over a course of years
  • Stress and depression may increase behavior
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12
Q

Gambling Treatment?

A
  • Gamblers Anonymous (GA)
  • Psychotherapy
  • Medications:
    • SSRI bupropion (Wellbutrin)
    • Opioid antagonist naltrexone (Vivitrol) for severe symptoms
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13
Q

Why Vivitrol ?

A
  • Pathological gambling and substance abuse have the following characteristics in common:
    • repetitive or compulsive engagement in a behavior despite adverse consequences
    • diminished control over the problematic behavior
    • an urge or craving prior to engagement in the behavior
    • a thrill when taking part in the behavior. These features have led to a description of pathological gambling as a behavioral addiction.
  • Basically this medication stops the release of dopamine, so pleasure isn’t gained from gambling, promiscuity, drinking alcohol, opioids etc.
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14
Q

CNS Stimulants?

A
  • CNS stimulant disorder
  • what do they do?
    • enhance alertness, euphoric feeling, high energy and wakefulness.
  • street drugs:
    • meth, cocaine, MDMA ( ecstasy)
  • prescription drugs:
    • ritalin and concerta, adderall
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15
Q

Meth Intoxication?

A
  • Intoxication: Feeling superhuman, euphoric, sociable, hypervigilant, tense, anxious and angry.
  • Meth psychosis: pulling hair, teeth and nails out. Also picking at skin due to delusions.
  • Meth Mouth: result of dry mouth, craving carbonated beverages, grinding teeth and poor oral health care
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16
Q

Rhabdomyolysis?

A
  • With ecstasy you can dangerously overheat and get rhabdomyolysis:
    • which is due to increased activity or trauma in the muscle that causes a breakdown in muscle (like from dancing all night)
    • This releases myoglobin that end up blocking gas and fluid exchange in liver, kidney, heart or lungs.
      • Results in shutting down of organs effected
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17
Q

Stimulant Withdrawal?

A
  • Most serious symptoms can be depression and suicidal thoughts (known as ”crashing”)
  • Begins within a few hours to several days. Additional symptoms: tired, vivid nightmares, increase appetite, insomnia, psychomotor agitation or retardation, impaired functioning.
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18
Q

Stimulant Withdrawal Therapy?

A
  • Treatment: Usually inpatient
    • Depending on drug; similar drug may be used to taper down safely
    • Psychosis- antipsychotics
    • No psychosis- diazepam (Valium) which helps with agitation and hyperactivity
    • Depression- antidepressants once withdrawal symptoms are done
  • Nursing Interventions:
    • Vital Signs (HR, BP, RR, O2, EKG monitoring if ordered if needed)
    • Psychosis may need 1-1
    • Depression- suicide or self harm assessment
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19
Q

Caffeine ?

A
  • CNS Stimulant
  • Sources: Energy drinks, pre workout, cola, coffee, tea
  • Desired Effect:
    • Increased Alertness, decreased fatigue
  • Intoxication: >250 mg
    • Tachycardia, arrythmias, muscle twitching, diuresis, GI upset, anxiety, insomnia
  • Withdrawal:
    • Can occur within 24 hours since last use, headache, n/v, muscle pain, irritability, inability to focus and drowsiness
20
Q

CNS Depressants info?

A
  • Sources:
    • sedatives, tranquilizers, and hypnotics.
  • What do they do?
    • slow brain activity, making them useful for treating anxiety, panic, acute stress reactions, and sleep disorders.
  • Street names
    • : bars, blues, candy, chill pills, french fries, downers, planks, sleeping pills, totem poles, tranks, zanies, and z-bar
  • Prescription medications:
    • Benzodiazepines, Ambien, Lunesta, Norco, Oxycodone, Morphine
21
Q

Alcohol?

A
  • Within the past year:
    • At least 2 symptoms to have this disorder in past 1 year.
      • 2-3 for mild disorder
      • 4-5 for moderate
      • 6 or greater for severe disorder
  • Functioning alcoholics
    • Denial
    • Rationalization
  • CAGE Question help person realize if they are an addict or not
    • 0-1 low risk
    • 2-3 high suspicion for alcoholism
    • 4= alcholic
22
Q

Inpatient Treatment - Alchol?

A
  • Need to know when the last drink was
    • Severe ETOH withdrawal kicks in around 48-72 hours after last drink
  • LLUMC and LLUBMC uses Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar)
    • assess ETOH withdrawal symptoms and gives them a grade of severity
    • Score of 67 points total.
    • Any score over 10 may need medication assisted treatment for safe withdrawal.
    • Alcohol withdrawal can kill u, insurance will pay for inpatient withdrawl treatment.
23
Q

Increasing blood pressure and pulse indicate ETOH withdrawal and health care provider needs to be contacted IMMEDIATELY!!!

A
24
Q

Delirium Tremens (DT)?

A
  • delirium tremens (DTs) is a rapid onset of confusion usually caused by withdrawal from alcohol. When it occurs, it is often 48 hours into the withdrawal symptoms and lasts for two to three days.
  • Physical effects may include shaking, shivering, irregular heart rate, and sweating.
25
Q

Wernicke Korsakoff Syndrome (WKS)?

A
  • neurological disorder.
  • WKS is caused by a deficiency in the B vitamin thiamine (the patient drinks alcohol more than they eat).
  • Thiamine plays a role in metabolizing glucose to produce energy for the brain.
  • Treatment: IV thiamine for 3-7 days until stable. Take thiamine supplement as long as the patient is consuming alcohol.
  • Key Presentation: Confabulation- symptom typically displayed by an individual with Wernicke-Korsakoff syndrome.
    • The individual attempts to make up for memory loss by filling in the blanks with false memories
    • Impaired memory, related to neurotoxicity of alcohols.
26
Q

Medications Used for ETOH Withdrawal?

A
  • Antabuse: Relapse Prevention- When using alcohol creates intense vomiting, headache, sweating, flushed skin, respiratory difficulties and confusion
    • Need to contract to abstain from ETOH. Other substances with ETOH like mouthwash or rubbing alcohol can trigger the effect.
  • Naltrexone: Relapse prevention- Takes away the “good feeling” by hindering reward center in the brain. No pleasure when drinking.
    • Example: Once a month injection known as Vivitrol
27
Q

Nursing Interventions ETOH?

A
  • Know s/s of ETOH withdrawal
  • Charting is important to capture the status of the patient, since decline can be quick
  • When a person is experiencing delusions or hallucinations as a result of ETOH withdrawal, 1-1 supervision is necessary
28
Q

Therapy Treatment ETOH?

A
  • Motivational Interviewing: A form of therapy that helps patient connect current behavior to future goals. Ex: Pt says that they want to grow old and enjoy retirement . You ask them: How is your current behavior helping you reach that goal or not reach it?
  • AA: Support group that uses 12 steps. Helps by offering peer support and teaching individuals to take sobriety one day at a time.
  • Intensive outpatient therapy: There’s one at the Chemical Dependency Unit at LLUBMC. Compliance is necessary and usually court mandate.
  • Outpatient: Mix of individual therapy, group therapy, online programs.
  • Rehab and Halfway houses: residential forms of detox and relapse prevention of ETOH abuse.
29
Q

Tobacco Use Disorder?

A
  • Can be both a stimulant and a depressant
  • Uses: relaxation and to decrease anxiety
  • Forms: cigarettes, E-cigarettes, cigars, chewing tobacco (all which contain additional harmful ingredients)
  • Associated with increase use of ETOH, and marijuana use disorders
  • Dependence happens quickly
  • Withdrawal symptoms: irritability, anxiety, depression, difficulty concentration, restlessness and insomniamnia
30
Q

Tobacco Use Treatmen?

A
31
Q

Benzodiazepines?

A
  • Sources: Anti-anxiety medications; Lorazepam, diazepam, alprazolam
  • Abuse Causes: Highly addictive, increases GABA which makes you feel good
  • Intoxication: (CNS) depression =impaired balance, drowsiness ataxia, and slurred speech. Severe symptoms include coma and respiratory depression.
  • Withdrawal:
    • Anxiety.
    • Panic.
    • Irritability.
    • Insomnia.
    • Sweating.
    • Headaches
    • Muscle pain and stiffness.
    • Poor concentration.
    • Most serious symptoms assessment findings are delirium and seizures
32
Q

Benzo Addiction Treatment?

A
  • Tapering: Slowly decreasing dose over
    • Reduce dose by 50% the first 2-4 weeks then maintain on that dose for 1-2 months then reduce dose by 25% every two weeks.
  • Medication: Gabapentin or Propanol to help with withdrawal s/s.
  • Therapy: Narcotics Anonymous to prevent relapse
33
Q

Opioid Use Disorder?

A
  • Sources: morphine or heroin
  • Huge opioid crisis in our country that starts with prescription medication
  • Leads to cravings and tolerance and significantly impairs functioning in everyday life (hence the term “downer”)
  • Intoxication: psychomotor retardation, pupil constriction, slurred speech, drowsiness, impaired and ultimately coma ( it slows down your CNS)
34
Q

Opioid Withdrawal?

A
  • Begins 6-8 hours after last use
    • N/V/D
    • Muscle aches
    • Fever
    • Insomnia
    • Lacrimation (watery eyes)
    • Piloerection (goosebumps)
    • Yawning
    • Rhinorrhea
    • Delirium or hallucinations
35
Q

Treatment for Opioid Overdose?

A
36
Q

How to use Narcan Spray?

A
  • What do you remember from the video you watched?
  • Naloxone (Narcan) rapidly reverse opioid overdose
  • Restores respiration
  • MOA: Opioid Antagonist – it BINDS to opioid receptors and can reverse and block the effects of other opioids
  • 2nd treatment may be needed because the Narcan can wear off before the opioid does!!!!!
  • Must be observed for 2 hrs after last dose
  • Must get to emergency room quickly
  • (know everything on this slide for the test)
37
Q

Opioid Abuse Treatment?

A
  • Opioid and partial opioid agonist are used for withdrawal treatments to reduce painful symptoms
  • Methadone
    • taper down
    • can create another addiction
    • that’s why there are clinics
  • Buprenorphine (Subutex), partial opioid agonist— Used at the BMC (taper)
  • Naltrexone (Vivitrol) —- Used outpatient at MAT clinic
38
Q

PCP (Angel Dust)?

A
  • PCP intoxication: medical emergency; dangerous and violent side effects; Hypertension, hyperthermia, seizures
  • Treatment: Benzos to calm (remember GABA), may need restraints, mechanical cooling for SEVERE hyperthermia
  • Withdrawal: elevated body temperature, seizures, and muscle breakdown, muscle twitching, agitation, and hallucinations may also occur depending on the length of use. Acidosis has also been reported in some PCP users undergoing withdrawal.
  • May re-experience symptoms even when they are not using
    • Reports feeling anxious and restless which usually leads to self medication with other substances.
39
Q

Inhalant Use Disorder?

A
  • Inhaling a substance to get high or get a euphoric feeling ( sniffing or huffing and bagged substance)
  • Causes euphoria
  • High risk of “sudden sniffing death” which is mostly connected to butane and propane
    • Can result in cardiac arrhythmias, coma, bronchospasms, respiratory depression
    • Usually occurs between the aged of 12-17
    • Long term use can lead to brain hypoxia
    • Tx with Haldol for severe agitation
40
Q

Hallucinogen Disorder?

A
  • PCP, LSD, ketamine
  • Causes disturbances in reality: AH, VH, TH, flashbacks, psychosis, delirium, panic attacks, mood and anxiety disorders
  • Intoxication: Paranoia, intense perceptions, impaired judgment, depersonalization and derealization
  • Withdrawal: headaches, cravings, sweating
41
Q

Synesthesia?

A
  • Caused by Hallucinogens
  • Senses cross
    • “I can taste red”
    • “I can smell you rubbing me”
42
Q

Cannabis Use Disorder?

A
  • Most widely used drug in the world
  • 4th most psychoactive drug in U.S. after caffeine, alcohol and nicotine
  • THC causes mind altering effects aka “head high”
  • With use with alcohol causes brighter colors and time seems to go slowly aka ”cross fading”
  • Higher doses and different strands (sativa vs. Indica): depersonalization and de-realization
  • Motor skills impaired for 8-12 hours aka “stuck”
  • Red eyes, increase appetite, tachycardia, marked impairment in cognition and performance aka Scooby Doo and Shaggy
  • Withdrawal symptoms (usually anxiety, insomnia and restless) can present up to a week after cessation
  • ***Vaping has higher doses of THC, which can be very dangerous***
43
Q

Negative Effects of THC?

A
44
Q

Beneficial side of THC?

A
45
Q

CBD vs THC

A
46
Q
A

Psych NRSG EXAM 2 (6 decks)

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