Chapter 22- substance use and addictive disorder Flashcards

Question

Wernicke Korsakoff Syndrome (WKS)?

Answer 1

* 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.

Answer 2

* 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

Answer 3

* 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

Answer 4

* 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.

Answer 5

* 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

Answer 6

* 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

Answer 7

* 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

Answer 8

* 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)

Answer 9

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

Answer 10

* 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)

Answer 11

* 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

Answer 12

* 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.

Answer 13

* 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

Answer 14

* 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

Answer 15

* Caused by Hallucinogens * Senses cross * "I can taste red" * "I can smell you rubbing me"

Answer 16

* 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\*\*\*