Chapter 8 Drugs of Abuse Flashcards
Cocaine
Cocaine is a highly addictive stimulant. It is usually snorted, smoked, or injected. Cocaine inhibits the uptake of dopamine in the brain and activates dopamine receptors in the brain reward system. This leads to rapid dependence.
Pharmacokinetics: Cocaine absorption rates depend on the route of administration. Smoking and IV methods result in the fastest absorption. Cocaine is rapidly metabolized by the liver. Cocaine readily crosses the placenta in pregnant patients and accumulates in fetal circulation.
Treatment: There are no FDA-approved medications to treat cocaine addiction.
Nurse Drug abuse
Most commonly used drugs Cannabis Cocaine Opioids Alcohol Nicotine Contributing factors Characteristics Management
Contributing Factors: Factors contributing to drug abuse among nurses are: chronic fatigue, illness, responsibility for patients’ responses to illness and dying, professional dissatisfaction, access t drugs, martial and child care problems, and downsizing.
Characteristics: Evidence of chemical dependence is seen by changes in personality and behavior, job performance, and attendance. Discrepancies in controlled-drug handling and records may indicate drug diversion, the deliberate redirecting of a drug from a patient or facility to the employee for personal use. Examples: frequent narcotic wastage, multiple corrections to med records, and frequent reports of unrelieved pain by patients.
Management: Management of drug abuse in nurses depends on the state in which the nurse practices and the policies of the employing facility. In an effort to help impaired nurses, the American Nurse s Association (ANA) strongly advocate for rehabilitation for nurses who are chemically dependent and alternatives to discipline including diversion programs associated with the state boards of nursing that allow nurses to maintain their licenses while being monitored through recovery, peer assistance program sand employee assistance programs.
Texas Peer Assistance Program for Nurses (TPAPN)
Alcohol
Pharmacokinetics: Alcohol is absorbed directly from the stomach and small intestine. Faster absorption occurs when alcohol is combined with carbonated beverages. Absorption is slowed by food. It crosses the placenta and can affect fetal development. Alcohol is primarily metabolized in the liver.
Pharmacodynamics: Alcohol affects almost all cells of the body. Alcohol is a general CNS depressant. The concentration of the alcohol is determined by assessing blood alcohol concentration. Alcohol interacts with many commonly prescribed OTC medications. Potentiation and cross tolerance may occur.
Short-term effects include N/V, HA, slurred speech, impaired judgment, memory loss, hangovers, and blackouts.
Long-term effects include stomach ailments, heart problems, cancer, brain damage, serious memory loss, immune system compromise, and liver cirrhosis.
Alcohol toxicity is a life-threatening condition that can occur by drinking large amounts of alcohol over a short period of time. Complications of alcohol toxicity include aspiration of vomitus, asphyxiation, severe dehydration, seizure, hypothermia, brain damage, and death. Treatment involves airway management and supplemental oxygen, correction of hypoglycemia is present, supportive care, and IV hydration. If the person is a chronic user, thiamine (B1) may be given to prevent neurological damage.
Alcohol treatment
Treatment: Initial treatment of alcohol intoxication or overdose requires the basic principles of airway, breathing, and circulation (ABC’s). No antidote is available. Drugs are available to facilitate alcohol withdrawal. Including benzodiazepines (for example, lorazepam (Ativan) and chlordiazepoxide (Librium). Rehabilitation and sustained abstinence is the primary long-term goal of alcohol treatment.
Drug-assisted treatment: Several drugs have been approved by the FDA to treat AUD; disulfiram, acamprosate, and naltrexone are the most commonly used.
Disulfiram causes intense side effects such as N/V, HA, chest pain, difficulty breathing, rash, and psychosis if alcohol is consumed. These side effects occur within 10 minutes of alcohol consumption and last for over an hour. It is best used in people that are newly abstinent.
Acamprosate is a GABA analogue thought to work in the brain to restore balance between neuronal excitation and inhibition via GABA and glutamate. It should only be used in people who are abstinent. It is contraindicated in people with a creatinine clearance less than 30 mL/min.
Naltrexone is a competitive opioid antagonist and is used in people who are abstinent.
Nonpharmacologic Therapy: Cognitive behavioral therapy (CBT), contingency management, motivational enhancement therapy, and twelve-step facilitation therapy.
Withdrawal symptoms and treatment
White Powder
Snort
