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z S15 HEHI 4 > chemical dependency > Flashcards

chemical dependency Flashcards

1
Q

dependence

A

state in which normal function only occurs in the presence of a drug; manifested as physical disturbance when drug is removed (withdrawal)

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2
Q

biological theory of addiction

A

specific effects on selected neurotransmitters

DOPAMINE especially!

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3
Q

psychological theory of addiction

A

defense mechanism against anxious impulses; self-medication for depression and other chronic stressors

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4
Q

behavioral theory of addiction

A

positive reinforcement

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5
Q

sociocultural theory of addiction

A

social and cultural norms; socioeconomic stress

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6
Q

abuse

A

pattern of use that results in negative consequences

  • inability to fulfill role expectations
  • participation in hazardous activities while impaired
  • recurring legal, personal problems
  • continued use despite problems
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7
Q

dopamine significance in addiction

A

regulates pleasure and pain, plays a major role in all addictions

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8
Q

psychological dependence

A

SUBJECTIVE experience of need for drug to experience “normal” functioning

ALL drugs/events that are mood altering have potential for psychological dependence.

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9
Q

physical dependence

A

an event occurs when TOLERANCE DEVELOPS in response to use of a psychoactive substance and upon cessation results in WITHDRAWAL sequela

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10
Q

tolerance

A

greatly increased amounts of substance needed to achieve intoxication or desired effect

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11
Q

withdrawal

A

SUBSTANCE SPECIFIC SYNDROME that follows cessation or reduction in intake of a psychoactive drug on which an individual is physiologically dependent

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12
Q

polysubstance abuse

A

abuse of more than one substance at a time

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13
Q

dual diagnosis

A

coexistence of major psychiatric disorder and substance related disorder (at least 50% addictions w/ mental illness)

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14
Q

chemical dependence phase I: prodromal

A
  • increase of tolerance
  • temporary loss of memory
  • sneaking chemical(s)
  • preoccupation with use of chemical
  • avoidance of reference to personal use

more frequent loss of memory –> phase II

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15
Q

chemical dependence phase II: crucial (basic)

A
  • loss of control, morning use of chemical(s), change in use pattern, periodic abstinence
  • alibis and excuses, protecting supply
  • reproof by significant others, loss of friendships, position
  • extravagance, escape
  • aggression, resentment, persistent remorse
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16
Q

chemical dependence phase III: chronic

A
  • more or less continuous use
  • ethical deterioration
  • inconsistent, inappropriate thinking
  • indefinable fears
  • tremors, psychomotor inhibitions
  • decrease of tolerance if ALCOHOL
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17
Q

common personality traits of chemically impaired

A
  • avoidance: emotional, physical
  • grandiosity
  • impulsiveness: craving/anxiety = act without thinking
  • manipulation: rationalizing, intellectualizing, projecting, excuses
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18
Q

associated personal factors of chemically impaired people

A
  • decreased tolerance for frustration
  • risk taking
  • low self-esteem, lack of success and meaningful relationships

can be good at appearing fine outwardly

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19
Q

cardinal symptom/most common defense mechanism*

A

DENIAL!*

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20
Q

family roles: codependence

A

dysfunctional behavioral patterns characterized by excessive focus on emotional, social, physical needs of another

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21
Q

codependent person: characteristics

A
  • develops unhealthy pattern of relating to others
  • low self-esteem, willingness to suffer
  • needs to be needed
  • strong urge to change, control others

codependent needs treatment if addict gets treatment or role will be screwed up

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22
Q

family roles: hero

A

exceeds at whatever he/she does to avoid dysfunctional feelings through the praise of others

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23
Q

family roles: mascot/clown

A

makes everything all right through humor and showing off

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24
Q

family roles: scapegoat

A

gets into trouble, takes focus off dysfunction in the family by bringing it onto him/herself

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25
Q

family roles: lost child

A

avoid family turmoil by being so quiet he/she is never noticed

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26
Q

alcoholism

A

primary, chronic disease with genetic psychosocial and environmental factors influencing its development and manifestations

  • often progressive, fatal
  • affects dopamine in brain enough to force adaptation because not working correctly
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27
Q

alcoholism: characteristics*

A
  • impaired control over drinking
  • preoccupation with alcohol
  • use despite adverse consequences
  • distortions in thinking; DENIAL*
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28
Q

alcoholism: specific s/s

A
  • gulping drinks
  • drinks alone
  • use as medicine
  • blackout
  • non-premeditated use
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29
Q

alcohol pharmacokinetics: absorption

A

20% stomach

80% small intestine

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30
Q

alcohol pharmacokinetics: distribution

A

all tissues and body fluids

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31
Q

alcohol pharmacokinetics: metabolism

A

PRIMARILY LIVER 90%

- consistent rate of metabolism

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32
Q

blood alcohol level

A

can be used to assess level of intoxication and level of tolerance
- as tolerance develops, discrepancy seen between BAL and expected behavior

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33
Q

ascites

A

?

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34
Q

alcohol withdrawal

A

early signs a few hours after decreasing alcohol (depends on how dependent and how much used)

signs peak after 24-48 hours then rapidly disappear

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35
Q

alcohol withdrawal: s/s

A
  • hyperalertness
  • jerky movements
  • irritability
  • easily startled
  • “shaking inside”
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36
Q

delirium tremens

A

aka DT aka alcohol withdrawal delirium

  • medical emergency that can result in death
  • delirium peaks at 2-3 days after cessation, lasts 2-3 days
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37
Q

delirium tremens: s/s

A
  • tachycardia, diaphoresis, elevated bp
  • disorientation, clouding of consciousness
  • visual, tactile hallucinations
  • hyperexcitability through lethargy (extremes)
  • paranoid delusions, agitation
  • fever (100 - 103F)
  • SEIZURES!
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38
Q

red flag of possible alcohol withdrawal

A

tactile hallucinations (not frequently seen in psychotic disorders!)

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39
Q

delirium tremens: pharm intervention

A

PRIORITY: long acting benzodiazepine

  • thiamine: prevent encephalopathy
  • folic acid/multivitamins: correct deficiencies
  • magnesium sulfate: reduce seizures
  • anticonvulsants: control seizures
40
Q

delirium tremens: thiamine

A

prevent encephalopathy

41
Q

delirium tremens: folic acid/multivitamins

A

correct deficiencies

42
Q

delirium tremens: mag sulfate

A

reduce seizures

43
Q

delirium tremens: anticonvolsants

A

control seizures

44
Q

delirium tremens: benzodiazepine

A

long acting; PRIORITY!

act on the benzodiazepine-GABA-chloride receptor complex, having a similar GABA-potentiating effect as alcohol

45
Q

cocaine/stimulant abuse: health issues

A
  • extreme weight loss
  • malnutrition
  • myocardial infarction
  • stroke
46
Q

intravenous drug use: health issues

A

infections, sclerosing of veins

47
Q

intranasal drug use: health issues

A

sinusitis, perforated nasal septum

48
Q

smoking substance: health issues

A

respiratory issues

49
Q

cns depressants: intoxication s/s

A
  • euphoria
  • sedation, unsteadiness
  • decreased: bp, hr, rr
  • cognitive decline
  • BARBS: cardiac, respiratory depression
50
Q

cns depressants: abrupt withdrawal s/s

A

seizures, coma, death

taking patient off benzo? WEAN

51
Q

taking patient off benzo?

A

WEAN!!!!

52
Q

cns depressants: withdrawal s/s

A
  • n, v
  • tachycardia
  • tremors
  • pupil dilation
  • severe insomnia
53
Q

pupil dilation cardinal sign of

A

cns depressant withdrawal

54
Q

cns depressant: therapeutic management of withdrawal

A

titrate with similar drug

55
Q

cns depressant: therapeutic management of overdose

A
  • induce vomiting, activated charcoal
  • gastric lavage
  • fluid support
  • seizure precautions
56
Q

stimulants: intoxication s/s

A
  • restless, agitated, anxious, increased vital signs
  • paranoia
  • absence of appetite
57
Q

stimulants: overdose s/s

A

myocardial infarction, stroke, collapse

58
Q

stimulants: withdrawal s/s

A

DEPRESSION, suicide, paranoia, n/v

59
Q

stimulant: therapeutic management of withdrawal

A
  • antidepressant

- dopamine agonist

60
Q

stimulant: therapeutic management of overdose

A
  • treat sx

- maintain body systems

61
Q

opioid drugs: common effects

A
  • euphoria
  • relaxed
  • lethargic
  • pupil CONSTRICTION
62
Q

pupil constriction cardinal sign of

A

opioid drug use!

63
Q

opioid drugs: intoxication effects

A

depressed vital signs, lethargy, coma leading to death

64
Q

opioid drugs: withdrawal s/s*

A

U N C O M F O R T A B L E!!!!!!!*

  • n, d, muscle cramps
  • chills
  • runny nose/eyes
65
Q

opioid drugs: therapeutic management of withdrawal

A

tapering, substitution

66
Q

opioid drugs: therapeutic management of overdose

A

narcotic antagonist (naloxone/Narcan)

67
Q

hallucinogens: common effects

A
  • altered thoughts, perceptions
  • diverse effects
  • intense, profound mood swings
68
Q

hallucinogens: toxic effects

A
  • acute panic reactions

- “flashbacks”

69
Q

hallucinogens: therapeutic management of toxic effects

A
  • decrease stimuli
  • LSD: no pharm
  • PCP: Haldol and/or Valium
70
Q

marijuana: physiological effect

A

cns depressant, also has hallucinogenic properties

71
Q

opioids: physiological effect

A

suppresses cns

72
Q

hallucinogens: physiological effect

A

inactivates some 5HT receptor sites and decreases GABA, which permits increased dopamine activity resulting in altered thoughts, perceptions

73
Q

marijuana: common/toxic effects

A
  • euphoria
  • time distortion
  • increased appetite
  • dry mouth, red eyes
  • may cause anxiety reactions

long term: memory loss

74
Q

caffeine: physiological effect/withdrawal

A

cns stimulant

- withdrawal: severe ha, irritability

75
Q

nicotine: physiological effect/withdrawal

A

cns stimulant of ne (nicotinic receptors)

- withdrawal: ha, anxiety, irritability

76
Q

inhalants: physiological effect

A

cns depressant

- prolonged use: toxic to brain

77
Q

steroids: mechanism & psych effect

A

alter genetic material to produce new proteins

- psych: psychotic symptoms

78
Q

therapeutic management of chemically impaired individual

A
  • acute treatment
  • rehabilitation
  • group treatment
79
Q

alcoholism: cns early effects

A

cns depression!: decreased inhibitions, judgment, memory, concentration, self-control

80
Q

alcoholism: cardiac early effects

A

increased hr, hypotension (common), hypertension, cutaneous dilation

81
Q

alcoholism: respiratory early effects

A

aspiration risk

82
Q

alcoholism: renal early effects

A

diuretic (inhibits adh)

83
Q

alcoholism: gi early effects

A

stimulates acid secretion, production; mucosal irritation

84
Q

alcoholism: pancreas early effects

A

epigastric pain, vomiting

85
Q

alcoholism: hepatic early effects

A

accumulation of fat, protein in liver

86
Q

alcoholism: hematological early effects

A

decreased wbc and platelet production, anemia, increase infection risk

87
Q

alcoholism: sexual early effects

A

decreased capacity for responsiveness, menstrual cycle changes

88
Q

alcoholism: cns late effects

A

seizures, atrophy, wernicke-korsakoff syndrome

89
Q

alcoholism: cardiac late effects

A

hyperlipidemia + chf, cad, cardiomyopathy

90
Q

alcoholism: respiratory late effects

A

risk: aspiration, ineffective breathing, ineffective airway

91
Q

alcoholism: gi late effects

A

gastritis, hemorrhagic ulcer and gi bleeds, nutritional and vitamin deficiency (damaged tract, malabsorption problems)

92
Q

alcoholism: pancreas late effects

A

pancreatitis, increased activity of enzymes = autodigestion of pancreas tissue

93
Q

alcoholism: hepatic late effects

A

vitamin b depletion, coagulation problems, necrosis, cirrhosis + associated secondary illnesses*, liver failure

*esophageal varices, portal hypertension, ascites, hepatic encephalopathy, hepatic coma

94
Q

alcoholism: hematological late effects

A

bone marrow depression, prolonged clotting (decrease in bile synthesis prevents absorption of fat soluble vitamins -> lack of vitamin K = insufficient clotting factors0

95
Q

alcoholism: sexual late effects

A

impotence, impaired fertility, sterility, gynecomastia

96
Q

wernicke-korsakoff syndrome

A

wernicke encephalopathy (damage to thalamus, hypothalamus) + korsakoff psychosis (permanent damage to areas controlling memory)

brain damage caused by a lack of vitamin B1 (common in alcoholics)

z S15 HEHI 4 (7 decks)

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