chemical dependency Flashcards
dependence
state in which normal function only occurs in the presence of a drug; manifested as physical disturbance when drug is removed (withdrawal)
biological theory of addiction
specific effects on selected neurotransmitters
DOPAMINE especially!
psychological theory of addiction
defense mechanism against anxious impulses; self-medication for depression and other chronic stressors
behavioral theory of addiction
positive reinforcement
sociocultural theory of addiction
social and cultural norms; socioeconomic stress
abuse
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
dopamine significance in addiction
regulates pleasure and pain, plays a major role in all addictions
psychological dependence
SUBJECTIVE experience of need for drug to experience “normal” functioning
ALL drugs/events that are mood altering have potential for psychological dependence.
physical dependence
an event occurs when TOLERANCE DEVELOPS in response to use of a psychoactive substance and upon cessation results in WITHDRAWAL sequela
tolerance
greatly increased amounts of substance needed to achieve intoxication or desired effect
withdrawal
SUBSTANCE SPECIFIC SYNDROME that follows cessation or reduction in intake of a psychoactive drug on which an individual is physiologically dependent
polysubstance abuse
abuse of more than one substance at a time
dual diagnosis
coexistence of major psychiatric disorder and substance related disorder (at least 50% addictions w/ mental illness)
chemical dependence phase I: prodromal
- 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
chemical dependence phase II: crucial (basic)
- 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
chemical dependence phase III: chronic
- more or less continuous use
- ethical deterioration
- inconsistent, inappropriate thinking
- indefinable fears
- tremors, psychomotor inhibitions
- decrease of tolerance if ALCOHOL
common personality traits of chemically impaired
- avoidance: emotional, physical
- grandiosity
- impulsiveness: craving/anxiety = act without thinking
- manipulation: rationalizing, intellectualizing, projecting, excuses
associated personal factors of chemically impaired people
- decreased tolerance for frustration
- risk taking
- low self-esteem, lack of success and meaningful relationships
can be good at appearing fine outwardly
cardinal symptom/most common defense mechanism*
DENIAL!*
family roles: codependence
dysfunctional behavioral patterns characterized by excessive focus on emotional, social, physical needs of another
codependent person: characteristics
- 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
family roles: hero
exceeds at whatever he/she does to avoid dysfunctional feelings through the praise of others
family roles: mascot/clown
makes everything all right through humor and showing off
family roles: scapegoat
gets into trouble, takes focus off dysfunction in the family by bringing it onto him/herself
family roles: lost child
avoid family turmoil by being so quiet he/she is never noticed
alcoholism
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
alcoholism: characteristics*
- impaired control over drinking
- preoccupation with alcohol
- use despite adverse consequences
- distortions in thinking; DENIAL*
alcoholism: specific s/s
- gulping drinks
- drinks alone
- use as medicine
- blackout
- non-premeditated use
alcohol pharmacokinetics: absorption
20% stomach
80% small intestine
alcohol pharmacokinetics: distribution
all tissues and body fluids
alcohol pharmacokinetics: metabolism
PRIMARILY LIVER 90%
- consistent rate of metabolism
blood alcohol level
can be used to assess level of intoxication and level of tolerance
- as tolerance develops, discrepancy seen between BAL and expected behavior
ascites
?
alcohol withdrawal
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
alcohol withdrawal: s/s
- hyperalertness
- jerky movements
- irritability
- easily startled
- “shaking inside”
delirium tremens
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
delirium tremens: s/s
- tachycardia, diaphoresis, elevated bp
- disorientation, clouding of consciousness
- visual, tactile hallucinations
- hyperexcitability through lethargy (extremes)
- paranoid delusions, agitation
- fever (100 - 103F)
- SEIZURES!
red flag of possible alcohol withdrawal
tactile hallucinations (not frequently seen in psychotic disorders!)
delirium tremens: pharm intervention
PRIORITY: long acting benzodiazepine
- thiamine: prevent encephalopathy
- folic acid/multivitamins: correct deficiencies
- magnesium sulfate: reduce seizures
- anticonvulsants: control seizures
delirium tremens: thiamine
prevent encephalopathy
delirium tremens: folic acid/multivitamins
correct deficiencies
delirium tremens: mag sulfate
reduce seizures
delirium tremens: anticonvolsants
control seizures
delirium tremens: benzodiazepine
long acting; PRIORITY!
act on the benzodiazepine-GABA-chloride receptor complex, having a similar GABA-potentiating effect as alcohol
cocaine/stimulant abuse: health issues
- extreme weight loss
- malnutrition
- myocardial infarction
- stroke
intravenous drug use: health issues
infections, sclerosing of veins
intranasal drug use: health issues
sinusitis, perforated nasal septum
smoking substance: health issues
respiratory issues
cns depressants: intoxication s/s
- euphoria
- sedation, unsteadiness
- decreased: bp, hr, rr
- cognitive decline
- BARBS: cardiac, respiratory depression
cns depressants: abrupt withdrawal s/s
seizures, coma, death
taking patient off benzo? WEAN
taking patient off benzo?
WEAN!!!!
cns depressants: withdrawal s/s
- n, v
- tachycardia
- tremors
- pupil dilation
- severe insomnia
pupil dilation cardinal sign of
cns depressant withdrawal
cns depressant: therapeutic management of withdrawal
titrate with similar drug
cns depressant: therapeutic management of overdose
- induce vomiting, activated charcoal
- gastric lavage
- fluid support
- seizure precautions
stimulants: intoxication s/s
- restless, agitated, anxious, increased vital signs
- paranoia
- absence of appetite
stimulants: overdose s/s
myocardial infarction, stroke, collapse
stimulants: withdrawal s/s
DEPRESSION, suicide, paranoia, n/v
stimulant: therapeutic management of withdrawal
- antidepressant
- dopamine agonist
stimulant: therapeutic management of overdose
- treat sx
- maintain body systems
opioid drugs: common effects
- euphoria
- relaxed
- lethargic
- pupil CONSTRICTION
pupil constriction cardinal sign of
opioid drug use!
opioid drugs: intoxication effects
depressed vital signs, lethargy, coma leading to death
opioid drugs: withdrawal s/s*
U N C O M F O R T A B L E!!!!!!!*
- n, d, muscle cramps
- chills
- runny nose/eyes
opioid drugs: therapeutic management of withdrawal
tapering, substitution
opioid drugs: therapeutic management of overdose
narcotic antagonist (naloxone/Narcan)
hallucinogens: common effects
- altered thoughts, perceptions
- diverse effects
- intense, profound mood swings
hallucinogens: toxic effects
- acute panic reactions
- “flashbacks”
hallucinogens: therapeutic management of toxic effects
- decrease stimuli
- LSD: no pharm
- PCP: Haldol and/or Valium
marijuana: physiological effect
cns depressant, also has hallucinogenic properties
opioids: physiological effect
suppresses cns
hallucinogens: physiological effect
inactivates some 5HT receptor sites and decreases GABA, which permits increased dopamine activity resulting in altered thoughts, perceptions
marijuana: common/toxic effects
- euphoria
- time distortion
- increased appetite
- dry mouth, red eyes
- may cause anxiety reactions
long term: memory loss
caffeine: physiological effect/withdrawal
cns stimulant
- withdrawal: severe ha, irritability
nicotine: physiological effect/withdrawal
cns stimulant of ne (nicotinic receptors)
- withdrawal: ha, anxiety, irritability
inhalants: physiological effect
cns depressant
- prolonged use: toxic to brain
steroids: mechanism & psych effect
alter genetic material to produce new proteins
- psych: psychotic symptoms
therapeutic management of chemically impaired individual
- acute treatment
- rehabilitation
- group treatment
alcoholism: cns early effects
cns depression!: decreased inhibitions, judgment, memory, concentration, self-control
alcoholism: cardiac early effects
increased hr, hypotension (common), hypertension, cutaneous dilation
alcoholism: respiratory early effects
aspiration risk
alcoholism: renal early effects
diuretic (inhibits adh)
alcoholism: gi early effects
stimulates acid secretion, production; mucosal irritation
alcoholism: pancreas early effects
epigastric pain, vomiting
alcoholism: hepatic early effects
accumulation of fat, protein in liver
alcoholism: hematological early effects
decreased wbc and platelet production, anemia, increase infection risk
alcoholism: sexual early effects
decreased capacity for responsiveness, menstrual cycle changes
alcoholism: cns late effects
seizures, atrophy, wernicke-korsakoff syndrome
alcoholism: cardiac late effects
hyperlipidemia + chf, cad, cardiomyopathy
alcoholism: respiratory late effects
risk: aspiration, ineffective breathing, ineffective airway
alcoholism: gi late effects
gastritis, hemorrhagic ulcer and gi bleeds, nutritional and vitamin deficiency (damaged tract, malabsorption problems)
alcoholism: pancreas late effects
pancreatitis, increased activity of enzymes = autodigestion of pancreas tissue
alcoholism: hepatic late effects
vitamin b depletion, coagulation problems, necrosis, cirrhosis + associated secondary illnesses*, liver failure
*esophageal varices, portal hypertension, ascites, hepatic encephalopathy, hepatic coma
alcoholism: hematological late effects
bone marrow depression, prolonged clotting (decrease in bile synthesis prevents absorption of fat soluble vitamins -> lack of vitamin K = insufficient clotting factors0
alcoholism: sexual late effects
impotence, impaired fertility, sterility, gynecomastia
wernicke-korsakoff syndrome
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)
