class 10 (addictions) Flashcards
stress and addicton
-stress is a leading risk factor & also a risk factor for reoccuring substance use
mental illness and addition
increases suicide risk
medical complications from addiction
increased risk of infection secondary to IV drug use, lifestyle (poor nutritition & high risk behaviours)
most common addictive substance
alcohol
DSM5 and substance use
recognizes SUD from 10 different classes of drugs: alcohol, caffeine, hallucinations, inhalants, opioids, sedatives/hypnotics/anxiolytics, stimulants, tobacco, other unknown sub
-increase in coke and meth
-ER visits double d/t prescription Rx
experimentation - holistic view of addiction
tries it once/for the first time
integral use - holistic view of addiction
wine at dinner every day
excessive use - holistic view of addiction
substance use affects family and friends
addiction - holistic view of addiction
physiological or psychological dependence
social, biological components
physiological dependence
CNS/PNS dependence
-need substance to function/avoid pain
psychological dependence
all the person thinks about
believes they cannot live without it
how does halflife affect withdrawl?
long halflife= less intense withdrawl
short halflife= intense withdrawl
what is concurrent disorder
coexisting dx to SUD
what is withdrawl
physiological/pyschological S&S after decrease in drug levels
what is tolerance
increasing need for drug to achieve affect d/t continued use
what is flashbacks
when someone reexperiences the effects of a drug days/months/years after use
what is synergistic effect
2+ drugs at the same time to prolong/intensify effect
-can be fatal
what is antagonistic effects
drugs taken will weaken/stop effect
i.e. opioids and naloxone
what is detoxification
using a process to safely & effectively to remove substance from their system (usually under HCP supervision)
what is relapse
returning back to drug use after a remission period
what is harm reduction
decreasing risk/harm to individuals using substances
i.e. clean needles, safe injections sites
how do you qualify for substance DEPENDENCE?
must have 3 or more of the following in a 12 month period:
-tolerance
-withdrawl
-taking more of the substance/over a longer period of time then intended
-persistence desire/unsuccessful efforts to cut down or control substance use
-spending a great deal of time in efforts to obtain,use,or recover from substance
-not managing to do what individual should at home, school, work
-deciding to use it again depsite knowing of/or experiencing problems associated with its use
how do you qualify for substance MISUSE?
1 or more of the following in a 12 month period:
-recurrent use results in failure to fulfill major role obligations
-recurrent use in hazardous situations
-recurrrent use legal problems i.e. DUIs
-recurrent use despite having persistence/recurrent social or interpersonal problems that arise as a result of the substance
how to opioids affect the body
CNS depression, decrease pain with a “high”
-decrease RR and cognitive function
-endocarditis, bowel infection, clogging of blood vessels in liver, lungs, brain
heroin, fentanyl, and carfentanyl in SUD
all opioids
heroin is processed from morphine
fentanyl is 3x potent than heroin
you can see, smell, or taste fentanyl (increased risk of OD)
carfentanyl is 100x potent than fentanyl (very easy to OD)
what is the opioid crisis
increasing # of people experiencing OD/death d/t opioids
~12 deaths per day
er visits 2x due to it
increasing common in women
growing more common d/t drug contamination (fentanyl)
canada’s focus for the opioid crisis
-emergency treatment fund
-opioid pubic awareness
-opioids data, surviellance, and research
-federal action on opioids
-Canada’s response to the opioid crisis
-supervised consumption sites
-canadian drugs and substances strategy
-substance use and addictions program
-the good samaritan drug overdose act
Acid descripiton/onset - club drugs
“mellow yellow” white odourless bitter powder
psychological dependence->physiological is less of a concern
~60min to kick in, peak is 2-4h, lasts 10-12h
flashbacks can happen after 1 use and be lifelong
what are the affects of acid - club drugs
depersonalization, distorted sensory perception
pseudohallucinations: visual (aware its a hallucination)
dilated pupils, sweating, heart palpitations, decreased coordination, increased RR, HR,Temp, anxiety, paranoia
ecstasy description/onset - club drugs
“E, X, molly, love drug”
tablet, capsule
~30min to kick in lasts 3-4h
what are the affects of ecstasy - club drugs
distorts time & perception
causes confusion & anxiety
risk for dehydration: increased HR, Temp=organ failure=death
insomnia, acute renal failure, hepatotoxicity, psychosis, panic attacks, depression, rhabdomyolysis(w/ ongoing use)
Rohypnol - club drugs
“roofie, date rape drug”
amnesia
anxiolytic
severe insomnia
ketamine - club drugs
“k”
can be problematic
dissociative->”k-hole”
lasts ~24h
methamphetamine - CNS stimulants
“crystal, ice, speed, meth”
acts like adrenaline
causes euphoria, aggression, anxiety, depression after
suicidal ideation
brain damage
Cocaine - CNS stimulants
“blow, snow, coke”
very addictive and hard to quit
vasoconstriction->MI
dilated pupils, excessive muscle movement
s&s of cocaine withdrawl
lethargic, N&V, depression, paranoia, anxiety, inc appetite, heart failure, MI, respiratory failure
alcohol use in canada
most common
overconsumption: health & social consequence
-follow canada’s guide on alcohol & health
-20% canadians consume above rec guidelines
-prevelent in ages 18-24
long term memory issues, mental health issues, cancer, cirrhosis
clinical opioid withdrawl scale (COWS)
clinical institue withdrawl assessment for alcohol (CIWA-Ar)
-used to assess for SUD/withdrawls
also must obtain FHx, blood work, psychosocial, hx of SUD (amount, when,where,how)
help create tx plan for someone in withdrawl
screening for pediatric & adolescent population
-should be performed at every well child visit, as well as episodic sick visits
-screenign does not yield formal Dx but guides decision making
-screening is designed to determine if the adolescent has used alcohol or drugs in prev 12m & determines level of risk
also screen for concurrent MHDx
what is the CRAFFT questionnaire for
assesses adolescents drug use
CRAFFT questionnaire meaning
C-> driven a Car on drugs
R->take them to Relax
A->take them Alone
F->do Friends use them
F->does Family use them
T->have you gotten in Trouble because of drugs
what is the CAGE questionnaire
-alcohol use questionnaire
-4 questions
-2 positives=suggestive, 3-4=diagnostic
computer & gambling addiction in Canada
increase in recent years
guidelines to follow BUT they use blanket statement=not individualized
gaming disorder
not offically in the DSM yet
d/t fortnite
uses same reward system as drugs
substance misuse in nursing
-job stress is leading contributing factor
-accessible d/t drug diversion
what is the transtheoretical model of change
allows pt to acknowledge behaviours
phases: precontemplation->contemplation->preparation->action->maintence and then the person exits the cycle into stable lifestyle ot reenters via relapse
nursing interventions for SUD
-self awarness of the nurse
-comprehensive assessment
-psychological interventions (motivational interviewing, CBT)
screen using COWs
how to have a difficult conversation about SUD with a pt
-pt may be in denial
-create relapse prevention plan(coping, pt involvement, support, identify triggers)
-teenager education about drugs 7 alcohol
-family education d/t recovery and thei role
-non-judgemental & encouraging
alcohol withdrawl treatment - pharmacological
Acamprosate (campral) (dec intake of ETOH thru restoring GABA system, cannot be taken w/impaired renal function)
naltrexone (revia) (non-selective opioid antagonist, interferes w reinforcement & dec cravings of ETOH)
tropiramate (topamax) (similar to campral)
opioid addiction treatment - pharmacological
methadone (Metadol): 1st line, no euphoria, blocks cravings, but can become dependent
Naltrexone (reVia,vivitrol);dec cravings, a single dose=72h opioid
clonidine (catapres);withdrawl, nonopioid suppressor, no dependence, must be taken regularly
buprenorphine (analgesic) blocks s&s of opioid wihdrawl->”matchstick” inserted under the skin for 6m
nicotine addiction treatment - pharmacological
bupropion (wellbutrin, zyban)
nicotine patch
e-cigarettes/vaping(may do more harm than good)
what is a harm reduction approach?
-dec risk/injury to individual
=/=abstinence
non-judgmental approach
key principles of harm reduction
pragmatism
human rights
priority of immediate goals
focus on harms
pragmatism - key principles of harm reduction
views both sides of illicit drug abuses
risk vs benefits to dec harm
human rights - key principles of harm reduction
self-determination
dignity
right to care
focus on harms - key principles of harm reduction
drug use secondary to effects of drug use (dec of negative effects vs dec drug)
priority of immediate goals - key principles of harm reduction
meeting person where they are
small wins
continue to show up for them
wellness is key
what are harm reduction strategies
peer support programs
supervised consumption sites
street nursing
how does a harm reduction approach help
dec OD’s & drug use associated dx (hep C, HIV)
dec stigma=inc therapeutic relationships
dec incarceration
tertiary prevention in SUD
dec complications & dysfunction in regards to addiction
if indigenous: healing lodges
opioid-dependent newborns
NAS: moving towards using rooming-in rather than morphine for withdrawl s&s
substance use in older adults
-there are resources available i.e. improving quality of life: substance-use and againg
