FINAL - Substance abuse Flashcards
In substance abuse disorder, the substance interferes with __________
An individual’s ability to fulfill role obligations
In substance abuse disorder, the individual would ____________ but cannot
The individual would like to cut down or control use but cannot
In substance abuse disorder, there is an excessive time spent _______ or ___________
Excessive time procuring the substance or recovering from effects
Addiction
Tolerance develops and increased amounts are necessary
Intoxication
Development of a REVERSIBLE substance-specific SYNDROME due to the ingestion of a substance
Withdrawal
Occurs upon abrupt reduction or discontinuation of a substance
In Alcohol Use Disorder, there is a problematic pattern of alcohol use which leads to
Clinically significant impairment or distress
Alcohol Use Disorder is a cluster of behavioral and physical symptoms (3)
Tolerance, Craving, Withdrawal
Alcohol withdrawal develops _____ hrs after reduction of intake
4-12 hrs
Normal male alcohol intake
No more than 14 drinks/week
Normal female alcohol intake
No more than 7 drinks/week (no more than 3 in one sitting)
Underlying change in brain circuits causes _______ and ________
Repeated relapses and intense drug craving
General physiological effects of alcohol
General, nonselective reversible depression of CNS
Once ingested, alcohol is immediately
Absorbed into the blood stream and carried to the brain, tissues, organs, and body secretions
Absorption of alcohol is influenced by (3)
Food, rate of drinking, type of alcohol
Chronic alcohol abuse results in
Multi-system impairments
Toxic effects of alcohol results in
malabsorption of nutrients - especially vitamin B (Thiamine)
Treatment for Peripheral Neuropathy
Reversible with abstinence
11 categories of physiological effects of alcohol
1) peripheral neuropathy
2) myopathy
3) cardiomyopathy
4) Wernicke’s encephalopathy
5) Korsakoff’s psychosis
6) Esophagitis
7) Gastritis
8) Pancreatitis
9) Hepatitis
10) Hepatic Encephalopathy
11) Cirrhosis
Alcoholic Myopathy (6)
- Muscle pain
- Swelling
- Weakness
- Reddish urine from myoglobin breakdown
- Elevated CPK, LDH, AST
- Vitamin B deficiency
Myopathy treatment
Abstinence, nutrition, Thiamine supplement
Most serious thiamine deficiency in alcoholics
Wernicke’s encephalopathy
Wernicke’s encephalopathy
- Paralysis of ocular muscles
- Diplopia
- Ataxia
- Somnolence
- Stupor
Treatment of Wernicke’s encephalopathy
Thiamine replacement to avoid death
Korsakoff’s Psychosis (3)
- Confusion
- Recent memory loss
- Confabulation
Which effect is seen in those recovering from Wernicke’s encephalopathy
Korsakoff’s psychosis
Treatment of Korsakoff’s psychosis
Thiamine replacement - PN or oral
How does alcohol effect myocardial cells? What odes it lead to? (3)
Accumulation of lipids in myocardial cells leads to enlargement, CHF, arrythmias
Signs of cardiomyopathy
- Enlargement, CHF, arrhythmias
- Tachycardia
- Dyspnea
- Edema
- Palpitations
- Non-productive cough
- Decreased exercise tolerance
- Elevated CPK, LDH, AST, ALT
Treatment of cardiomyopathy
Abstinence
Alcohol Intoxication - levels, lethal
100-200 mg/dL, lethal if 400-700 mg/dL
Intoxication symptoms (9)
FUN IS MIDDI Flushed face Unsteady gait Nystagmus Incoordination Slurred speech Mood lability Impaired social or occupational functioning Disinhibition Impaired judgment
Alcohol Withdrawal symptoms (8)
Autonomic hyperactivity
- Agitation
- Visual, tactile, auditory hallucinations/illusions
- Anxiety
- Generalized tonic-clonic seizures
- N/V
- Insomnia
- Sweating
- Hand tremors
Alcohol withdrawal, course of treatment
Benzos - Librium, Ativan
Start with high doses and reduce by 20-25% each day
Tremor treatment
Libirum 25-100 mg q4-6 hrs
Hallucination/agitation treatment
Libirum IV 0.5mg/kg at 12.5 mg/min until calm
Withdrawal seizure, DT treatment
Libirium IV 0.1 mg/kg at 2.0 mg/min
Individuals with liver disease should use…
Shorter acting Ativan
Nutrition intervention
Thiamine replacement
For breakthrough symptoms…
Monitor and give additional doses of benzos
Physiological effects of Opioids CNS (7): GI: Cardiovascular: Sexual function:
CNS - euphoria, respiratory distress, mood changes, mental clouding, drowsiness, pain reduction, pupillary constriction
GI - diminished
CV - hypotension
Sexual function - decreased libido and function
Opioid Overdose Triad
Pinpoint pupils + unconsciousness + respiratory depression
Opioid Overdose signs (6)
- O2 less than 86%
- Bradycardia
- Hypotension
- Unresponsive
- Loud Snoring
- Triad
Opioid overdose treatment
Narcan - IM, IV, SC, Nasal
-Takes 3-7 minutes so give assisted breathing until it takes effect
Opioid Withdrawal symptoms (12)
- Dysphoric mood
- N/V
- Muscle aches
- Lacrimation (tearing) or rinorrhea (runny nose)
- Diarrhea
- Pupillary dilation, piloerection, sweating
- Yawning
- Fear
- Insomnia
When do opioid withdrawal symptoms occur?
6-8 hrs after last dose
When does opioid withdrawal peak?
2nd or 3rd day
When do opioid withdrawal symptom subside?
5-10 days
Drug treatments for opioid withdrawal
Methadone substitution - daily maintenance
Buprenorphine - office supply via MD
Methadone
daily opioid withdrawal treatment
Which drug do you get a month supply of at the MD
Buprenorphine
Drug for nicotine/tobacco abuse
Buproprion
