Lecture 3: Substance Abuse

Question 1

Annual Cost of Substance abuse in US

Answer 1

500 Billion annually

1. alcohol (highest cost)
2. illicit drugs
3. tobacco

Question 2

Addiction

Answer 2

Overwhelming Compulsion / mental / craving / nothing matters

• Repetitive drug-taking behavior
• Serious health and social consequences

Question 3

Substance Dependence

Answer 3

Physical and psychological desire to take a drug

Cannot stop taking drug w/out withdrawals

Question 4

Physical Dependence Ex.

Answer 4

Opioids
alcohol
sedatives
some stimulants
nicotine

Question 5

Psychological Dependence Ex.

Answer 5

Marijuana

Anti-anxiety drugs

Question 6

Tolerance

Answer 6

Body adapts to repeated admin of a drug
-requires higher doses of drug to produce initial effect

Common in substances that affect nervous system

Question 7

Cross-Tolerance

Answer 7

Requires dosage adjustment to obtain therapeutic benefit

Ex.

Anesthetic w/ sedatives

Question 8

Stimulants (Uppers)

Answer 8

Ex. Cocaine / Amphetamines / Methamphetamines
Pts die of cardiac arrest w/ cocaine

-Fight or flight – Blood flow goes to vital organs
-vasoconstriction in the periphery
-Increased heart rate and respirations
-Increased BP
-dilated pupils
sweating
tremors

Question 9

Downers (relaxers)

Answer 9

Ex. Benzodiazipines / Alcohol / Opioids / Marijuana / Barbiturates

Opioids attach to receptors in the brain stem:

• Heart rate, BP, and respiratory rate are all decreased
• Vasodilation
• unclear mental status
• reddening of the skin

Question 10

Alcohol (CNS Depressant)

Answer 10

Alcohol withdrawal syndrome is severe and may be life threatening

benzodiazepines are the preferred drug class for treatment of alcohol withdrawal

help patients with alcoholism with ABSTINENCE

Question 11

Antabuse (disulfiram)

Answer 11

Makes someone toxic almost immediately after consuming alcohol. Stays in system for 2 weeks.

Question 12

Nicotine

Answer 12

Affects nervous, cardiovascular, and endocrine system

-Very quickly leads to physical and psychological dependence

Question 13

Marijuana

Answer 13

MOST COMMONLY used illicit drug

• Causes disconnected thoughts, paranoia, euphoria
• Causes RED BLOOD SHOT EYES

Question 14

Withdrawal Definition

Answer 14

Often withdrawal symptoms and signs are the opposite of what the drug originally causes.

Question 15

Opioid withdrawal symptoms

Answer 15

Sympathetic response:

Excessive sweating
Restlessness
goose bumps 
Muscle spasms
N/V

Question 16

Barbiturates Withdrawal Symptoms

Answer 16

Insomnia
Anxiety weakness
seizures
delirium

Question 17

Alcohol Withdrawal symptoms

Answer 17

Withdrawal can be life threatening

-Treat alcohol withdrawal w/ benzodiazepines or Librium

Question 18

Stimulant withdrawal Vs. Downer withdrawal

Answer 18

Withdrawing from a downer is much more dangerous than withdrawing from a stimulant

Question 19

With IV-drug users nurse must consider…

Answer 19

HIV infection
Hepatitis
TB

Question 20

CNS Stimulants

Answer 20

• Sense of exhilaration / reduced appetite
• High psychological dependence
• Less severe physical signs
• Increases CNS and Cardiac activity

Question 21

Sedatives Prescribed for Sleep disorders

Answer 21

• Physical dependence, psychological dependence, and tolerance to high doses
• Moderate-to-high psychological dependence
• Moderate-to-EXTREME physical signs of withdrawal

Question 22

Opioids prescribed for severe Pain

Answer 22

• Addiction occurs rapidly
• Intense withdrawal symptoms
• High psychological dependence

Heroin

Question 23

Nicotine Withdrawal Symptoms

Answer 23

Irritability, anxiety, and restlessness
INCREASED appetite, headache, insomnia
Decrease in HR and BP

Question 24

Marijuana Withdrawal Symptoms

Answer 24

Irritability and restlessness
Insomnia and tremors
Chills and weight loss

Question 25

Example of RN intervention

-Substance Abuse

Answer 25

Alcohol can cause cross tolerance w/ ANESTHESIA

Nicotine replacement