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Mental Health Nursing > Lecture 8 - Substance Use & Disorders > Flashcards

Lecture 8 - Substance Use & Disorders Flashcards

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1
Q

Which substances are most used in the general Canadian population?

A

Caffeine, tobacco, Alcohol, Cannabis, amphetamines, hallucinogens, problematic prescriptions.

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2
Q

How does the frequency of drinking change with age, income, and education?

A

It increases.

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3
Q

How does smoking and elicit drug use change with age, income, and education?

A

It decreases

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4
Q

How do the effects of drinking change with age?

A

Older adults are more susceptible to the effects of alcohol d/t increased body fat, reduction of lean mass, reduction of total water volume, and increases incidences of polypharmacy.

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5
Q

Which substance costs the most for Canada in the categories of healthcare, lost productivity, and criminal justice?

A

Alcohol, followed by the tobacco.

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6
Q

What is a substance use disorder?

A

A chronic and recurrent use of a substance over 12 months, which is compulsive and characterized by a continued use despite physical and psychological harms.

Diagnosis is specified according to substance.

+ 11 diagnostic criteria that determine severity of the illness.

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7
Q

What determines the severity of a substance use disorder?

A

Based on 11 diagnostic criteria:
Mild - 2-3 criteria
Moderate - 4-5 criteria
Severe - 6-7 criteria

Must be present within a a 12 month period

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8
Q

What are the 11 criteria to a substance use disorder?

A
  1. Substance often take in larger amounts or over a longer period of time than intended
  2. There is a persistent desire or unsuccessful effort to cut down or control substance use
  3. A great deal of time is spent in activities necessary to obtain, use, or recover from the effects of the substance
  4. Cravings
  5. Recurrent use resulting in failure to fulfill major role obligations at work, school, or home.
  6. Continues use despite having persistent or recurrent social or interpersonal problems caused by or exacerbated by the effects of the substance
  7. Important social, occupational or recreational activities are given up or reduced because of use
  8. Recurrent use situations in which it is physically dangerous
  9. Cont use despite knowledge or having persistent or recurrent physical or psychological problem that is likely to have been caused by or exacerbated by the substance.
  10. Tolerance
  11. Withdrawal
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9
Q

What is tolerance?

A

Either:
a - a need for markedly increased amounts of the substance to achieve intoxication or desired effect

or

b - marked by diminished effect with continued use of the same amount of a substance

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10
Q

What is withdrawal?

A

Manifests as either:

a - the characteristic of withdrawal syndrome

b - the same (or closely related) substance are taken to relieve or avoid withdrawal symptoms

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11
Q

What are the four Cs of substance use disorder?

A

Compulsive use
Cravings
Continued use despite serious consequences
Can’t stop.

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12
Q

What kinds of factors contribute to the etiology of substance disorders?

A

–> Environmental/cultural
–> Biology
–> Psychological

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13
Q

How does substance use change the reward system of the brain?

A

Dopamine reward system change physically to respond positively to drug use
–> More common with faster acting substances d/t direct cause and effect, such as IV, inhaled, or smoked drugs

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14
Q

How does the psychological cycle of tolerance and use develop?

A

Pleasure –> repeat use –> tolerance –> increased use

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15
Q

What personality phenotypes are associated with alcohol use disorder?

A

Neuroticism, impulsivity, extroversion.

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16
Q

What is the psychoanalytical perspective on substance use?

A

Substance use may be caused caused by conflicts amongst components of the self, fixation on infantile past, and/or seeking sensuous satisfaction

Failure of the ego to response issues between conscious and instincts (id) can lead to maladaptive coping responses

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17
Q

How does developmental theory explain substance use?

A

Substances are used to full an empty space left by a lack of healthy attachment during childhood.

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18
Q

Why does the use of crack cocaine precipitate the spread of hep c?

A

Burning of the lips through use of a pipe and spread blood between between users.

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19
Q

What is a concurrent disorder? What kind of disorders are usually associated with it?

A

Psychological/psychiatric disorder + substance use disorder

Often anxiety related, mood disorders, eating disorders.

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20
Q

What should you assess when assessing someone for use of substances?

A
  1. Name of substance
  2. Quantity used (or amount spent)
  3. Frequency (+ first daily dose w nic)
  4. Number years using
  5. Age of first use
  6. Route of administration

Explore reasons for substance use, past harms, past attempts to reduce consumption.

Ask about the clients goals about substance use.

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21
Q

If a person reports IV or inhaled drug use, what further assessments must be completed?

A

Ask:
Do you have access to sterile needles or inhaled supplies?
Do you or have you shared injection supplies with other people

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22
Q

What is the most important question to ask someone who is using substances?

A

Ask the client what their goal is.

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23
Q

Alcohol increases what psychiatric risks?

A

Alcohol can worsen effects of existing psychiatric conditions and may increase the risk of depression, suicide, homicide, and the risk of harm to self and others.

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24
Q

what makes alcohol with other substances so dangerous?

A

Causes respiratory CNS depression, disinhibition, and has cumulative effects when combines with barbiturates, benzos, psychotropic medications, and opioids.

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25
Q

How does chronic alcoholism kill people?

A

Cirrhosis, portal HTN –> esophageal varices –> hemorrhage, hepatic encephalopathy.

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26
Q

How does alcohol affect males and females differently?

A

Women metabolize alcohol differently than men and are more likely to experience adverse physiological effects.

Men become more impulsive and are more likely to cause harm to others.

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27
Q

What tools are available for assessing alcohol use?

A

Alcohol Use Disorder Identification Test (AUDIT)
–> Consists of 10 questions about recent use, dependence, and related problems

CAGE Questionnaire
C - effort to Cut down
A - Annoyed by criticism of drinking
G - Guilty
E - Eye-Opening: Drink in the morning to steady nerves or a hangover?

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28
Q

What is the threshold for alcohol intoxication?
At what rate does the body eliminate alcohol?

A

0.08% (80 mg/dL)
–> 5.5 hours for elimination because the body can eliminate approx 15 mg/h

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29
Q

What are the three levels are alcohol withdrawal?

A

Minor, Intermediate, Major (delirium tremens)

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30
Q

What does minor ethanol withdrawal look like? How long does it take to resolve?

A

Anxiety, N/V, coarse tremor, sweating, tachy, HTN, headache, insomnia
–> Usually resolves within 48-72 hours

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31
Q

What does intermediate ethanol withdrawal look like?

A

Minor symptoms plus seizure, dysthymias, and/or hallucinations
–> Pts retain insight into unreal nature or hallucination and remain oriented and alert.

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32
Q

What is DT? what does delirium tremens look like? When does it occur?

A

Major Ethanol Withdrawal looks like severe agitation, gross tremulousness, and is marked by psychomotor and autonomic hyperactivity, global confusions, disorientation, and hallucinations.
–> Occurs 5-6 days after severe untreated withdrawal and sudden death may occur
–> 20% death rate

33
Q

What differentiates hallucinations from intermediate ethanol withdrawal from hallucinations in psychosis?

A

Insight with hallucinations related to alcohol remains intact.

34
Q

What is the Clinical Institute Withdrawal Assessment for Alcohol?

A

An assessment that considers frequency and severity of N/V, tremor with arms extended, paroxysmal sweats, anxiety, agitation, tactile/visual/auditory disturbances, headache, and orientation to assess the severity of alcohol withdrawal

35
Q

What are some tips for safer alcohol drinking?

A
  1. Set limits and stick to them
  2. 1:1 ratio alcohol to non
  3. Eat before and while drinking
  4. Consider your age, weights, and health problems that might suggest lower limits
  5. Do not drive or get into a car with someone who had been drinking
36
Q

What are naturally occurring opioids?

A

Morphine + codeine

37
Q

What are semi-naturally occurring opioids?

A

Heroin

38
Q

What are synthetic occurring opioids?

A

Oxycodone, methadone, fentanyl, meperidine, hydrocodone, propoxyphene, tramadol.

39
Q

Most opioid related deaths in Canada occur in which province?

A

BC, followed by Ontario, then Alberta.

40
Q

Are withdrawals from opioids life threatening? What are the symptoms?

A

No.

Symptoms:
Tachy, diaphoresis, restlessness, dilated pupils, myalgia, N/V/D, tremor, yawning, anxiety/irritability, goosebumps

41
Q

What scale is used to quantity opioid withdrawal symptoms?

A

The Clinical Opiate Withdrawal Scale

42
Q

What is the most important fact to prevent opioid death?

A

Reduced use will result in reduced tolerance.

43
Q

What can prevent opioid OD?

A
  1. Be aware of decreased tolerance
  2. Do not mix with other CNS depressants
  3. Do not use alone (or w someone using the same drug)
  4. Be aware of drug quality and potency
  5. Be ware of your health status
  6. Use safe routes
44
Q

Why is not practically applicable to arrest major drug dealers?

A

Removing people’s access to safe and reliable supply means they will seek untrusted supply.

45
Q

What drug routes are safest?

A

Swallowed –> inhaled –> injected

46
Q

What are S/S of opioid OD?

A

–> Decreased LoC
–> Decreased resp rate (<12/min)
–> Constricted pupils
–> Hypoxia

47
Q

What are unwanted effects of administering naloxone?

A

Narcan only lasts for 30-90 minutes.

Therefor no medical treatment after Narcan can lead to repeat OD
–> +If they’re completely sober (d/t narcan) and use again the subsequent OD with be even more severe.

48
Q

The high with cocaine is often combined with…

A

A significant depressive phase that results in irritability, fatigue, mood depression, lethargy, apathy, dehydration, and abd cramps.

strength of high decreases and severity of increases with chronic repeat use.

49
Q

Amphetamines are similar to cocaine except for…

A

no analgesic effects with amphetamine

50
Q

What are amphetamines used to treat? What are its effects?

A

ADHD, narcolepsy, depression, obesity
–> alertness, concentration, energy, euphoria
–> Suppressed appetite.

51
Q

Modest consumption of ____ is not associated with adverse consequences (but may have withdrawal effects) and is not included int he DSM-5 SUD definition. What can high doses of this drug lead to?

A

Caffeine
–> high doses can lead to tachypnea/cardia, and vasomotor and cardiac muscle contractions.

52
Q

What are symptoms of nicotine withdrawal?

A

Cravings, irritability, restlessness, difficulty concentration, depression, frustration, anxiety, insomnia, fatigue, decreased appetite.

53
Q

What are the three groups of hallucinogens? What drugs are included in them? What are their secondary effects?

A

Indolylalkylamine: LSD, psilocybin
–> No secondary effects

Phenylethylamines: mescaline, MDMA
–> Secondary stimulant effect (encourage hydration)

Arylcyclohexylamines: PCP, Ketamine
–> Dissociative anesthetics, secondary depressant effect.

54
Q

What is amotivational syndrome?

A

Low ambition, decreased volition, poor academic and scholastic performance associated with heavy, chronic cannabis use.

55
Q

Cannabis use is a risk factor for what?

A

Development of schizophrenia, psychosis
–> Especially when used in early teens.

56
Q

Effects of inhalants are CNS depression and are similar to alcohol. What are some serious health consequences of them? What kinds of substances do people inhale?

A

Serious conditions: Hearing loss, bone marrow suppression, permanent brain damage.
Damage to lungs, heart, kidney, liver.
–> People inhale acetone, markets, hobby glue, rubber cements, nitrites, pain thinners.

57
Q

What is important to know about use of inhalants?

A

Death is not dose dependent.

58
Q

What is Motivational interviewing?

A

A directive, patient-centered style of counseling that helps pts to explore and resolve their ambivalence about changing their behaviours.

exploration and goal setting is not linear, relapse is a part of recovery.

59
Q

What are the steps of the stages of change model?

A
  1. Pre-contemplation: No intention to quit over the last 6 mo
  2. Contemplation: Aware of problem, not considering making serious change
  3. Preparation: Prepared to quit in next 30 days
  4. Action: Quit within last 6 months and is applying cessation skills
  5. Maintenance: quit more than 6 months ago

Relapse is a part of recovery

60
Q

What is the continuum of drug use?

A

Abstinence <–> experimental/situation <–> social/managed <–> problematic/dependence <–> complex addiction

61
Q

What psychosocial interventions can be used for those with substance use disorders?

A

CBT - changes the way one thinks about situation and their emotional reaction to augment behavioural response

Contingency Management (Behavioural Therapy) - token economy

Twelve-Step Facilitation - conceptualized substance-dependence as an incurable, progressive disease that has spiritual, cognitive and behavioural components. (AA)

62
Q

What psychosocial interventions can be used for substance-use disorders?

A

Group Therapy - supportive others who might offer a variety of coping strategies, public nature of group therapy can serve as a deterrent for relapse

Family Therapy - Improve family functioning, reduce stressors, smooth marital adjustment, lessen domestic violence and verbal conflict.

63
Q

What available pharmacotherapy is there for smoking cessation?

A

NRT
–> patches, gum, inhalers, lozenges

Bupropion (Wellbutrin, Zyban)
–> Antidepressant that reduces withdrawal symptoms and depression associated with quitting

Varenicline (Champix)
–> No withdrawal or pleasurable experience is a cigarette is smokes. Can exacerbate pre existing mood disorders like anxiety, depression, agitation, irritability, suicide risk

64
Q

What pharmacotherapy is available for alcohol use disorder?

A

Monitor and treat withdrawal symptoms with diazepam or lorazepam.

Disulfiram (antabuse)
–> reaction when alcohol consumed

Naltrexone (Revia)
–> Opioid antagonist that cannot be used in combo with other opioids. Reduces cravings and pleasure associated with alcohol.
–> Contraindicated in liver disease

Acamprosate (campral)
–> Curbs cravings

65
Q

What supplemental pharmacotherapy is given to those with alcohol use disorder

A

Thiamine (B1)
–> 100 mg daily reduces ataxia, confusion, disorientation
–> 80% of adults with chronic alcoholism have deficiency.

Folic Acid (B9)
–> 400mg daily. 2/3 of people who binge drink have deficiency

May need to supplement based on needs for Ca, Mg, phosphorous.

66
Q

What pharmacotherapy is available for opioid use disorder?

A

Agonists
–> methadone, buprenorphine/naloxone for substitution therapy

Withdrawal might be treated with clonidine, acetaminophen, ibuprofen, dimenhydrinate, loperamide, trazodone.

67
Q

What are the priorities for a person with acute substance intoxication?

A
  1. Stay with the person + safety
  2. VS - resp status
  3. Inquire about the last dose taken: substance, administration, dose

For depressant: Assess consciousness
For stimulants: reduce stimuli

68
Q

mentally ill people are ___ times more likely to smoke and are less likely to quit.

A

2-3

69
Q

Excessive or long-term use of alcohol can cause what?

A

Adversely effects all body systems and can result in…
–> neuropathy, myopathy, cardiomyopathy
–> gastritis, pancreatitis, Hepatitis, Cirrhosis
–> leukopenia, thrombocytopenia
–> Sexual dysfunction

70
Q

What is Wernicke-Korsakoff’s Syndrome?

A

A memory disorder caused by thiamin (B1) deficiency, can be caused by chronic alcoholism

71
Q

Which demographics use opioids most?

A

All at relatively similar incidences except youth (15-19) who are slightly lower.

72
Q

Which demographic has the highest incidence of cocaine use?

A

young adults (20-24)

73
Q

Which demographic has the highest and lower incidence of methamphetamine use?

A

Lowest: 15-19
Highest: 20-24

74
Q

Which demographics have the highest incidences of cannabis use?

A

20-24

75
Q

What are the 5As of smoking cessation?

A
  1. Ask the patient about their habits
  2. Advise them to quit
  3. Assess their readiness to quit
  4. Assist them in attempts to quit or promote motivation for them to quit
  5. Arrange a follow up
76
Q

Synthetically produced versions of cannabis are used for treatment of which conditions?

A

Appetite stimulation, Pain, nausea, MS

77
Q

What did Gagnon et al identify?

A

There are several limitations to nursing program’s coverage of knowledge necessary about substance use.
Students have more working knowledge of legal substances and (wrongfully) believe them to be less harmful than illegal ones.

78
Q

What is harm reduction?

A

A range of practices and strategies focused on reducing harm associated with drug use
–> Based on improving social justice and understand that addiction is a complex, multi faceted phenomenon.

Mental Health Nursing (18 decks)

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