m2 day 3 Flashcards
substance use disorders
3 key points, characterized by, criteria 11
key points:
- Chronic
- Recurrent
- Compulsive
Characterized by
- continued use despite physical and psychological harms
- Occurs over time and alters the brain’s structure –> lose control over their use of substances
Disorder based on 11 diagnostic criteria and must present within a 12 month period:
2-3 criteria is required for mild substance use
4-5 is moderate,
6-7 is severe
11 diagnostic criteria of substance use
- large amounts or over a longer period of time than intended.
- desire or unsuccessful efforts to cut down or control substance use.
- A great deal of time is spent in activities necessary to obtain, use, or recover from effects of the substance.
- Craving, or a strong desire to use.
- failure to fulfill major role obligations at work, school or home.
- Continued use despite having persistent social or interpersonal problems caused or exacerbated by the effects of substance
- Important social, occupational or recreational activities are given up or reduced because of use.
- Recurrent use in situations in which it is physically hazardous
- Continued use despite knowledge of having a persistent or recurrent physical or psychological problem that is likely to have been caused or exacerbated by the substance.
- Tolerance
- Withdrawal,
4 C’s of substance use
Compulsive Use
Cravings
Continued Use
- Despite Serious Consequences
Can’t Stop
bioogical and psychological factors to substance use
SPRTI, personality, psychoanalytical, developmental
cBiology – brain changes with prolonged substance use
- Increased reinforcement mechanism of the brain (dopamine)
- Physiological brain changes alter one’s judgement, decision making, learning, memory and behavioural control.
- Use not only for pleasure, but for survival.
Psychological factors
- Substances = Pleasure = Repeated use = Tolerance = Increased use
- Personality traits: neuroticism, impulsivity, and extroversion.
- Psychoanalytical: Conflicts with the ‘self’ (Unresolved issues of the Ego)
- Developmental Theory: Substances fill empty space left by lack of attachment during childhood.
probelms associated w substance use disorder
- Infectious diseases (hepatitis B & C, HIV, STIs, TB)
- Injection-related infections (cellulitis, abscess, thrombophlebitis, endocarditis, sepsis)
- Overdose (fatal and non-fatal)
- Concurrent disorders: anxiety related disorders, mood disorders, eating disorders
- Social problems (dysfunctional family life, difficulties with employment, incarceration)
- pain, suicide/self-harm
substances
SNC depressors
Sedatives, hypnotics, anxiolytics
Synthetic medications that are sedating, induce sleep and reduce anxiety
- Benzodiazepines: diazepam, oxazepam, temazepam, lorazepam
- Flunitrazepam (ruffies, rophies, roachies) which is the ‘date rape’ drug
- GHB is another illegal drug frequently used in the club scene
- Use of these drugs typically co-occurs with alcohol making their use extremely dangerous
- Side effects related to benzodiazepine withdrawal
substances
Alcohol
- Alcohol reaches all tissues in the body and crosses the placenta resulting in teratogenic effects to the developing fetus
- Can worsen existing psychiatric conditions (increase the risk of depression, suicide, homicide and the risk of harm to self and others)
- Excessive or long-term use of alcohol can adversely affect all body systems (itis and opathies).
- Can lead to varying degrees of cognitive impairment (Wernick-Korsakoff’s syndrome – thiamine deficiency)
alcohol withdrawl and pharmacotherapy
minor, intermediate, major W
Minor withdrawal -
- may include anxiety, nausea and vomiting, coarse tremor, sweating, tachycardia, hypertension, head ache, insomnia – usually resolved within 48-72 hours.
Intermediate withdrawal
- patients experience minor withdrawal symptoms in addition to seizures, dysrhythmias, and/or hallucinations, - patients remain aware of the unreal nature of their auditory or visual hallucinations and remain oriented and alert.
Major withdrawal (delirium tremens)
- severe agitation, gross tremulousness, marked psychomotor and autonomic hyperactivity, global confusion, disorientation and auditory, visual or tactile hallucinations.
- Tends to occur 5 or 6 days after severe untreated withdrawal and sudden death may occur.
pharm
- benzos –> dangerous withdrawl symtpmos
- thiamine –> reduce ataxia
- folic acid –> deificiency so we want to supplement
- supplementation of lost electrolytes -
- disulfram
- nalextrone –> opiod antagonist
- acamprosate –> cravings
opioids and pharmacotherapy
types of opiods, withdrawl and pharm
Opioids can be licit or illicit drugs
- Naturally occurring : Morphine and codeine
- Semi-synthetic: Heroin
- Synthetic: oxycodone, methadone, fentanyl, merperidine, hydrocodone, propoxyphene, tramadol, etc.
- Act by attaching to the endogenous opioid receptors in the brain
withdrawl
- When opioids are discontinued, symptoms may include severe cravings, severe respiratory and gastrointestinal side effects – typically not life threatening but very uncomfortable
phram
- naloxone (narcan) and methadone
- symtpm tx aswell
opiod overdose risk factors and signs
Opioid overdose risk factors
- Decreased tolerance
- Mixing drugs
- Using alone
- Drug quality and potency
Health status
Route
Opioid Overdose – Signs
- Decreased level of consciousness
- Decreased respiratory rate (<12/min)
- Meiotic (constricted) pupils
- Hypoxia
- Naloxone = Antidote
stimulant
cocaine
- Snorted, smoked, or injected
- Crack cocaine (crystalized): Faster Acting
- Rapidly crosses the blood-brain barrier
- Physical effects: alertness and energy and bizarre behaviours potentially leading to violence and potential risk of harm, tachycardia or bradycardia, pupil dilation, hypo or hyper tension, nasal septum destruction, respiratory distress, chest pain, arrhythmias, seizures, coma
- The high is followed by a significant and intense depressive phase (“the crash”) resulting in irritability fatigue, mood depression, lethargy, abdominal and muscle cramps, dehydration, apathy.
stimulant
amphetamines
- Methamphetamines, amphetamines, methylphenidate, dextroamphetamine and some diet medications.
- Can be taken orally, snorted, smoked or injected.
- Act like adrenaline and activate the CNS and peripheral nervous system.
- Increases alertness, concentration, energy, euphoria… suppreses appetite.
- Similar presentation as cocaine except for its analgesic effect.
5 A’s of smoking cessation and pharmacotherapy
The 5A’s of smoking cessation
1. Ask patients about their smoking status
2. Advise them to quit
3. Assess their readiness to quit
4. Assist them in their attempts to quit or promote motivation for them to quit
5. Arrange for follow-up
pharm
- Nicotine replacement therapy (NRT)
- Bproprion (Wellbutrin, Zyban)
- Varenicline (Champix)
hallucinogens
psyc /pysical effects
Psychological effects:
- Paranoia, anxiety, depression, synesthesia, hallucinations, judgement alterations.
Physical effects:
- Pupil dilation, tachycardia, diaphoresis, tremors, palpitations, lack of coordination, increased temperature, pulse and respirations, muscle rigidity, seizures, agitation.
3 groups (see Table 18-11):
1. Indolealkylamines (ex: LSD, psilocybin):
- No secondary stimulant effect.
1. Phenylethylamines (ex: mescaline, ecstasy, MDMA): Secondary stimulant effect.
1. Arylcyclohexylamines (Dissociative aneasthetics - ex: PCP, Ketamine):
- Secondary depressant effect.
cannabis
- Body stores cannabinoids in fat tissue and in the brain causing urine drug screens to remain positive for weeks.
- May result in the development of psychotic symptoms and the use of cannabis –> recognized as an independent risk factor for the development of schizophrenia and psychosis.
- Synthetically produced to treatment selected medical conditions/symptoms (e.g., appetite stimulations, pain, MS, nausea)
