Substance Abuse Flashcards by Ashley Ross

Occurs when the recurrent use of alcohol and/or drugs causes clinically and functionally significant impairment, such as health problems, disability, and failure to meet major responsibilities at work, school, or home.

Substance Use Disorder

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Intense craving for the substance and an excessive amount of time is spent trying to procure more of the substance or recover from the effects of its use

Addiction

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Development of exhilaration and emotional frenzy or lethargy and stupor.
Reversible following excessive use of a substance.

Intoxication

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Occurs upon abrupt reduction or discontinuation of a substance that has been used regularly over a prolonged period of time.
Can be physical or psychological.

Withdrawal

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process of safely withdrawing from a substance. (physical needs of the body)

detoxification

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Common screening tool of substance abuse that IDENTIFY substance abuse (4)

 Michigan Alcohol Screening Test (MAST)
 Drug Abuse Screening Test (DAST)
 CAGE
 AUDIT

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Common screening tools to assess if pt is going through withdrawal (2)

Clinical Institute Withdrawal Assessment of Alcohol Scale (CIWA)
Clinical Opiate Withdrawal. Scale

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Cage questionnaire (4)

o Have you ever felt you should cut down on your drinking/drug use?
o Have people annoyed you by criticizing your drinking/drug use?
o Have you ever felt guilty about your drinking/drug use?
o Have you ever had a drink/used a drug first thing in the morning (eye opener) to steady your nerve, get rid of a hangover, or to get the day started?

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How many questions need to be positive for a CAGE questionnaire in order for it to be positive for addiction?

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Assessment –> questions to ask for urgency of situation

pattern of drinking

- How many days/ week does the person drink

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what is the BAC that is the legal intoxication level

.08 or 80 mg

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Alcohol Effects (SAMSGIN)

slurred speech
attention impairment and arrest respiratory
memory impairment
stupor or coma or death
gait unsteady
incoordination
nystagmus (rapid eye movement)

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Alcohol Withdrawal Symptoms (HITS)

hallucinations (visual, tactile)
increased vs and insomnia
tremens (lethal)
shaking, sweating, seizures, stomach pain

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What vital sign is increased when detox is starting

increased BP

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Delirium Tremens s/s (DEATH)

delirious
autonomic disturbance
tremors
hallucination

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Medications for ETOH withdrawal (4)

Diazepam
chlodiazepoxide
lorazepam
phenobarbital

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Meds besides benzos used for ETOH withdrawal

magnesium sulfate

- Thiamine

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What is KORSAKOFF syndrome

disturbance of short term memory with thiamine deficiency in alcohol abuse

What is wernicke’s encephalopathy?

-neurlogic disease that is caused from alcohol abuse

s/s wernicke’s encephalopathy-4

ataxia
6th facial nerve palsy
nystagmus
confusion

what is prescribed to prevent Korsakoff-Wernickes syndrome

thiamine

What does disulfiram do?

It is used as alcohol aversion therapy –> if a client takes disulfiram and drinks alcohol they will experience flushing, a throbbing headache, sweating, and N/V

When can disulfiram be given?

10-14 days after last drink

What is the most important pt education for someone taking disulfiram?

Client must avoid common products such as shaving cream, aftershave, cologne, deodorant and OTC meds

What does naltrexone do?

unknown how it works, but it decreases cravings

s/s sedative/hypnotics/anxiolytics sx (SAMSGIN)

- Slurred Speech (Sams Gin) - Attention impairment and Arrest Respiratory - Memory impairment - Stupor or coma or death - Gait unsteady - Incoordination - Nystagmus

s/s sedative/hypnotics/anxiolytics withdrawal symptoms sx (PASTNITES)

- Psychomotor agitation - Anxiety - Seizures (Grand‐Mal)  not as deadly as alcohol seizures - Transient hallucinations - Nausea or vomiting - Insomnia - Tremor increased (hand) - Excitability‐autonomic (Increased HR and BP) - Sweating (diaphoresis)

Medications for sedative/hypnotics/anxiolytics withdrawal (3)

- clonazepam (Klonopin) - chlordiazepoxide (Librium) - phenobarbital (Phenobarb)

Opioid effects (6)

- Slurred speech - impaired memory - pupillary changes - Decreased respirations and level of consciousness which can cause death - Impaired judgement and social functioning

Opioid Withdrawal Symptoms (ARMYFINDS)

``` Aches (muscular) Rhinorrhea (or lacrimation) Mood‐dysphoric (depression) Yawning Fever Insomnia Nausea/vomiting Diarrhea Sweating ``` - Don't forget pupillary dilation or piloerection - WITHDRAWAL IS VERY UNPLEASANT BUT NOT LIFE THREATENING

Meds for Opioid Addiction (4)

- Clonidine - Methadone - Buprenorphine - Naltrexone

Opioid Rescue Drugs (2)

- Naloxone | - Flumazenil

Cocaine effects (ACODEBLUE)

* Agitation or retardation (psychomotor) * Cardiac (tachycardia) * Opening of the pupil * Diaphoresis (or chills) * Encephalopathic‐like changes (seizures, confusion, dyskinesias, dystonias, or coma) * Blood pressure (elevated) * Loss of stomach content * Unstable muscle‐associated changes (diaphramatic, cardiac, and skeletal) i.e., muscle weakness, respiratory depression, chest pain, or cardiac arrhythmias * Evidence of weight loss and rhinorrhea

Cocaine Withdrawal Symptoms (PANTS)

* P –Psychomotor agitation or retardation * A –Appetite increases * N ‐Nightmares (vivid, unpleasant dreams) * T ‐Tiredness (fatigue) * S ‐Sleep (hypersomnia or insomnia)

Is cocaine withdrawal life threatening?

no, but there is an occurrence of SI

Warning signs of substance abuse in healthcare workers 8)

```  Absenteeism  Irritability  Mood changes  Sloppy care/client complaints  Problems with drugs  Errors in judgment  ETOH on breath  Disappearance ```

Common Defense mechanisms for substance abuse-6

- blaming - denial - isolation - minimizing - projection - rationalization

Pointing to others as the cause of the behavior. (“I wouldn’t drink so much if you would just quit nagging me.”)

blaming

Refusing to acknowledge that a problem exists. (“I could quit drinking whenever I want to – I just don’t want to.”)

denial

Abandoning friends or family members in order to pursue one’s addiction without being criticized or asked to stop

isolation

Attempting to downplay the severity of one’s dependence upon alcohol. (“I only have one or two drinks to wind down after work. It’s no big deal.”)

Minimizing

Taking negative emotions one is feeling and assigning them to others, which some experts believe to be associated with paranoia. (“Husband is drinking but accuses wife of being alcoholic.”)

Projection

Supplying reasons that “justify” one’s unhealthy behavior. (“Hey, I don’t want to drink so much, but it’s the only way that I can deal with the pressures at work and still keep my job.”)

Rationalization