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NSG 313 > Substance Abuse > Flashcards

Substance Abuse Flashcards

1
Q

Alcohol Abstinence Syndrome Onset

A

12-72 hours after last drink

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2
Q

Alcohol Abstinence Syndrome Mild SEs:

A

disturbed sleep, weakness, nausea, anxiety, mild tremors

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3
Q

Alcohol Abstinence Syndrome Severe SEs:

A

Can last 5-7 days
Early:
cramping, vomiting, hallucinations, increased HR & BP, tremors, tonic-clonic seizures
Delirium Tremens (DT): severe hallucinations, incontinence, & severe tonic-clonic seizures; can lead to cardiovascular collapse and death!

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4
Q

CIWA:

A

Clinical Institute Withdrawal Assessment:
Identifies stage and severity of ETOH withdrawal
Assessment includes:
-N/V
-HR and Pulse rate
-Tremors
-Paroxysmal sweats
-Hallucinations (tactile, auditory, & visual)

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5
Q

CIWA score dictates (3):

A

1) what drug is used
2) the dose needed
3) the need for continued assessments

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6
Q

Goal of ETOH Withdrawal Management

A

Minimize the S/S of withdrawal
-calm the CNS stimulation
Want drugs with a longer duration of action (lorazepam)

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7
Q

3 Drugs Identified for Management of Sxs (Treatment) of Alcohol Abstinence Syndrome:

A

1) Benzodiazepines
- Lorazepam (Ativan)
2) Anti-epileptic drugs
- Carbamazepine (Tegretol)
3) BP meds
- Atenolol, Propanolol, clonidine

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8
Q

Alcohol Abstinence Syndrome & Benzodiazepines

A

MOST EFFECTIVE DRUG for ETOH withdrawal

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9
Q

Benzodiazepines MOA:

A

CNS Depression; Calm CNS stimulation by working on GABA

-prevent seizures and Delirium Tremens (DT)

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10
Q

Alcohol Abstinence Syndrome & Anti-epileptic Drugs:

A 
Carbamazepine (Tegretol)
CNS Depression (same as benzos)
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11
Q

Alcohol Abstinence Syndrome & BP Meds

A

Atenolol, Propanolol
Used as an Adjunct (PRN) for Sx management
-Improve VS (decrease BP & HR)
-decreased ETOH cravings

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12
Q

Alcohol Abstinence Syndrome & Clonidine

A

Alpha-agonist BP med used for Sx management

Decrease autonomic aspects of withdrawal

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13
Q

Drugs for ETOH Abstinence:

A

1) Disulfiram (Antabuse)

2) Naltrexone (Re Via, Vivitrol)

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14
Q

Disulfiram (Antabuse)

A

Moderately effective for ETOH abstinence

Terrible Sx may occur if ETOH is consumed

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15
Q

Disulfiram (Antabuse) SEs:

A

If ETOH is consumed: N/V, flushing, palpitations, HA, diaphoresis, polydipsia, weakness, blurred vision, HYPOTENSION

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16
Q

Disulfiram (Antabuse) Patient Teaching:

A

Stays in system for up to 2 weeks;
AVOID ETOH and ETOH-containing products
(mouth wash, vanilla extract, lotions, colognes, etc.); 7 mLs of ETOH can cause a reaction

17
Q

Naltrexone (Re Via, Vivitrol) & ETOH

A

STRONGLY effective for ETOH abstinence

Pure Opioid Antagonist
-Blocks dopamine release, blocking the pleasure from drinking
DECREASES CRAVINGS

18
Q

Naltrexone (Re Via, Vivitrol) Administration & Considerations:

A

Dosing: single PO dose, or monthly depot IM injection

Works better in younger populations
Works best in conjunction with supportive therapy

19
Q

Nicotine Withdrawal Onset & Duration:

A

onset within 24 hours

Can last for weeks/months

20
Q

Nicotine Withdrawal S/S

A

Cravings, nervousness, restlessness, irritability, impatience, increased hostility, insomnia, impaired concentration, increased appetite, and weight gain

21
Q

1st Line Agents for Nicotine Cessation:

A

Nicotine Type:
-patch, gum, lozenge, nasal spray, inhaler

Non-nicotine Type:

1) Varenicline (Chantix)
2) Bupropion SR (Zyban)

22
Q

The 2 Best Methods for Nicotine Cessation Therapy:

A

1) Varenicline (Chantix) used alone
OR
2) Patch + short-acting nicotine product (gum, nasal spray, lozenge)

23
Q

Nicotine Replacement Therapy:

A

Giving nicotine in small doses that are slowly decreased over time

  • Less pleasure rec’d than with cigarettes
  • Takes away the symptoms of withdrawal

Recommended combo therapy:

1) Patch
2) short-acting product (gum or nasal spray)

24
Q

Nicotine Gum Special Considerations:

A

Dosing is dependent on their use from the time they wake up and use nicotine
Patient teaching:
-only use for 6 months
-only chew intermittently to control release of nicotine

25
Q 
Bupropion SR (Zyban) 
What is it? and SEs?
A

Atypical antidepressant (same as Welbutrin)
-structurally similar to amphetamines
SEs:
dry mouth, insomnia, weight loss

26
Q

Bupropion SR (Zyban) & Nicotine Cessation

A

Lower doses are used for smoking cessation

REDUCES URGE TO SMOKE and decreases withdrawal Sxs

27
Q

Varenicline (Chantix)

What is it? SEs?

A 
Partial Agonist on nicotinic receptors
SEs:  
Nausea, sleep disturbances, HA; 
Neuropsychiatric effects (suicide risk!) 
Cardiovascular effects (angina, HTN, MI)
28
Q

Varenicline (Chantix) & Nicotine Cessation

A

MOST EFFECTIVE

-blocks activation of the nicotinic receptors that promote the release of dopamine

29
Q

Opioid Withdrawal Onset & Duration:

A

~10 hours after the last dose

Can last 7-10 days

30
Q

Opioid Withdrawal S/S:

A

Early: (10 hours after last dose)
Yawning, rhinorrhea, sweating

Anorexia, irritability, tremor, and ”gooseflesh”

At worse:
Violent sneezing, weakness, N/V/D, abdominal cramps, bone and muscle pain, muscle spasms, kicking movements

31
Q

Is Opioid Withdrawal Dangerous?

A

NO; Unpleasant but not dangerous

32
Q

Drugs for LT Management of Opioid Addiction:

A

1) Opioid Agonist
- Methadone
2) Opioid agonist-antagonist
- Buprenorphine (Suboxone)
3) Opioid Antagonist
- Naltrexone (Re Via, VIvitrol)

33
Q

Opioid Agonist (Methadone) for Opioid Addiction

A

Used as “maintenance” for people not ready to come off of opioids completely

No opioid withdrawal or opioid-induced euphoria
Creates a high degree of tolerance;
taking a street drug can’t produce the desired effect (Less likely to seek them)

Once-a-day, low dosing (long half-life)
-Has to be delivered by an approved treatment program

Same patient teaching as with opioids

34
Q

Buprenorphine (Suboxone) & Opioid Addiction:

A

Partial agonist (mu receptors); Full antagonist (kappa receptors)

  • Suppress opioid cravings
  • High doses can block opioid-induced euphoria
  • Ceiling to resp. depression (safer than methadone*)

Can be sublingual and buccal

35
Q

buprenorphine (Suboxone) + Naloxone

A

buprenorphine + naloxone

Mixed with naloxone to discourage IV drug abuse.

36
Q

Naltrexone for Opioid Addiction

A

Pure Opioid Antagonist
Used AFTER detox (can cause withdrawal)
Blocks euphoria and Prevents opioid use

PO and IM (depot) formulations

NSG 313 (4 decks)

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