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Psych Exam 2 > Substance Abuse > Flashcards

Substance Abuse Flashcards

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1
Q

substance use disorder

A

addiction

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2
Q

substance induced disorder and etc.

A

disorders associated with the use of substances

intoxication, withdrawal, delirium, neurocognitive disorder, psychosis, and can create other psychiatric conditions including anxiety, OCD, depression, psychosis, bipolar, sexual dysfunction and more

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3
Q

crucial part of how this develops
Pathologically pursuing reward and/or relief by substance use and other behaviors.

A

brain reward system

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4
Q

personal side effects to substance addiction

A

*Interferes with ability to fulfill role/obligations
*Attempts to cut down or control use fail
*Intense craving for the substance
*Excessive amount of time spent trying to
Procure substance
Recover from use
*Difficulty with interpersonal relationships or social isolation
*Engagement in risk taking activities when impaired
*Tolerance develops – amount required to achieve desired effect increases
*Substance specific symptoms occur upon discontinuation of use

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5
Q

a state of disturbance in cognition, perception, behavior, level of consciousness, judgement, and other functions that is directly attributable to the effects of a psychoactive drug

A

intoxication

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6
Q

reversible syndrome of symptoms after excessive use of substance
direct effect on CNS

A

substance intoxication

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7
Q

Abrupt reduction or discontinuation of a substance used regularly over a prolonged period of time

A

substance withdrawal

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8
Q

Clinically significant s/s as well as psychological changes such as disruption in thinking, feeling and behavior
Often substance specific features

A

substance-specific syndrome

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9
Q

substances for possible addiction

A

COFFEE, alcohol, cannabis, hallucinogens, inhalants, opioids, sedative-hypnotics, or anxiolytics, stimulants and tobacco or nicotine

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10
Q

biological factors as predisposing factors for substance use

A

genetics
biochemistry

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11
Q

psychological factors as predisposing factors for substance use

A

Developmental Influences
Cognitive Factors
Personality Factors
Sociocultural Factors
(Social Learning, Conditioning, Cultural and Ethnic Influences)

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12
Q

Phase I of alcohol use disorder

A

Pre-alcoholic Phase
Relieving everyday stress or tensions

Tolerance may build up and it takes one drink initially and later 2 or 3 to get the desired effect.

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13
Q

Phase II of alcohol use disorder

A

Early alcoholic phase
Blackouts

No longer a pleasure but a craving builds.
Blackouts are common. Sneaking drinks.
Guilt and defensiveness start to be common coping mechanisms.
Denial and rationalization common

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14
Q

phase III of alcohol use disorder

A

The crucial phase
Lost ability to choose whether to drink
Extremely ill

No longer a pleasure but a craving builds. Blackouts are common. Sneaking drinks. Guilt and defensiveness start to be common coping mechanisms. Denial and rationalization common
Phase III: Lost control of use completely and addiction is evident. Binge drinking for hours or days even occurs. Individual is very ill in this phase. Anger and aggression are common manifestations. Drinking is the sole focus and the person is willing to risk everything for the drink. Often in this phase, loss of job, marriage, family, friends and self-respect are noted.

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15
Q

phase IV of alcohol use disorder

A

The chronic phase
Emotional and physical disintegration
Helplessness and life-threatening physical

Emotional and physical disintegration. Person is usually intoxicated more often than not and emotional disintegration is evidenced by profound helplessness and self-pity. Impaired reality testing may result in psychosis. Withdrawal triggers symptoms of hallucinations, tremors, convulsions, severe agitation, and panic.

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16
Q

Nerve damage resulting in pain, burning, tingling, prickly sensation in extremities.
due to vit B deficiency

A

peripheral neuropathy

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17
Q

B vitamin deficiency mediated effects of alcohol

possible symptoms:

A

alcoholic myopathy

sudden onset of pain in muscles, swelling, weakness and myoglobinuria

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18
Q

Most serious form of Thiamine deficiency.

A

Wernicke’s encephalopathy

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19
Q

Syndrome of confusion, loss of recent memory, and confabulation.

A

Korsakoff’s Psychosis

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20
Q

physiologic effects of alcohol

A

esophagitis
esophageal varices
alcoholic cardiomyopathy
gastritis
pancreatitis
alcoholic hepatitis
leukopenia
thrombocytopenia
sexual dysfunction

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21
Q

End stage of alcohol liver disease and results from long-term chronic alcohol abuse. Widespread liver destruction replaced by fibrous (scar) lesions.

A

cirrhosis of the liver

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22
Q

complications of cirrhosis of the liver

A

Portal Hypertension
Ascites
Esophageal Varices
Hepatic Encephalopathy

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23
Q

alcohol intoxication in blood alcohol levels

A

between 100-200

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24
Q

Within 4-12 hours of cessation of or reduction of alcohol in heavy/prolonged alcohol use

A

alcohol withdrawal

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25
Q

priority interventions for alcohol withdrawal

A

Help the client express their feelings directly and openly for 30 min at least twice a day
Engage in self-evaluation to describe strengths and areas that support or development is needed and use journaling daily to record.
Verbalize their process for solving problems to staff
Practice nonchemical alternatives to dealing with acute stress and difficult situations with the goal of identifying and practicing at least three skills during their inpatient stay.

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26
Q

implementation of skills for alcohol withdrawal

A

Focusing on the here and now and what the client can do to redirect their behavior and life
Guide the client to the conclusion that sobriety is a choice they can make
If self-evaluation identified areas in which the patient needs support and development, ensure that resources are arranged upon discharge for this to happen
Validate when the patient is able to problem solve more clearly and help the client find acceptable ways to express feelings with positive reinforcement as they practice these techniques.

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27
Q

sedative/hypnotic use disorder drugs

A

Barbiturates
Nonbarbiturate hypnotics
Antianxiety agents
Club Drugs

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28
Q

examples of barbiturates

A

phenobarbital

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29
Q

examples of nonbarbiturate

A

Estazolam, Restoril, Halcion, Lunesta, Zolpidem or Ambien – referred to as sleepers

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30
Q

examples of antianxiety agents

A

Xanax, Clonazepam, Diazepam, Lorazepam are most common. Green and white pills. Color often helps determine dose.

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31
Q

examples of club drugs

A

Flunitrazepam, GHB commonly called Roofies, Liquid X, GHB, and rope or Rohypnol

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32
Q

One drug results in lessened response to other drugs

A

cross tolerance

33
Q

One drug can prevent withdrawal symptoms related to physical addiction to another drug

A

cross-dependence

34
Q

effects of sedatives and anxiolytics on the body

A

Sleep and dream
Respiratory depression
Cardiovascular effects
Renal function
Hepatic effects
Body temperature
Sexual dysfunction

35
Q

timing of symptoms for short acting sedatives

A

symptoms can begin in 12-24 hours and peak at 24-72 hours finally subsiding at 5-10 days

36
Q

timing of symptoms for sedatives with longer half-lives

A

it may take 2-7 days for symptoms to start and they peak at day 5-8 but subside after 10-16 days.

37
Q

symptoms of autonomic hyperactivity

A

(sweating and pulse greater than 100), increased hand tremors, insomnia, nausea, vomiting, hallucinations, illusions, psychomotor agitation, anxiety, and seizures and delirium

38
Q

psychomotor stimulation

A

Augmentation or potentiation of norepinephrine, epinephrine or dopamine

39
Q

stimulants effects on the body

A

CNS System (Tremor, restlessness, insomnia and agitation)
Cardiovascular/Pulmonary
(Increased BP, HR, Arrythmias
Relax bronchial smooth muscles)
Gastrointestinal and Renal
(Constipation and difficulty urinating)
Sexual Dysfunction
(Increased urges)

40
Q

signs of amphetamine and cocaine intoxication

A

Euphoria, impaired judgement, confusion and changes in vital signs
Coma and Death possible

41
Q

signs of caffeine intoxication

A

jittery and shaky
Restlessness and insomnia common

42
Q

withdrawal symptoms of Amphetamine and cocaine withdrawal:

A

Dysphoria, fatigue, sleep disturbances and increased appetite

43
Q

symptoms of caffeine withdrawal

A

Headaches, fatigue, drowsiness, irritability, muscle pain/stiffness, nausea and vomiting

44
Q

nicotine withdrawal symptoms

A

Dysphoria, anxiety, difficulty concentrating, irritability, restless, increased appetite

45
Q

cues for stimulant withdrawal

A

agitation, mood swings, disorientation, seizures, hallucinations, physical pain and discomfort, hostile behavior, uncooperative, disturbance in concentration, attention span or ability to follow direction

46
Q

priority nursing interventions for pt with stimulant withdrawal

A

Safety of the patient – keep free of injury
Reduce aggression and hostile behaviors
Respond to reality orientation
Verbalize and express fear and/or anxiety

47
Q

possible implementation for pt with stimulant withdrawal

A

It may be necessary to assign patient to 1:1 or closer observation
Seizure precautions may be needed
Decrease environmental stimuli when the client is agitated – may need time in their room
Avoid lengthy interactions
Keep your voice soft even when they are loud
Speak clearly – which is hard with a mask on – but this is a frustration for many patients
Do not moralize or chastise the client for substance abuse. Maintain a nonjudgmental attitude
Talk to the patient in simple concrete language
Reorient the patient as needed when they become confused.

48
Q

cannabis use effects on the body

A

Cardiovascular
Respiratory
Reproductive
CNS
Sexual Functioning

49
Q

signs of cannabis intoxication

A

Impaired motor coordination, euphoria, anxiety, sensation of slowed time, and poor judgement
Conjunctival injection, increased appetite, dry mouth, tachycardia
Impaired motor skills 8-12 hours

50
Q

signs of cannibas withdrawal within the week of cessation

A

Irritability, anger, or aggression
Nervousness, restlessness, or anxiety
Sleep difficulty ( insomnia, disturbing dreams)
Decreased appetite or weight loss
Depressed mood
Physical symptoms such as abdominal pain, tremors, sweating, fever, chills, or headache

51
Q

cues for cannabis withdrawal

A

Frequent use, denial of implications of substance use, exacerbation of symptoms, failure to keep appointments, poor impulse control, incongruence between therapeutic regimen and personal values or desires, knowledge deficit or skill deficit, lack of motivation for change.

52
Q

priority nursing interventions for cannabis withdrawal

A

Verbalize the need for compliance with treatment plan
Take medications as directed
Identify difficulties associated with substance use
Refrain from substance use

53
Q

implementation for cannabis withdrawal

A

Discuss pattern of relapse in a non-judgemental manner
Encourage the client to ask questions if they are uncertain about treatment plan
If patient is having symptoms such as difficulty sleeping, encourage them to tell staff as they might be symptoms we can assist with
Give positive feedback for honest reporting and recognize progress no matter how small

54
Q

plans of care for cannabis withdrawal

A

Patient will verbalize knowledge of substance abuse as a disease
Patient will verbalize risks related to drug ingestion
Patient will accept referral for treatment outpatient with appointments set prior to discharge
Patient will abstain from the use of substances

55
Q

opioid use disorder effects on the body

A

CNS Effects
Euphoria, drowsiness, mental clouding
Gastrointestinal Effects
Decreased peristaltic activity
Cardiovascular Effects
Hypotension
Sexual Functioning Effects
Decreased functioning
Decreased libido

56
Q

s/s of opioid intoxication

A

Consistent with the half-life of most opioid drugs
Usually last for several hours
Initial Euphoria followed by apathy, dysphoria, psychomotor agitation or retardation, and impaired judgement

57
Q

SEVERE opioid intoxication signs

A

resp depression
coma
death

58
Q

short acting opioid withdrawal symptom timing

A

Symptoms occur within 6-8 hours, peak within 1-3 days and gradually subside 5-10 days

59
Q

long acting opioid withdrawal symptoms occur when

A

Symptoms occur within 1-3 days, peak between 4-6 days and subside in 14-21 days

60
Q

ultra short acting opioid withdrawal symptoms occur when

A

Symptoms begin quickly, peak 8-12 hours and subside in 4-5 days

61
Q

opioid withdrawal symptoms:

A

Dysphoria
Muscle aches
Nausea/Vomiting
Lacrimation (tearfulness) or rhinorrhea
Pupillary dilation
Piloerection (goose bumps)
Sweating
Abdominal cramping
Diarrhea
Yawning
Fever
Insomnia

62
Q

steps to the nursing assessment for a pt dealing with addiction

A

Examine your feelings, attitudes, and personal experiences and bias
Motivational Interviewing techniques
Drug history and assessment
Become comfortable asking hard questions without judgement
Clinical Institute Withdrawal Assessment for Alcohol Scale or CIWA
CAGE Questionnaire for assessment of alcohol use disorder
Clinical Opiate Withdrawal Scale or COWS

63
Q

CAGE alcoholism screening

A

-Concern by the person that there is a problem
-Apparent to others that there is a problem
-Grave consequences
-Evidence of dependence or tolerance

64
Q

questions of the CAGE alcoholism screening

A

-have you ever felt that you should CUT down on the drinking?
-have you ever become ANNOYED by criticisms of your drinking?
-have you ever felt GUILTY about your drinking?
-have you ever had a morning EYE OPENER to get rid of a hangover?

65
Q

Coexisting substance disorder and mental health disorder

A

dual diagnosis

66
Q

program combing cognitive and behavioral disorders

A

CBT

67
Q

Desired clinical outcomes for nursing interventions include “the client”:

A

Has not experienced physical injury
Has not caused harm to self or others
Verbalizes responsibility for behavior
Demonstrates adaptive coping mechanisms they can use in stressful situations
Shows no signs of infection or malnutrition
Verbalizes importance of abstaining from use of substances to maintain optimal wellness

68
Q

evaluation of pt recovering from substance use disorder

A

Has detox occurred without complication?
Is the patient still in denial?
Does the patient accept responsibility for their own behaviors?
Has a correlation been made between personal problems and substance use?
Does the client still make excuses or blame others for their substance use?
Has the client remained substance free during treatment?

69
Q

therapy options for substance use disorders

A

Various support groups patterned after AA, but for individuals with problems with other substances too
Counseling individually or with family
Group Therapy
CBT often used

70
Q

Major Self-Help organization for treatment of alcoholism

A

Alcoholics Anonymous or AA

71
Q

12 step process for AA

A

Specific guidelines on how to attain and maintain sobriety with tokens for duration of abstinence

72
Q

may be required to reduce life-threatening effects including seizures associated with withdrawal

A

substitution therapy

73
Q

pharmacotherapy for alcohol withdrawal

A

ativan protocols - benzos
anticonvulsants
multivitamin therapy
thiamine (Vit B)
Disulfiram (Antabuse)
gabapentin

SSRI’s
Acamprosate (Campral)
Naltrexone
Nalmefene

74
Q

narcotic antagonists

A

Naloxone or Narcan
Naltrexone or RiVia
Nalmefene or Revex

75
Q

narcotic antagonists

A

Naloxone or Narcan
Naltrexone or RiVia
Nalmefene or Revex

76
Q

opioids

A

Methadone
Buprenorphine or Suboxone
Clonidine

77
Q

depressants

A

Phenobarbital (Luminal)
Long-acting Benzodiazepines

78
Q

stimulants

A

Minor and Major Tranquilizers
Anticonvulsants
Antidepressants

Psych Exam 2 (9 decks)

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