Substance Abuse Flashcards
1
Q
What is addiction?
A
A strong need to use a substance
2
Q
Phases of Addiction
A
- The Prealcoholic Phase
- The Early Alcoholic Phase
- The Crucial Phase
- The Chronic Phase
3
Q
The Prealcoholic Phase
A
- Characterized by using alcohol to relieve everyday stress and tensions of life
- Parents may have provided modeling to the person as a child
- Tolerance develops, therefore the amount desired to achieve the desired effects steadily increases
- The first phase of addiction
4
Q
The Early Alcoholic Phase
A
- Begins with blackouts (anterograde amnesia)
- Drinking is no longer a sense of pleasure, but a requirement
- Behaviors: secret drinking, hiding the alcohol, rapid consumption of drinks
- Feels an overwhelming sense of guilt, and defensiveness about his/her drinking
- Defense Mechanism: Denial and Rationalization
- The second phase of addiction
5
Q
The Crucial Phase
A
- Loss of control. Can no longer make the choice whether or not to drink
- The person is very ill. Have episodes of sickness, loss of consciousness, squalor, and degradation
- Drinking is the total focus and is willing to risk losing everything to maintain the addiction
- Defense Mechanism: Anger and Aggression
- The third phase of addiction
6
Q
The Chronic Phase
A
- Emotional and physical disintegration
- Person is intoxicated more than sober
- Evidenced by a deep helplessness and self-pity; may result in psychosis
- Physical manifestations can be life-threatening (as it effects every system of the body)
- Abstaining results in hallucinations, tremors, convulsions, severe agitation, and panic
- Depression and suicidal thought are not unusual
- The fourth phase of addiction
7
Q
Cultural Influences on Alcohol
A
One’s culture helps to establish patterns of substance abuse. This is done by molding attitudes, influencing patterns of consumption based on cultural acceptance, and the availability of the substance
8
Q
Alcohol’s Effects: Italians and French
A
- Have a low dependency of alcohol
- Tend to have a “healthier” perception
- Exposure at an early age and the influence of moderation by parents at an early age are believed to be the reason of low dependency
9
Q
Alcohol’s Effects: Native-Americans
A
- Have a high dependency rate of alcoholism
- Due to social and cultural influences, genetics, and personal attitudes
- Death rate is seven times higher than non-Native Americans
10
Q
Alcohol’s Effects: Northern Europeans vs Southern Europeans
A
- Northern Europeans have a higher incidence of alcoholism than Southern Europeans
- Example: Irish - influence of Pubs, holidays that encourage drinking (St. Patrick’s Day)
11
Q
Alcohol’s Effects: Asians
A
- Asians have a low incidence of alcoholism
- Recent research indicates that it may be related to genetics and how alcohol is consumed
- Many experience unpleasant symptoms when alcohol is consumed
12
Q
Alcohol’s Physical Effects on the Body (chronic use)
A
- Peripheral neuropathy
- Alcoholic myopathy
- Wernicke’s encephalopathy
- Korsakoff’s Psychosis
- Alcoholic Cardiomyopathy
- Cirrhosis
13
Q
Chronic Alcohol Use: Peripheral Neuropathy
A
- Pain, burning, tingling, or prickly sensations of the extremities
- Believed to be a lack of B-vitamins (particularly thiamine B1)
14
Q
Chronic Alcohol Use: Alcoholic Myopathy
A
Thought to be a result of vitamin B deficiency - especially thiamine
15
Q
Alcoholic Myopathy Treatment
A
- Abstain from alcohol
- Vitamin supplements
- Nutritious diet
16
Q
Chronic Alcohol Use: Wernicke’s encephalopathy
A
- Most serious form of thiamine deficiency
It causes brain damage in lower parts of the brain (thalamus and hypothalamus). If not replaced quickly, will result in death
17
Q
Wernicke’s Encephalopathy Symptoms
A
- Paralysis of ocular muscles
- Diplopia
- Ataxia
- Somnolence
- Stupor
18
Q
Chronic Alcohol Use: Korsakoff’s Psychosis
A
- This tends to develop as Wernicke’s symptoms disappear
- Korsakoff’s psychosis results from damage to the area of the brain involved with memory
- Wernicke’s encephalopathy and Korsakoff’s psychosis are usually paired together and known as Wernicke-Korsakoff syndrome
19
Q
Chronic Alcohol Use: Alcoholic Cardiomyopathy
A
Due to an accumulation of lipids in the myocardial cells, causing enlargement and weakened heart
20
Q
Chronic Alcohol Use: Cirrhosis
A
It occurs at the end of alcoholic liver disease resulting from long-term chronic alcohol abuse. There is wide spread destruction of liver cells which are replaced by fibrous scar tissue
21
Q
Complicated Withdrawal Syndrome
A
- Also known as Delirium Tremors (DTs)
- May progress to alcohol withdrawal delirium, which usually occurs on the 2nd or 3rd day following cessation or reduction
- These symptoms may last 48-72 hours and is considered a medical emergency
- This type of withdrawal may progress to death
22
Q
Symptoms of Alcohol Withdrawal
A
- Coarse tremor of hands, tongue, or eyelids
- N/V
- Malaise or weakness
- Tachycardia
- Sweating
- Increased blood pressure
- Anxiety, depressed, or irritable mood
- HA
- Insomnia
23
Q
Symptoms of Complicated Withdrawal Syndrome
A
- Symptoms of alcohol withdrawal
- Hallucinations
- Seizures
- Stroke level blood pressure
- Delirium (confusion, excitement, disorientation, clouding of consciousness)
24
Q
Screening for Alcohol Abuse
A
CAGE
C - Have you ever felt life you should cut down on your drinking
A - Have people annoyed you by criticizing your drinking?
G - Have you ever felt bad or guilty about your drinking?
E - Have you ever had a drink first thing in the morning to steady your nerves or to get rid of a hangover (eye opener)?
25
What is a very important thing to remember about the treatment of alcoholism?
Not only is the client responsible for this, but the client must also address issues with self-esteem. Self-esteem issues are just as important as accepting responsibility and accepting one's own actions.
26
Alcoholics Anonymous
Is the original 12-step program which was built on the foundation that support and encouragement from others with alcoholism provides support and reinforcement to those on the road to recovery. It is considered the most effective treatments of alcoholism. AA provides members with patience, empathy, and understanding. Members have their dependent needs met while helping others.
* AA promotes that total abstinence is the only cure
27
Other Treatment Groups for Alcoholism
1. Al Anon
2. Al-a Teen
3. ACOA (Adult Children of Alcoholics)
28
Al-Anon
Support group for spouses and friends of individuals with alcoholism
29
Al-a Teen
A nationwide support group for teens (children over 10 years of age) who have alcoholic parents
30
ACOA
Adult Children of Alcoholics
| Support group for adults who were raised in alcoholic homes
31
Medications for Alcohol Detoxification
1. Chlordiazepoxide
2. Lorazepam
3. Diazepam
32
Chlordiazepoxide Classification
Anxiolytic, Benzodiazepine
| ** Used for alcohol detoxification
33
Chlordiazepoxide Route
PO
34
Chlordiazepoxide Dosages
5, 10, 25 mg
35
Chlordiazepoxide Contraindications
1. Glaucoma or a predisposition for glaucoma
2. COPD or other respiratory problems
3. Muscle problems
4. Depression
5. Suicidal tendencies
6. Porphyria (hematological disorder)
7. Pregnancy (can cause harm to fetus)
36
Lorazepam Classification
1. Anxiolytic
2. Benzodiazepine
3. Sedative-Hypnotic
* * Used for alcohol detoxification
37
Lorazepam Route
PO, IM, IV
38
Lorazepam Dosages
PO: 0.5, 1, 2 mg
| IM/IV: 2, 4 mg/mL
39
Lorazepam Contraindications
Do not give with alcohol, with depressed vital signs, or pregnancy
40
Diazepam Classification
1. Benzodiazepine
2. Antiepileptic
3. Skeletal muscle relaxant
41
Diazepam Route
PO, Rectal, IM, IV
42
Diazepam Dosages
PO: 2.5, 10, 20 mg
Rectal: 2.5, 5, 10, 20 mg
IM/IV: 5 mg
43
Diazepam Contraindications
1. Pregnancy (can cause cleft lip, cleft palate)
2. Glaucoma
3. Asthma, or other respiratory problems
4. Kidney problems
5. Myasthenia gravis.
6. Also do not use ETOH with diazepam (can increase the effects)
44
Medications Following Alcohol Detoxification
1. Naltrexone
2. Disulfram
3. MVI and thiamine (B1) and folic acid (B9) replacement
45
Naltrexone
A pure opioid antagonist that suppresses craving and pleasurable effects of alcohol
46
Naltrexone: Side Effects
1. Insomnia
2. Anxiety
3. Muscle aches
4. Abdominal pain
5. Suicidal thoughts
6. Depression
7. Hepatoxicity
47
Naltrexone: Nursing Interventions
1. Assess patient's history to see if patient is also dependent on opioids
2. Inform patient to take with meals (as it causes GI distress)
3. IM injections can be administered if patient has difficult adhering to medication regimen
48
Disulfram
- This is a daily p.o. medication that is a type of aversion (behavioral) therapy.
- Should only be prescribed after the patient has detox’d d/t there is a severe hypersensitivity to alcohol.
- Patient should not have had anything containing ETOH (aftershave, mouthwash) within 12 hours. Makes the patient SEVERELY ILL (nausea, vomiting, weakness, palpitations, sweating, and hypotension).
- Med should not also be taken with metronidazole.
49
Disulfram Dosage
500 mg for 1-2 weeks; maintenance dose is 250 mg/day
50
Disulfram Side Effects
1. Severe headache
2. Sweating
3. Dry mouth
4. Flushing
5. Impotence
6. Metallic taste
7. Peripheral neuropathy
* ** Severe effects can include:
8. Optic neuritis
9. Arrhythmias
10. Seizures
11. Psychosis
12. Acute MI
13. Hepatitis
51
Disulfram Nursing Interventions
- Inform the patient of the potential dangers of drinking alcohol
- Advise to avoid any products that contain alcohol (cough syrups, aftershave lotion)
- Encourage to wear a medical alert bracelet
- Encourage the patient to participate in a 12-step program
52
Examples of Barbiturates
1. Phenobarbitol
2. Secobarbital
3. Amobarbital
53
Examples of Non-Benzodiazepines / Non-Barbiturate Hypnotics
1. Chloralhydrate
2. Triazolam
3. Temazepam
4. Zolpidem
54
Examples of Benzodiazepine Anti-anxiety Agents
1. Diazepam
2. Alprazolam
3. Lorazepam
4. Flunitrazepam
55
Non-Benzodiazepines
These medications are composed of a different chemical structure, but act on the same brain receptors as benzodiazepines. Believed to have less side effects and risk of dependency than benzos
56
Benzodiazepines
Common use includes treatment of anxiety, acute stress reactions, and panic disorders. Should not be prescribed for long-term use due to increased risk for development of tolerance, dependence, or addiction
57
Barbiturates
Not used as frequently to reduce anxiety or aid with sleep disorders due to there being an increased risk for overdose compared to benzos. However, they are used in surgical procedures and with seizure disorders
58
Effects of Sedative-Hypnotics: Sleep and Dream
Barbiturates decreases amount of sleep time spent with dreaming
59
Effects of Sedative-Hypnotics: Respiratory
Inhibits the reticular activating system resulting in respiratory depression
60
Effects of Sedative-Hypnotics: Cardiovascular
Has a hypotensive effect in large doses. With high doses of barbiturates, can cause decreased cardiac output, decreased cerebral blood flow and impairment of myocardial contractility
61
Effects of Sedative-Hypnotics: Renal
Suppress urine function (high doses enough to produce anesthesia). Usual doses do not
62
Effects of Sedative-Hypnotics: Liver
Jaundice (high doses) of barbiturates
63
Effects of Sedative-Hypnotics: Body Temperature
Decrease in body temperature (high doses)
64
Effects of Sedative-Hypnotics: Sexual Functioning
Causes a biphasic response. CNS depressants initially cause an increase in libido, and then are followed by a decrease in the ability to sustain an erection.
65
Sedative, Hypnotic, or Anxiolytic Intoxication
Intoxication behaviors include inappropriate sexual or aggressive behaviors, impaired judgment, slurred speech, unsteady gait, stupor or coma.
66
Sedative, Hypnotic, or Anxiolytic Intoxication Overdose Symptoms
Overdose symptoms include: n/v, shallow respirations, weak rapid pulse, coma or death.
67
Sedative, Hypnotic, or Anxiolytic Intoxication Potential Complication
Risk for Aspiration (overdose)
68
Medication that is used to detox from CNS depressants
Phenobarbital
A long acting anticonvulsant used to suppress withdrawal symptoms. Dosage required to suppress withdrawal symptoms is administered and once stabilized, dose is gradually decreased until withdrawn.
- When administered intravenous, infuse very slowly, (60mg/min); inject partial dose and observe for response.
- Nursing Intervention: monitor Phenobarbitol levels. Normal plasma levels 10-35µg/mL
69
CNS Stimulants
1. Amphetamines
2. Nonamphetamines stimulants
3. Cocaine
4. Caffeine
5. Nicotine
70
Amphetamine Examples
1. Dextroamphetamine
2. Methamphetamine
3. Amphetamine
71
Nonamphetamine Stimulants
1. Phendimetrazine
2. Benzphetamine
3. Methylphenidate
72
Amphetamines
- Many begin using these to control weight. - Also produce a pleasurable effect.
- Tolerance builds: therefore patient will increase dosage in order to maintain pleasurable effect. Eventually, effects diminish, and there is a corresponding increase in the dysphoric effects. Even though the person feels unpleasant side effects, there is a persistent craving for the drug.
73
Cocaine
- Potent vasoconstrictor.
- Medical uses: used in nasal surgery, eye surgery, used in combination with morphine in an elixir to give terminally ill patients who are experiencing chronic pain.
74
CNS Stimulants Effects on the Body: Central Nervous System
* Stimulates the CNS resulting in tremors, restlessness, anorexia, insomnia, increased motor activity.
- Amphetamines, non-amphetamine stimulants, and cocaine produce increased alertness, decreased fatigue, elation and euphoria. Chronic use may result in compulsive behavior, paranoia, hallucinations, and aggression
75
CNS Stimulants Effects on the Body: Cardiovascular/Pulmonary (Amphetamines)
- Increased BP
- Increased HR
- Cardiac arrhythmias
76
CNS Stimulants Effects on the Body: Cardiovascular/Pulmonary (Cocaine)
- Due to its vasoconstrictor effects, it causes a rise in myocardial demand for O2 and increases HR.
- PC: MI, V-Fib, and sudden death.
- Inhaled cocaine can cause pulmonary hemorrhage and pneumonia.
77
CNS Stimulants Effects on the Body: Cardiovascular/Pulmonary (Caffeine)
- Increase HR, palpitations, and cardiac arrhythmias.
| - Induces dilation of pulmonary and general systemic blood vessels and constriction of cerebral blood vessels
78
CNS Stimulants Effects on the Body: Cardiovascular/Pulmonary (Nicotine)
- Stimulates the sympathetic nervous system, resulting in increased HR, increased BP, and increased cardiac contractility.
- Contractions of gastric smooth muscles associated with hunger are inhibited—thereby producing a mild anorexic effect
79
CNS Stimulants Effects on the Body: GI and Renal (Amphetamines)
1. Constipation (d/t decrease in GI motility)
| 2. Urinary retention (d/t contraction of the bladder sphincter).
80
CNS Stimulants Effects on the Body: GI and Renal (Caffeine)
Increase in urination
81
CNS Stimulants Effects on the Body: GI and Renal (Nicotine)
Stimulates the hypothalamus to secrete ADH, therefore there is a decrease in urination and diarrhea as nicotine increases the tone and activity of the bowel
82
CNS Stimulant Intoxication: Amphetamine and Cocaine
1. Euphoria, anxiety, tension, anger, etc.
2. Physical effects include dilated pupils, perspiration or chills, increase or decrease in BP and HR, n/v, weight loss, respiratory depression, seizures, coma, etc.
83
CNS Stimulant Intoxication: Caffeine
1. Restlessness
2. Flushed face
3. Diuresis
4. Tachycardia
84
CNS Stimulant Withdrawal: Amphetamine and Cocaine
1. Dysphoria
2. Fatigue
3. Vivid and unpleasant dreams
4. Insomnia or hypersomnia
5. Increased appetite
85
CNS Stimulant Withdrawal: Caffeine
1. HA
2. Fatigue
3. Anxiety
4. Irritability
5. Depression
86
CNS Stimulant Withdrawal: Nicotine
1. Insomnia
2. Irritability
3. Decreased HR
4. Increased appetite or weight gain
87
Treatment for CNS Stimulant Withdrawal
1. Chlordiazepoxide
2. Haloperidol
3. Diazepam
4. Phentolamine
5. Amitriptyline
6. Protriptyline
7. Nortriptyline
88
Treatment for Nicotine Withdrawal
1. Bupropion
2. Nicotine gum
3. Nicotine patch
89
Examples of Inhalants
1. Fuel
2. Solvents
3. Adhesives
4. Aerosol propellants
5. Paint thinners
90
Inhalants Methods of Use
1. “huffing”—a procedure in which a rag is soaked with the substance is applied to the mouth and nose and the vapors are breathed in.
2. “bagging,” in which the substance is placed in a paper bag and inhaled from the bag by the user.
They are also inhaled directly from the container or sprayed in the mouth or nose.
91
Effects on the Body with Inhalant Use: CNS
1. Peripheral neuropathies
2. Generalized weakness
3. Cerebral atrophy
4. Cerebellar degeneration
92
Effects on the Body with Inhalant Use: Respiratory
1. Upper/lower airway irritation
2. Pulmonary hypertension
3. Coughing
4. Cyanosis
93
Effects on the Body with Inhalant Use: GI
1. Abdominal pain
2. N/V
3. Rash around the nose and mouth
4. Unusual odor of breath
94
Effects on the Body with Inhalant Use: Renal
Chronic renal failure
95
Effects on the Body with Inhalant Use: Sudden Sniffing Death
This is the result of prolonged periods of inhalant abuse. Can cause:
1. Arrhythmias
2. V-fib
3. Decreased cardiac output
4. Respiratory depression
5. Death
96
Treatment for Inhalant Use
Treatment for overdose is supportive which can include
- Outpatient therapy
- 12 step programs
- Support groups
- Inpatient rehabilitative program for severe addiction.
* * Treatment plan may include the use of B12 and folate for neuro symptoms
97
Opioids of Natural Origin
1. Opium
2. Morphine
3. Codeine
98
Opioid Derivatives
1. Heroin
2. Hydromorphone
3. Oxycodone
99
Synthetic Opiate-Like Drugs
1. Meperidine
2. Methadone
3. Propoxyphene
100
Opioid Effects on the Body: CNS
1. Euphoria
2. Mood changes
3. Mental clouding
4. Drowsiness
5. Reduction in pain
6. Pupillary constriction
7. Respiratory depression
8. Cough suppression
9. N/V
101
Opioid Effects on the Body: GI
1. Increased stomach and intestinal tone
2. Decreased peristalsis
3. Constipation
4. Fecal impaction can occur if the opioid use is chronic
102
Opioid Effects on the Body: Cardiovascular
Hypotension (in high doses)
103
Opioid Effects on the Body: Sexual Functioning
1. Decreased sexual pleasure
2. Indifference to sexual activity
3. Retarded ejaculation
4. Impotence
5. Orgasm failure
104
Opioid Intoxication: Behavioral or Psychological Symptoms
1. Initially euphoria
2. Then followed by apathy
3. Dysphoria
4. Psychomotor agitation or retardation
5. Impaired judgment
105
Opioid Intoxication: Physical Symptoms
1. Constricted pupils
2. Decreased BP
3. Drowsiness
4. Slurred speech
5. Psychomotor retardation
* * Severe intoxication can lead to respiratory depression, coma, and death
106
Meperidine Withdrawal
Begins quickly, peaks 8-12 hours, complete in 4-5 days
107
Heroin Withdrawal
Begins 6-12 after last dose, peaking 1-3 days, and gradually subside over4-5 days.
** Heroin addicts often shows visible signs of dilated pupils, panic, chills, muscle cramps, nausea, and profuse sweating.
108
Methadone Withdrawal
Begins 1-3 days after last dose, gradually completing in 10-14 days
* * Symptoms can occur within hours to days with Opioids--depending on the drug.
* * Symptoms include yawning, agitation, insomnia, irritability, rhinorrhea, muscle cramps, panic, n/v, fever, chills, bone pain, and lacrimation
109
Medications to Treat Opioid Withdrawal
1. Methadone
2. Levomethadyl
3. Clonidine
4. Subutex
110
Opioid Withdrawal Treatment: Methadone
Oral opioid that replaces the opioid to which the client is addicted
111
Opioid Withdrawal Treatment: Levomethadyl
Narcotic—similar in effect and side effects to morphine.
| ** Highly addictive and its use is similar to that of methadone
112
Opioid Withdrawal Treatment: Clonidine
Controls symptoms related to autonomic hyperactivity - N/V
| ** Watch for hypotension
113
Opioid Withdrawal Treatment: Subutex
Angonist-antagonist opioid
| ** Used for detox and maintenance (not commonly used)
114
Hallucinogens Examples
1. Mescaline
2. LSD
3. DMT
4. MDMA
5. PCP
115
Hallucinogens Effects on the Body: Physiological
1. N/V
2. Chills
3. Pupil dilation
4. Increased BP
5. Increased HR
6. Increased temp
7. Loss of appetite
8. Insomnia
9. Sweating
10. Decreased respirations
11. Increased BG
116
Hallucinogens Effects on the Body: Psychological
1. Heightened response to color, texture, and sounds,
2. Heightened body awareness
3. Visual distortion
4. Sense of slowing of time
5. Magnification of all feelings: love, lust, hate, joy, anger, pain, terror, despair, paranoia, euphoria, depersonalization, increased libido.
117
Toxic Reactions to Hallucinogens
1. Panic reactions (bad trip)
| 2. Flashbacks
118
Phencyclidine (PCP) Intoxication
1. Belligerence
2. Impulsiveness
3. Psychomotor agitation
4. Vertical or horizontal nystagmus
5. Altered perception of pain
6. Muscle rigidity
7. Seizures
8. Coma.
* * Usually will develop within an hour of use (less when it is smoked, snorted, or IV)
119
LSD Overdose S/Sx
1. Psychosis
2. Brain damage
3. Death
120
PCP Overdose S/Sx
1. Psychosis
2. Hypertensive crisis
3. Respiratory arrest
4. Hyperthermia
5. Seizures
121
Withdrawal of Hallucinogens
There is no withdrawal syndrome for hallucinogens although there are some that report cravings for the drug.
** Long term PC: flashbacks. These can occur long after all traces of the drugs are no longer present in the body and may persist up to 5 years.
122
Cannabis Effects on the Body: Cardiovascular
1. Tachycardia
| 2. Orthostatic hypotension
123
Cannabis Effects on the Body: Respiratory
1. Laryngitis
2. Bronchitis
3. Cough
4. Hoarseness
124
Cannabis Effects on the Body: CNS
1. Euphoria
2. Relaxed inhibitions
3. Disorientation
4. Depersonalization
5. Relaxation.
* * Higher doses:
6. Impaired judgment of time and distance
7. Impaired recent memory
8. Tremors
9. Conjunctival redness
125
Cannabis Effects on the Body: Sexual Functioning
1. Increased sexual satisfaction
| 2. Decreased inhibitions
126
Withdrawal of Cannabis
Length of acute detox is 2-3 days, as metabolites remain in the body for up to two weeks.
** Drug intervention is not usually required and there are minimal signs of withdrawal other than cravings, anxiety and restlessness
127
Common Drugs that are Abused by Healthcare Workers
1. Alcohol
2. Methamphetamines
3. Ecstasy
4. Cocaine/crack
5. Morphine
6. Hallucinogens
7. Ritalin
8. Demerol
9. Marijuana
10. Fentanyl
128
Signs that a Healthcare Professional is Abusing Drugs
1. Severe mood swings (this includes irritability or euphoria)
2. Elaborate excuses
3. Very defensive
4. Offering to administer another nurse’s narcotics/medications
5. Leaving off the floor several times during a shift
6. Excessive absences or working excessively
7. Wearing long sleeves to work
8. Controlled meds being administered on their shift more than other shifts
9. Visibly intoxicated, stumbling, drowsiness
10. Heavy wastage of drugs
11. Drugs and syringes in pockets
129
What to do if you suspect a nurse of abusing drugs?
Report it!!
