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Complex Pt Management > Substance Abuse > Flashcards

Substance Abuse Flashcards

1
Q

What is the neurochemical basis for substance abuse?

A
  • Neurochemical changes accumulate with time
  • excess dopamine induced by the drug causes reinforcement of pleasure
  • Brain adjust to excess dopamine, thus causing tolerance to the drug
  • Escalating amounts of the drug needed to achieve the same effect
  • Combo of genetic, environmental and developmental factors
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2
Q

What is the Use Continuum?

A

Use - Can put children at risk of harm
Abuse - 1 in 12 months (failure to fulfill obligations at work, physically hazardous situations, illegal problems, continued social or interpersonal problems)
Dependence - 1 symptom in 12 months (needs more for “high”, withdrawal, longer amounts over period of time, unsuccessful to cut down, time spent obtaining, continued despite knowledge)

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3
Q

What examples of Rx drugs that can be abused?

A

Opiods, stimulants (ADHD), CNS depressants, Tramadol

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4
Q

Examples of OTC drugs?

A

cough suppressants, sedative antihistamines, decongestants, laxatives, analgesics.

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5
Q

What is the most common mood altering drug in the world?

A

Caffeine - 30mg or less can alter self reports of mood and affect behavior

  • 100mg/day can lead to physical dependence/withdrawal symptoms
  • Medicinal products w/ caffeine
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6
Q

Withdrawal management of opioids

A
  • usually not life threatening
  • may require methadone if addition is long standing
  • meds to manage withdrawal symptoms (cloneadine, buprenorphine)
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7
Q

Withdrawal management of benzodiazepine

A
  • Generally involves gradually decreasing doses over time
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8
Q

Withdrawal management of stimulants

A

Behavioral management most important

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9
Q

Withdrawal management of alcohol

A
  • symptoms may appear w/in 6-24 hours, most severe after 36-72
  • Goals: Control agitation, decrease risk of seizures, decrease risk of injury and death
  • ICU or locked IP ward
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10
Q

Medical interventions Medications for alcohol withdrawal

A

Check Lab values of electrolytes, pancreatic enzymes, hematocrit, platelets, and liver function

  • Supportive care with frequent vital signs
  • Medications: IV thiamine, meds to control agitaiton, IV Benzodiazepine, Antipsychotics
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11
Q

Withdrawal PT implications

A
  • Not advised to perform exercises

- consulted with pt is not arousable or agitated

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12
Q

How does substance abuse affect the body?

A
  • Overal decline in immune function
  • Increase susceptibility to disease
  • Enhanced by substance abuse related organ system pathologies
  • risk of infections
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13
Q

how does substance abuse effect the cardiovascular system?

A
  • Cardiomyopathy (heart muscles from alc = HF)
  • Cardiovascular disease (Risk of MI, CVA, PVD)
  • Arrhythmias (imbalanced calcium in cellular levels)
  • Endocarditis or heart Valve infection (from needles)
  • HTN (doubled by alcoholism)
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14
Q

How does substance abuse affect the Pulmonary system?

A
  • Respiratory depression
  • Impaired cough and gag reflex
  • Aspiration
  • Lung infections
  • Pulmonary Edema
  • Nasal Passageway infections
  • Interstitial lung disease
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15
Q

How does substance abuse effect the GI system?

A
  • Gastritis (stomach irritation)
  • Esophageal cancer
  • Decreased gastric and intestinal motility
  • Malabsoption (water decreased)
  • Cancers of GI tract
  • Ischemic Colitis
  • Constipation (small bowel Obstruction)
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16
Q

How does substance abuse effect the Hepatic system?

A

Alc
- Fatty liver, alcoholic hepatitis, Cirrhosis, Hepatic encephalopathy
Drug induced Liver injury

17
Q

How does substance abuse effect the pancreatic system?

A
  • Pancreatitis: chronic and acute

- Pancreatic cancer

18
Q

How does substance abuse effect the Renal system?

A
  • hypoatremia (hypovolemia (depletion from GI fluid losses)
  • Renal tubular dysfunction
  • Acute renal failure
19
Q

What are the neurological effects of substance abuse?

A
  • Direct influence on CNS/PNS
  • Changes in structure CNS PNS
  • Other organs (nutritional deficiencies , toxic accumulation of byproducts normally eliminated through other organ systems
  • trauma caused during intoxication
20
Q

What is korsakoff syndrome?

A
  • due to lack of thiamine
  • Associated w/ long term alcohol use
  • Progression from untreated Wernicke syndrome
  • Amnestic syndrome characterized w/ impaired recent memory and relatively intact intellectual function
21
Q

What is alcohol abuse related dementia?

A

Generally a dx of exclusion

Hx of chronic alcohol use, 10 years younger than those with Alzheimer’s

22
Q

What is substance abuse psychosis?

A
  • Characterized by delusions and hallucinations, commonly with mental illness
  • More common w/ Methamphetamines, cannabis, cocaine, alcohol,
  • May wear off after use is stopped by some persist after long term use
23
Q

Describe disorders of movement with substance abuse

A
  • Stroke - cerebral atrophy, CVA < 35 years w/ cocaine, amphetamines, MDMA, LSD, PCP
  • Cerebellar degernation - Chronic alcohol use , brad based unstable gait, incoordination, upper limbs rarely involved
  • Transient chorea/buccolingual dyskinesias (crack dancing, self limiting mvmovents, non life threatening
  • Tremors (withdrawal symptoms)
24
Q

Peripheral nervous system disorders

A
  • Peripheral neuropathy (chronic alcohol use, symmetrical, bilateral mixed sensory and motor types, may appear asymptomatic, may have muscle weakness, diminished tendon reflexes)
  • Automatic neuropathy
    (chronic alcohol use, impairs control of BP, HR, sweating, bowel and bladder emptying
25
Q

What is Wernicke’s encephalopathy?

A
  • Thiamine deficiency
  • Bleeding in the brainstem/hypothalamus
  • Presentation: progressive external ophthalmoplegia, horizontal nystagmus, bilateral rectus palsy, ataxia, confusion, disorientation,, can progress to paralysis.
  • Prevention and treatment = thiamine replacement
26
Q

PT Interventions for substance abuse?

A
  • Treat what you see!
  • Exercise can help substance abuse and withdrawal symptoms, anxiety, depression, abstinence rates, mood regulations, coping, stress reacitivty,

Complex Pt Management (12 decks)

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