Substance Abuse Flashcards
What is the neurochemical basis for substance abuse?
- 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
What is the Use Continuum?
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)
What examples of Rx drugs that can be abused?
Opiods, stimulants (ADHD), CNS depressants, Tramadol
Examples of OTC drugs?
cough suppressants, sedative antihistamines, decongestants, laxatives, analgesics.
What is the most common mood altering drug in the world?
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
Withdrawal management of opioids
- usually not life threatening
- may require methadone if addition is long standing
- meds to manage withdrawal symptoms (cloneadine, buprenorphine)
Withdrawal management of benzodiazepine
- Generally involves gradually decreasing doses over time
Withdrawal management of stimulants
Behavioral management most important
Withdrawal management of alcohol
- 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
Medical interventions Medications for alcohol withdrawal
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
Withdrawal PT implications
- Not advised to perform exercises
- consulted with pt is not arousable or agitated
How does substance abuse affect the body?
- Overal decline in immune function
- Increase susceptibility to disease
- Enhanced by substance abuse related organ system pathologies
- risk of infections
how does substance abuse effect the cardiovascular system?
- 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)
How does substance abuse affect the Pulmonary system?
- Respiratory depression
- Impaired cough and gag reflex
- Aspiration
- Lung infections
- Pulmonary Edema
- Nasal Passageway infections
- Interstitial lung disease
How does substance abuse effect the GI system?
- Gastritis (stomach irritation)
- Esophageal cancer
- Decreased gastric and intestinal motility
- Malabsoption (water decreased)
- Cancers of GI tract
- Ischemic Colitis
- Constipation (small bowel Obstruction)
How does substance abuse effect the Hepatic system?
Alc
- Fatty liver, alcoholic hepatitis, Cirrhosis, Hepatic encephalopathy
Drug induced Liver injury
How does substance abuse effect the pancreatic system?
- Pancreatitis: chronic and acute
- Pancreatic cancer
How does substance abuse effect the Renal system?
- hypoatremia (hypovolemia (depletion from GI fluid losses)
- Renal tubular dysfunction
- Acute renal failure
What are the neurological effects of substance abuse?
- 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
What is korsakoff syndrome?
- 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
What is alcohol abuse related dementia?
Generally a dx of exclusion
Hx of chronic alcohol use, 10 years younger than those with Alzheimer’s
What is substance abuse psychosis?
- 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
Describe disorders of movement with substance abuse
- 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)
Peripheral nervous system disorders
- 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
