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mental health/psych > substance abuse (halter ch 22) > Flashcards

substance abuse (halter ch 22) Flashcards

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1
Q

3 major categories substance related disorders

A
  • substance use disorders
  • substance induced disorders
  • substance withdrawal disorders
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2
Q

psychoactive substances

A

DEPRESSANTS:
-alcohol

STIMULANTS:

  • caffeine
  • meth
  • cocaine
  • dexedrine

TOBACCO:
-cannabis

HALLUCINOGENS
INHALANTS
OPIOIDS 
-percocet
-heroine
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3
Q
  • Disease of dysregulation in the hedonic pathways of the brain
  • Progressive and leads to disability
A

addiction

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4
Q

using a substance to excess

A

intoxication

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5
Q

No longer respond to a drug (less impact) than

when initially used

A

tolerance

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6
Q

syndrome that occurs when a person stops

using a drug

A

withdrawal

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7
Q

5 schedules of drugs

A
  • schedule 1: high potential for abuse, no medical use
  • schedule 2: high potential for abuse, need Rx
  • schedule 3: moderate potential for abuse, need Rx
  • schedule 4: low risk for abuse, need Rx
  • schedule 5: low risk for abuse, OTC
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8
Q

addiction DSM 5 criteria (Time 2 CUT DOWN PAL)

A

Time spent

(2 or more in 12 month period)

Cravings
Unable to stop
Tolerance

Dangerous
Others affected
Withdrawal
Neglects responsibilities

Problems made worse
Activities stopped
Larger amounts or for longer

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9
Q

gambling disorder criteria (6)

A
  • need to gamble with increasing amounts $
  • irritable when trying to cut down/stop
  • lies to conceal extent
  • preoccupied with gambling
  • “chasing” one’s losses
  • relies on others for $
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10
Q

examples schedule one drugs

A

meth

heroine

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11
Q

physical adverse effects alcohol

A
  • peripheral neuropathy
  • wernicke-korsakoff syndrome
  • alcohol dementia
  • sleep disturbance
  • cardiomyopathy
  • esophagitis
  • gastritis
  • cirrhosis
  • leukopenia
  • thrombocytopenia
  • sexual dysfunction
  • pancreatitis
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12
Q

nonreversible adverse effect alcohol:

  • vit b deficiency
  • ocular paralysis
  • ataxia-
  • somnolence
  • confusion
  • death
A

wernicke-korsakoff syndrome

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13
Q

adverse effect alcohol:

  • tachycardia
  • dyspnea
  • edema
  • nonproductive cough
  • heart is enlarged and weakened
A

cardiomyopathy

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14
Q

how soon does alcohol withdrawal occur (hrs)

A

12 hrs

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15
Q

S+S alcohol withdrawal

A
  • increased HR
  • increased bp
  • increased temp
  • sweating
  • confusion
  • anxiety
  • difficulty sleeping
  • hand tremors
  • N/V
  • muscle cramps
  • impaired appetite
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16
Q

-Powerfully addictive stimulant
-white, odorless, bitter-tasting crystalline
powder that easily dissolves in water or alcohol
-can be smoked, snorted, orally ingested, or
injected

A

methamphetamine

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17
Q

other names for meth

A
  • speed
  • meth
  • chalk
  • ice
  • crystal
  • crank
  • glass
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18
Q

short term effects of meth

A
  • brief rush of euphoria
  • increased bp and RR
  • dangerously elevated body temp
  • loss of appetite
  • sleeplessness
  • dilated pupils
  • heavy sweating
  • N/V/D
  • uncontrollable jaw clenching
  • seizures, sudden death
  • paranoia, unpredictable behavior
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19
Q

long term effects of meth

A
  • high bp
  • prolonged anxiety, paranoia
  • psychotic behavior, hallucinations, delusions
  • homicidal/suicidal thoughts
  • cracked teeth
  • sores, skin infections
  • strokes, heart infections, lung disease, kidney damage, liver damage
  • increased risk behavior
  • w/ pregnancy: premature birth and birth defects
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20
Q

The most dangerous stage of methamphetamine abuse occurs when an abuser has not slept in 3-15 days and is irritable and paranoid

A

“tweaking”

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21
Q

meth withdrawal S+S for low-moderate amount

A
  • depression
  • anxiety
  • increased appetite
  • sleep disturbance
  • psychomotor retardation
  • anhedonia
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22
Q

meth withdrawal S+S for significant amount

A
  • exhaustion
  • intense depression
  • suicidal ideation
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23
Q

opioid intoxication S+S

A
  • decreased perception pain
  • euphoria
  • sleepiness
  • confusion
  • constipation
  • nausea
  • constricted pupils
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24
Q

opioid overdose S+S

A
  • pinpoint pupils
  • decreased HR
  • decreased temp
  • decreased breathing
  • unresponsive/unconscious
  • pulmonary edema
  • shock/death
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25
Q

common opioid withdrawal S+S

A
  • N/V/D
  • stomach cramps
  • sweating
  • anxiety
  • insomnia
  • dilated pupils
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26
Q

3 phases care for substance abuse

A
  1. detox (acute care setting)
  2. intermediate care (education)
  3. rehab (12 step program, support)
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27
Q

4 interventions for med detox from alcohol

A
  • long acting benzo
  • treat symptoms with meds
  • anti seizure meds
  • nutritional supplements (B12, magnesium, folate)
28
Q

vitamin to reverse peripheral neuropathy caused by alcohol

A

vit b12

29
Q

meds to help maintain alcohol abstinence (3)

A
  • disulfiram (antabuse)
  • naltrexone (revia)
  • campral
30
Q

how does disulfiram (antabuse) help with alcohol abstinence? side effects?

A

-blocks ALDH, causes SE if taken with alcohol

SE: headache, N/V, sweating

31
Q

how does naltrexone (revia) help with alcohol abstinence

A
  • opioid antagonist
  • decreases cravings
  • works best with psychosocial intervention
32
Q

how does campral help with alcohol abstinence

A

-reduces physical and emotional discomfort when quitting drinking

33
Q

meds to help with opioid detox (5)

A
  • naloxone (narcan)
  • clonidine (catapres)
  • methadone (LAAM)
  • naltrexone
  • buprenorphine (suboxone)
34
Q

how does naloxone (narcan) help with opioid detox

A

-treats opioid overdose

35
Q

how does clonidine (catapres) help with opioid detox

A
  • antihypertensive med

- suppresses withdrawal symptoms

36
Q

how does methadone (LAAM) help with opioid detox

A
  • longer acting opioid helps with cravings

- titrated over 21 days

37
Q

detox nursing interventions (8)

A
  • monitor VS frequently
  • notify dr if P>120, and bp >160/>100
  • emergency seizure protocol
  • fall precautions
  • decrease stimulation
  • fluids
  • withdrawal education
  • anti-anxiety meds, re-orient
38
Q

what VS should you notify the hcp about for pt in detox

A

pulse >120

bp >160/>100

39
Q

very serious SE of alcohol withdrawal

A

DT (delirium tremons)

40
Q

S+S DT with alcohol withdrawal (5)

A
  • altered sensorium (confusion, delusions, hallucination)
  • high pulse, bp, RR, breathing
  • fever
  • seizures
  • heart attack
41
Q

what is included in phase 2 of substance withdrawal recovery (intermediate care, education)

A
  • impulse control (identify, avoid, coping)
  • cognitive approaches
  • meet the needs the drugs met
  • learning theory
  • dealing with grief
  • spiritual needs
42
Q

what is included in phase 3 of substance withdrawal recovery (rehab)

A
  • 12 step process
  • continued Tx for effects of addiction on life
  • individual therapy
43
Q

program for impaired nurses (substance abuse, substance dependency, anxiety disorders, major depression, bipolar disorder, schizophrenia, schizoaffective disorder)

A

TPAPN

texas peer assistance program for nurses

44
Q

assessment for alcohol withdrawal

A

CIWA-Ar

clinical institute assessment alcohol scale

45
Q

stipulations for nurses participating in TPAPN

A
  • has to be supervised
  • can’t work shifts over 12 hours
  • can’t have access to controlled meds
  • can’t work nights
  • can’t work overtime for 6 months
  • has to stay in program for 2+ years
46
Q

assessment for opioid withdrawal

A

COWS

clinical opiate withdrawal scale

47
Q

what score on COWS indicates mild withdrawal?

moderate withdrawal? moderately severe withdrawal? severe withdrawal?

A

mild: 5-12
moderate: 13-24
moderately severe: 25-36
severe: 36+

48
Q

what categories are assessed on COWS (11)

A
  • resting pulse rate
  • sweating
  • restlessness
  • pupil size
  • bone/joint aches
  • runny nose/tearing
  • GI upset
  • tremor
  • yawning
  • anxiety/irritability
  • gooseflesh skin
49
Q

what categories are assessed on CIWA (10)

A
  • N/V
  • tremor
  • tactile disturbances
  • auditory disturbances
  • visual disturbances
  • sweating
  • anxiety
  • headache
  • agitation
  • orientation
50
Q

examples schedule 1 drugs (2)

high risk, no medical use

A

heroin

LSD

51
Q

examples schedule 2 drugs (3)

high risk, need Rx

A

methadone
meperidine (demerol)
methylphenidate (ritalin)

52
Q

examples schedule 3 drugs (3)

low to moderate risk, need Rx

A

testosterone
hydrocodone
buprenorphine (suboxone)

53
Q

examples schedule 4 drugs (3)

low risk, need Rx

A

alprazolam (xanax)
lorazepam (ativan)
propoxyphene/acetaminophen (darvocet)

54
Q

when could alcohol withdrawal seizures occur (hrs)

A

12-24 hrs into withdrawal

55
Q

screening tools to assess alcohol use (4)

A

AUDIT
CAGE
CAGE-AID
T-ACE

56
Q

what substances are classified as depressants (4)

A
  • alcohol
  • benzos
  • GHB
  • barbiturates
57
Q

what substances are classified as stimulants (7)

A
  • amphetamines
  • methamphetamines
  • cocaine
  • caffeine
  • nicotine
  • ADHD meds (aderall, ritalin)
  • diet pills (dexadrine)
58
Q

what substances are classified as opiates (4)

A
  • heroin
  • opium
  • methadone
  • pain meds (morphine, codeine, hydrocodone)
59
Q

what substances are classified as hallucinogens (5)

A
  • LSD
  • PCP
  • peyote
  • mescaline
  • mushrooms
60
Q

signs of use: depressants (alcohol, barbiturates, benzos)(3)

A
  • depression major brain functions
  • psychomotor impairment
  • decreased REM sleep
61
Q

signs of withdrawal: depressants (alcohol, barbiturates, benzos) (9)

A
  • tremors
  • agitation
  • anxiety
  • sweating
  • increased HR and bp
  • sleep disturbances
  • seizures
  • delusions
  • DTs
62
Q

signs of use: stimulants (amphetamines, cocaine) (5)

A
  • brief euphoria
  • irritability, restlessness
  • sweating
  • weight loss
  • increased HR, bp, temp
63
Q

signs of withdrawal: stimulants (amphetamines, cocaine) (3)

A
  • depression
  • fatigue
  • suicidal ideation
64
Q

signs of use: opiates (heroin, morphine, meperidine, codeine, opium, methadone) (5)

A
  • euphoria
  • drowsiness
  • constricted pupils
  • constipation
  • resp depression
65
Q

signs of withdrawal: opiates (heroin, morphine, meperidine, codeine, opium, methadone) (8)

A
  • yawning
  • sweating
  • nose running/tearing
  • sleep disturbance
  • tremor
  • irritation
  • N/V/D
  • increased HR, bp, temp, RR
66
Q

signs of use: marijuana (5)

A
  • relaxation
  • mild euphoria
  • dry mouth
  • increased appetite
  • increased HR
67
Q

signs of use: hallucinogens (LSD, PCP, DMT, mescaline, MDMA) (6)

A

-hallucinations
-impaired orientation
-tremor
-N/V
-increased HR, bp, temp
PCP: -hyperactive, may be violent

mental health/psych (14 decks)

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