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PPC2 Exam 1 > Substance Abuse: Others > Flashcards

Substance Abuse: Others Flashcards

1
Q

Tobacco Products (7)

A
  1. Cigarettes
    a. Electronic cigarettes are addictive as well
    i. Appeal to young crowd; marketing approach similar to the 50s/60s for cigarettes
    ii. Contains formaldehyde
  2. Smokeless tobacco (snuff and chew)
  3. Snus: moist smokeless tobacco products (mini-teabag)
  4. Cigars (Swishers e. g.) and pipes
  5. Bidis and kreteks
  6. Flavored cigarettes
    a. Clove and others recently banned by FDA
    b. Menthol cigarettes (heavily marketed in Africa)
  7. Blunts
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2
Q

Nicotine Pharmacology (2)

A
  1. Nicotine is an exogenous agonist at neuronal nicotinic acetylcholine receptor (nAChR)
2. Binding leads to increase in neurotransmitters (increases binding of NTs)
o Epinephrine
o Norepinephrine
o Serotonin
o GABA
o Glutamate
o ß-endorphins
o Dopamine
o Bottom line is that it is highly addictive
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3
Q

E-Cigarette (10)

A
  1. Keeps it up to a vapor point
  2. Not up to combustion point
  3. Produces water level
  4. Nicotine in the same dose whether you vaporize or burn it.
  5. Recent data with formaldehyde reported in Pediatrics
  6. Found plutonium in them
  7. Not a smoking cessation ad
  8. Now advertising as a smoking alternative
  9. Not a drug delivery device
    a. “Hookah pens” or “e-hookahs” or “vape pipes
    i. Can cause nicotine poisoning
  10. Manufacturers cannot make the claim that it will help you stop smoking
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4
Q

PNP Role (4)

A
  1. Screen for smoking
  2. Refer to quitline – New York state will provide the patient with nicotine patches
  3. Fax the form that you are referring the person
  4. Fax Referral is a program that builds on the services Tobacco Quit Line offers by creating partnerships with healthcare providers. Through the Fax Referral Program, tobacco users no longer have to take the first step by calling the Quit Line; instead, after talking with their clinician, they can agree to have the Quit Line call them
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5
Q

Quitline Referrals (3)

A
  1. Tobacco users who would like to make a quit attempt in the next 30 days can sign a Fax Referral enrollment form during a face-to-face intervention at a doctor’s office, hospital, dentist’s office, clinic or agency site.
  2. The form is then faxed to the Quit Line.
  3. Within 48 hours, a quit coach makes the initial call to the tobacco user to begin the intervention
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6
Q

Types of Inhalants (6)

A
  1. Volatile solvents
  2. Aerosols
  3. Gases such as whipped cream container
  4. Chemical component
  5. Organic nitrites
  6. Drug screen will not show any of these substances
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7
Q

Methods of Inhalant Use (5)

A
  1. Huffing: inhalant soaking rag placed over mouth and nose
  2. Sniffing or snorting directly from container
  3. Bagging: inhaling a substance from a paper or plastic bag
  4. Spraying the aerosol directly into the mouth
  5. Inhaling balloons filled with nitrous oxide
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8
Q

Inhalant Abuse (5)

A
  1. Intoxication typically brief, lasting only a few minutes
  2. Repeated use is needed to maintain high
  3. Loss of control and less inhibition with repeated use
  4. Acute effects typically followed by drowsiness and lingering headache
  5. Addiction and withdrawal symptoms rarely occur
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9
Q

Pharmacological Effects of Inhalant Use (4)

A
  1. Rapid high resembling alcohol intoxication
  2. With initial excitation followed by drowsiness, disinhibition, lightheadedness, and agitation
  3. If sufficient amounts are inhaled, nearly all solvents and gases produce anesthesia
  4. Loss of sensation and can lead to a loss of consciousness
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10
Q

Inhalant Use by ages (4)

A
  1. Inhalant use may precede tobacco, alcohol, and cannabis use
  2. New user ages 12-15 year with their most common substances—glue, shoe polish, spray paints, gasoline, lighter fluids
  3. New users 16-17 most common abuse is nitrous oxide or whippets
  4. Adults most commonly use nitrites
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11
Q

How can inhalant abuse be recognized? (8)

A
  1. Chemical odors on breath or clothing
  2. Paint or other stains on face, hands, or clothes
  3. Hidden empty spray paint or solvent containers, and chemical-soaked rags or clothing
  4. Drunk or disoriented appearance
  5. Slurred speech
  6. Nausea or loss of appetite
  7. Inattentiveness, lack of coordination, irritability, and depression
  8. Come in looking like they took something/are acting strange
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12
Q

Short Term Effects of Inhalant use – Non-specific symptoms (2)

A
  1. Headaches
  2. Muscle weakness
  3. Abdominal pain
  4. Severe mood swings
  5. Violent behavior
  6. Belligerence
  7. Slurred speech
  8. Numbness
  9. Tingling of hand/feet
  10. Nausea
  11. Depressed reflexes
  12. Stupor
  13. Loss of consciousness
  14. Limp spasm
  15. Fatigue
  16. Lack of coordination
  17. Apathy
  18. Impaired judgement
  19. Dizziness
  20. Lethargy
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13
Q

Lethal effects of inhalant use (5)

A
  1. Sudden sniffling death syndrome
  2. Can occur with first use in a healthy individual
  3. Most commonly with aerosols, butane, propane
  4. Increased risk by inhaling from a paper or plastic bag in an enclosed space
  5. Sudden death is due to cardiac dysrhythmia or asphyxiation
    - Cardiac dysrhythmia is most common cause of death from these
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14
Q

Inhalant Use Mortality (6)

A
  1. Approximately 100- 200 deaths per year
  2. Direct toxicity—asphyxiation, cardiac dysrhythmia
  3. Unintentional injury-trauma, traffic crashes, fires, falls, drowning
  4. Aspiration of vomitus
  5. Suffocation when using plastic bag
  6. Life threatening seizures
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15
Q

Inhalant Toxicity in Chronic Use: Neurotoxic Effects (5)

A
  1. Loss of myelin in CNS and PNS similar to MS
  2. Cognitive impairment to severe dementia
  3. Impairment of movement, perception, vision, and hearing loss
  4. MRI shows atrophy, white matter changes, peripheral neuropathy similar to Guillain Barré syndrome
  5. Neurological toxicity can lead to cerebellar ataxia, optic neuropathy(loss of vision), parkinsonism, multifocal cortical and subcortical injury, peripheral neuropathy
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16
Q

Inhalant Toxicity in Chronic Use: Cardiac, lungs, kidney, hematological, pregnancy (5)

A
  1. Cardiac: Dysrhythmias, myocarditis, CHF
  2. Lungs: Emphysema, Goodpasture syndrome
  3. Kidney: renal tubular acidosis, nephritis, nephrosis, renal failure
  4. Hematological: bone marrow failure and subsequent aplastic anemia
  5. Pregnancy: reduced birth weight, microcephaly skeletal abnormalities, delayed neurobehavioral development
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17
Q

Irreversible effects of inhalant use (4)

A
  1. Hearing loss: spray paints, glues, dry cleaning chemical, correction fluid
  2. Peripheral neuropathies or limb spasms: glues, gasoline, shipped cream dispenser, gas cylinders
  3. CNS or brain damage: sprays paints, glues, dewaxers
  4. Bone marrow suppression
    •Aplastic suppression → would need to be replaced with a bone marrow transplant
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18
Q

Inhalant Use Comorbidities (7)

A
  1. More psychopathology when they use inhalants alone
  2. Conduct disorders
  3. Personality disorder
  4. Mood disorder: anxiety and depression
  5. Low self-esteem: poor future orientation
  6. Family disruption: foster care or child abuse
  7. Poor school performance or poor attendance
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19
Q

Acute Presentation of Inhalant Abuse (15)

A
  1. Toxidrome
  2. Asphyxia
  3. Cardiac dysrhythmias
  4. Respiratory depression
  5. Lacrimation/salivation
  6. Seizures
  7. Delirium/stupor
  8. Coma/sudden death
  9. No withdrawal signs
  10. Treatment
  11. Assess for odor on breath
  12. Respiratory and circulatory support
  13. Treat dysrhythmias/avoid pro dysrhythmic drugs
  14. Assess for hepatic, cardiac, and CNS, PNS effects
  15. Inhalants not in urine drug screen
20
Q

Public Health approach to Prevent Inhalant Abuse (8)

A
  1. Use water based products
  2. Supervise use of solvent based product
  3. Use low odor markers
  4. Use correction tape instead of fluid
  5. Use hand pumps instead of aerosol cans
  6. Use solid air fresheners and deodorant
  7. Use cooking oil in a spray pump
  8. No aerosols for whipped cream
21
Q

Marijuana (9)

A
  1. Cannabis Sativa plan
  2. Psychoactive ingredient Λ9-tetrahydrocannabinol (THC)
  3. Lasts from minutes to hours
  4. Metabolism in liver
  5. Half life of 20 to 30 hours
  6. Mostly cleared through feces with small amount through urine
  7. Increase in potency 2 to 7 fold since 1960
  8. Double risk of schizophrenia and psychotic symptoms
  9. High potency cannabis called “skunk” can be inhaled, vaporized or used through e cigarette
22
Q

DSM-V Criteria for Marijuana (3)

A
  1. Cannabis Intoxication
    i. Impaired motor coordination
    ii. Euphoria
    iii. Anxiety
    iv. Perception of slowed time
    v. Poor judgment
  2. Social withdrawal plus ≥2 additional symptoms within 2 hours of use
  3. Red eyes, increased appetite, dry mouth, or elevated heart rate
23
Q

Problematic use of cannabis with significant impairment or distress within 1 year, development of ≥ 2 of the following (8)

A
  1. Need for larger doses for longer period of time than intended
  2. Persistent desire to use
  3. Unsuccessful efforts to cut down or stop
  4. Considerable time spent thinking about or obtaining cannabis
  5. Recurrent use resulting in missing important life events
  6. Persistent use despite social or interpersonal repercussions
  7. Neglecting important social, occupational or recreational activities
  8. Persistent use despite continued problems
24
Q

Forms of Marijuana (6)

A
  1. Hashish
    i. Dried exudate from top and underside of leave
    ii. 10% to 20% potency
  2. Hash oil
    i. Concentrated Hashish distillate
    ii. 15% to 30% potency
  3. Sensimilla
    i. Derived from seedless female flower
  4. Blunts
    i. Cigarettes filled with marijuana
  5. Sherms
    i. Water or wet joint dipped into phenocyclidine (PCP) and dissolved in organic solvent such as formaldehyde
  6. Wax
    i. Potency 50% to 90%
    ii. Made in marijuana dispensaries with butane and resins of leaves resembles ear wax
    iii. Vaporized and smoked without any odor
25
Q

Psychological and Physiologic Effects of Marijuana (3)

A

a. Peaks at 30 minutes after inhalation
b. 1 to 5 hour after ingestion
c. Lasts for 2-4 hours

26
Q

Positive effects of marijuana (5)

A

i. Heightened perception
ii. Relaxation euphoria
iii. Sensation of time slowing
iv. Increased appetite
v. Decreased pain

27
Q

Negative effects of marijuana (8)

A

i. Paranoia
ii. Anxiety
iii. Irritability, impaired short term memory
iv. Elevated blood pressure
v. Elevated heart rate 20-50 beats per minute above baseline
vi. Dry mouth and throat
vii. Conjunctiva injection

28
Q

Cannabis Dependence (4)

A
  1. More common in men
  2. 18 to 30 year old
  3. Blacks are more likely to carry the NRGI gene (susceptibility for gene for cannabis dependence
  4. Daily use of cannabis is associated with increased risk for anxiety disorder even after discontinuation of marijuana
29
Q

Cannabis Withdrawal Syndrome (4)

A
  1. Occurs after frequent and heavy use of marijuana
  2. Up to 85% of users experience
  3. Adverse psychological features that include mood changes of irritability and anxiety, anger, or insomnia or sleep with unpleasant dreams
  4. Adverse physiological effects
    - GI distress
    - Decreased appetite, tremors, diaphoresis, thermo dysregulation and headache
30
Q

Opioid addiction definition

A

Primary chronic neurologic disease with genetic, psychosocial and environmental factors influencing its development and manifestations; impaired control over drug use, compulsive use, and continued use, despite harm to self or others

31
Q

What does opioid addiction involve? (9)

A
  1. Involves reward center in brain (associated with affective responses to brain involves dopamine)
  2. Susceptible individuals have alteration of limbic or related systems that cause sensitization to reinforcing effects of drugs
  3. Drug seeking
  4. Doctor shopping
  5. Polypharmacy
  6. Inability to take drugs on schedule
  7. Reports of lost RX
  8. Isolation from social groups and family
  9. Use of analgesics for sedation or increased energy
32
Q

Prescription medication

A
  1. Narcotics
  2. Drugs for attention deficit/hyperactivity
    - If a child has family history or history of addiction may not want to use stimulants as treatment for ADHD
  3. Legal with prescription
    • 2011, 15.2% of 12th graders reported having abused prescription medication
    • Effects — depend on medication; potentially dangerous (e. g., respiratory depression, organ failure)
    • Evaluation and management)
33
Q

Dextromethorphan (DXM) (5)

A
  1. Street names include
    • “Triple-C,” “candy,” “red devils,” “velvet”, and “robo”
    • Users of DMX called “syrup heads”, or described as “robotripping”
    • “skittling
  2. Antihistamines increase danger or lethality
  3. Pure DXM powder available online
  4. Adolescents most likely to use
    • 2011, 5.5% of 10th graders and 5.3% of 12th graders reported abusing cough and cold medication; effect — varies by dose; 4
  5. Typical therapeutic dose 15 to 30 mg qid
34
Q

DXM First plateau

A

First plateau occurs if 100 to 200 mg ingested

*Mild inebriation or stimulation

35
Q

DXM Second Plateau (4)

A
  1. Euphoria
  2. Mild hallucinations
  3. Slurred speech
  4. Loss of short-term memory
36
Q

DXM Third Plateau (3)

A
  1. Altered consciousness
  2. Impaired vision
  3. Loss of motor coordination
37
Q

DXM Fourth Plateau

A

Mind-body dissociation

38
Q

DXM Life threatening reactions (6)

A
  1. Serotonin syndrome
  2. High fever
  3. Rhabdomyolysis - Severe muscle pain and elevated CK
  4. Arrhythmias
  5. Loss of consciousness
  6. Brain damage
39
Q

Serotonin Syndrome: 10 symptoms

A

symptoms may occur w/i minutes or hours

  1. Agitation or restlessness
  2. Diarrhea
  3. Fast heart beat and high blood pressure
  4. Hallucinations
  5. Increased body temperature
  6. Loss of coordination
  7. Nausea
  8. Overactive reflexes
  9. Rapid changes in blood pressure
  10. Vomiting
40
Q

Serotonin Syndrome Treatment (4)

A
  1. Benzodiazepines such as Diazepam (Valium) or Lorazepam (Ativan) to decrease agitation, seizure-like movements, and muscle stiffness
  2. Cyproheptadine (Periactin), a drug that blocks serotonin production
  3. Fluids by IV
  4. Withdrawal of medicines that caused the syndrome
41
Q

General Info: Salvia (6)

A 
1. Street names —
o “Maria Pastora”
o “Divine Mexican mint”
o “Sage of the seers”
o “Sally D”
  1. Perennial herb in mint family native to Mexico; active ingredient
  2. 5.9% of 12th graders reported use
  3. Savinorin A (divinorin A);
    o Modes of use — with chewing and “parking,”
    o Effects occur within 5 to 10 min;
  4. With smoking: effects occur within 30 seconds and last for 30 min
  5. Not detectable on standard drug screens
42
Q

Effects of Salvia (6)

A
  1. Hallucinations
  2. Sensations of bright lights
  3. Vivid colors and shapes
  4. Body or object distortions
  5. Uncontrolled laughter
  6. Sense of loss of body
43
Q

SBIRT screening (3)

A
  1. Screening quickly assess the severity of substance use and identifies level of treatment
  2. Brief intervention focuses on increasing insight and awareness regarding substance use and motivation to behavior change
  3. Referral to Treatment provides those needing more extensive treatment access to specialty care
44
Q

FRAMES Screening (6)

A
  1. Feedback is given to the individual about personal risk or impairment
  2. Responsibility for change is placed on the patient
  3. Advice to change is given by the provider
  4. Menus of options is offered for behavioral change, support, and/or treatment
  5. Empathic style is used in counseling
  6. Self-efficacy or optimistic empowerment is engendered in the patient
45
Q

Assess and Assist (5)

A
  1. Assess
    • Ask about behavioral health risks and factors affecting choice of behaviors change goals/methods
  2. Advise
    • Give clear, specific, specific behavior change advice including info about personal harms/benefits
  3. Agree
    • Collaborate select appropriate treatment goals and methods
  4. Assist
    • Using behavior change techniques aid patient in achieving agreed upon goal by acquisition of skills, confidence, or social environment
  5. Arrange
    • Schedule follow-up contract
46
Q

Tips with parents (6)

A
  1. Start at age 11
  2. Take 5 minutes to talk with parents before adolescent walks in
  3. Parents need to know about teen’s choice
  4. Encourage them to share worries
  5. Will share if substance abuse beyond experimentation, driving while intoxicated, suicidal or homicidal thoughts
  6. Talk about contracting
47
Q

Tips with adolescents (10)

A
  1. When probing about sensitive issues, validate your reason to know (ex: important for health)
    o Let them know you’re there to be a neutral voice and not there for judgments
    o Want them to feel comfortable asking questions about drug use
  2. Adolescent values autonomy ask questions in context of their choice
  3. With regard to use of e.g.. alcohol, if patient does not want to answer or states it is stupid question as drugs are illegal, try to stick with yes or no answers
  4. Ask about use of alcohol or drugs
  5. Ask if they are concerned
  6. Probe further if patient at stages 3 or 4 of substance abuse
  7. At this point, needs referral to treatment program
  8. If patient is not concerned, ask if anyone else is concerned
  9. Ask about concerns of drug use among close friends
  10. CAGE screen (cut back, annoyed, guilty, eye opener)

PPC2 Exam 1 (13 decks)

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