Substance Misuse Flashcards by Hanabi San

Substance Misuse Leads to Dependence

Physical dependence
Psychological dependence
Habituation
Addiction

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Commonly Misused Substances

Opioids:
heroin
codeine phosphate
hydrocodone
hydromorphone
meperidine hydrochloride
morphine
fentanyl
oxycodone

Stimulants:
racemic amphetamine
dextroamphetamine
methamphetamine
cocaine

Depressants:
Benzodiazepines
Barbiturates
Marihuana

Alcohol

Anabolic steroids

dextromethorphan hydrobromide

Lysergic acid diethylamide (LSD)

Methamphetamine

Methylenedioxymethamphetamine (ecstasy, molly)

Nicotine

Phencyclidine (PCP)

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Opioids

Also known as narcotics

Affect areas outside the central nervous system (CNS)

Intended drug effects: relieve pain, reduce cough, relieve diarrhea, and induce anaesthesia

High potential for misuse and psychological dependency; promote relaxation and euphoria

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Opioids: Methadone

Used to treat opioid dependence

Goal: to reduce the patient’s dosage gradually so that eventually the patient can live permanently drug free

Relapse rates are often high; the drug can be misused.

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Opioids: Heroin (diacetylmorphine)

-Injected (“mainlining” or “skin popping”)
-Sniffed (“snorted”)
-Smoked

Causes a brief “rush” followed by a few hours of a relaxed, contented state

Large doses can stop respirations.

One of 10 most misused drugs in Canada

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Opioids: Adverse Effects

CNS
Drowsiness
Diuresis
Miosis
Convulsions
Nausea, vomiting
Respiratory depression

Non-CNS
Hypotension
Constipation
Decreased urinary retention
Flushing of the face, neck, and upper thorax
Sweating, urticaria, and pruritus

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Opioid Drug Withdrawal

Peak period 1 to 3 days
Duration 5 to 7 days

Signs
Drug seeking, mydriasis, diaphoresis, rhinorrhea, lacrimation, vomiting, diarrhea, insomnia, elevated blood pressure (BP) and pulse

Symptoms
Intense desire for drug, muscle cramps, arthralgia, anxiety, nausea, malaise

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Opioid Drug Withdrawal: Treatment

Block opioid receptors so that use of opioid drugs does not produce euphoria.

naltrexone hydrochloride, an opioid antagonist

methylnaltrexone bromide (Relistor®), an injectable form of naltrexone

Naloxone (for overdose) combined with buprenorphine hydrochloride (Suboxone®) or with hydromorphone hydrochloride (Targin®)

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Stimulants

4 effects
4 drugs

Elevation of mood
Reduction of fatigue
Increased alertness
Invigorated aggressiveness

Amphetamines
Cocaine
Methamphetamine
methylenedioxymethamphetamine

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Methamphetamine

Stronger effects than other amphetamines

Pill form

Powder form: snorted or injected

Crystallized form

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Methamphetamine Crystallized form

Also known as “ice,” “crystal,” “glass,” “crystal meth”

Smokable; more powerful form

Sales of over-the-counter ephedrine, pseudoephedrine, and red phosphorus are now restricted to be beyond the counter in pharmacies only.

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Methylenedioxymethamphetamine

Also known as “ecstasy” and “E”

Usually prepared in secret home laboratories

More calming effects than other amphetamine drugs

Usually taken by pill

“Raves”

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Cocaine

From the leaves of the coca plant

Snorted or injected intravenously

Highly addictive—physical and psychological dependence

Powdered form

Also called “dust,” “coke,” “snow,” “flake,” “blow,” “girl”

Crystallized form (smoked)

Also called “crack,” “freebase rocks,” “rock”, “candy”

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Stimulants: Adverse Effects

CNS
Restlessness
Syncope (fainting)
Tremor
Hyperactive reflexes
Talkativeness
Irritability
Insomnia
Fever
Euphoria
Confusion
Aggression
Increased libido
Anxiety
Delirium
Paranoid hallucinations
Suicidal or homicidal tendencies

Cardiovascular
Headache
Chilliness
Pallor or flushing
Palpitations
Tachycardia
Cardiac dysrhythmias
Anginal pain
Hypertension or hypotension
Circulatory collapse

Gastrointestinal
Dry mouth
Metallic taste
Anorexia
Nausea
Vomiting
Diarrhea
Abdominal cramps

Fatal hyperthermia

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Stimulant Overdose results in?

Death results from
-Convulsions
-Coma
-Cerebral hemorrhage

May occur during periods of intoxication or withdrawal

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Stimulant Withdrawal

Peak period 1 to 3 days

Duration 5 to 7 days

Signs
–Social withdrawal, psychomotor retardation, hypersomnia, hyperphagia

Symptoms
–Depression, suicidal thoughts and behaviour, paranoid delusions

No specific pharmacological treatments

Depressants

Drugs that relieve anxiety, irritability, and tension when used as intended

Also used to treat seizure disorders and induce anaesthesia

Depressants: Two main pharmacologic classes

Benzodiazepines
Barbiturates

Marihuana (“pot,” “grass,” “weed”)
flunitrazepam (Rohypnol®): not legally available in Canada; known as “roofies”

Depressants: Benzodiazepines and barbiturates

increase the action of gamma-aminobutyric acid, an amino acid in the brain, which inhibits nerve transmission in the CNS

Results in sedation, muscle relaxation, and relief of anxiety

Marihuana (δ-9-trans-tetrahydrocannabinol)

Define:

Benzodiazepines

Barbiturates

Benzodiazepines: anxiety, to induce sleep, to sedate, and to prevent seizures

Barbiturates: sedatives and anticonvulsants and to induce anaesthesia

Depressants: Adverse Effects

CNS
-Drowsiness, sedation, loss of coordination, dizziness, blurred vision, headaches, and paradoxical reactions

Gastrointestinal
-Nausea, vomiting, constipation, dry mouth, and abdominal cramping

Pruritus and skin rash

Marihuana: “amotivational” syndrome

Depressants: Withdrawal

Peak period
2 to 4 days for short-acting drugs
4 to 7 days for long-acting drugs

Duration
4 to 7 days for short-acting drugs
7 to 12 days for long-acting drugs

Signs
Increased psychomotor activity; agitation; muscular weakness; hyperthermia; diaphoresis; delirium; convulsions; elevated BP, pulse rate, and temperature; others

Symptoms
Anxiety, depression, euphoria, incoherent thoughts, hostility, grandiosity, disorientation, hallucinations, suicidal thoughts

Depressants: Withdrawal Treatment

Treatment involves tapering of the drug over the course of 7 to 10 days or 10 to 14 days.

Alcohol

More accurately known as ethanol

Causes CNS depression by dissolving in lipid membranes in the CNS

Few legitimate uses of ethanol and alcoholic beverages

Used as a solvent for many drugs

Systemic uses of ethanol: treatment of methyl alcohol and ethylene glycol intoxication (e.g., from drinking automotive antifreeze solution)

Ethanol: Drug Effects

CNS depression Respiratory stimulation or depression Vasodilation, producing warm flushed skin Increased sweating Diuretic effects

Effects of Chronic Ethanol Ingestion

Nutritional and vitamin deficiencies (especially B vitamins) -Wernicke’s encephalopathy -Korsakoff’s psychosis -Polyneuritis -Nicotinic acid deficiency encephalopathy Seizures Alcoholic hepatitis, progressing to cirrhosis Cardiomyopathy

Effects of Chronic Ethanol Ingestion

Fetal alcohol spectrum disorder (FASD) Pregnant women should be educated about the effects of alcohol consumption. FASD is characterized by: -Craniofacial abnormalities -CNS dysfunction -Prenatal and postnatal growth retardation

Ethanol: Withdrawal

Signs and symptoms: Elevated blood pressure, pulse rate, and temperature Insomnia Tremors Agitation Classified as mild, moderate, or severe

Ethanol: Withdrawal Treatment

Benzodiazepines are the treatment of choice --diazepam (Valium®) --Dosage and frequency depend on severity. acamprosate calcium For severe withdrawal, monitoring in a Critical Care Unit is recommended.

Treatment of Alcoholism

disulfiram (Antabuse®) (no longer manufactured in Canada) -Acetaldehyde syndrome naltrexone acamprosate calcium -Newest treatment Counselling -Individual -Alcoholics Anonymous

Nicotine

Many smoke to “calm nerves.” Releases epinephrine, which creates physiological stress rather than relaxation Tolerance develops Physical and psychological dependency Withdrawal symptoms occur if stopped. No therapeutic uses Two hundred known poisons are present in cigarette smoke.

Nicotine: Drug Effects

Transient stimulation of autonomic ganglia Followed by more-persistent depression of all autonomic ganglia CNS and respiratory stimulation followed by CNS depression Increased heart rate and BP Increased bowel activity Nicotine found in nature (i.e., tobacco plants) has no known therapeutic uses. Nicotine is medically significant because of its addictive and toxic properties.

Nicotine Withdrawal

Manifested by cigarette craving --Irritability, restlessness, decreased heart rate and BP Cardiac symptoms resolve in 3 to 4 weeks, but cigarette craving may persist for months or years.

Nicotine: Withdrawal Treatment

Treatments provide nicotine without the carcinogens in tobacco. -Nicotine transdermal system (patch) – found to be more effective than gum but may cause rash -nicotine polacrilex (gum) -Inhalers -Nasal spray

bupropion hydrochloride (Zyban®):

may be prescribed to aid in smoking cessation First nicotine-free prescription medication to treat nicotine dependence

varenicline tartrate (Champix®)

Stimulates nicotine receptors

Nursing Implications

Assessments should include nonjudgemental and open-ended questions about substance abuse. Be observant for clues to substance misuse so as to avoid withdrawal symptoms. The most dangerous substances in terms of withdrawal are CNS depressants such as barbiturates, benzodiazepines, and alcohol. Establish therapeutic rapport, and use empathy toward the patient.

Assessment tools for substance misuse:

CAGE Alcoholism Screening Test Adapted to Include Drugs (CAGE-AID) Substance Abuse Subtle Screening Inventory (SASSI) Michigan Alcoholism Screening Test Geriatric version (MAST-G) Problem Oriented Screening Instrument for Teenagers (POSIT)

Nursing Implications

Patient safety is of utmost importance at all times during patient care but especially when the patient is experiencing the signs and symptoms of withdrawal. Provide monitoring and support as needed throughout the withdrawal process. Educate the patient and family members or significant others about the recovery process. Emphasize that recovery is lifelong.