Substance-Related And Addiction Disorders Flashcards
A state of disturbance in cognition, perception, behavior, level of consciousness, judgment, and other functions directly attributable to a psychoactive drug’s effects may be marked by a physical and mental state of exhilaration and emotional frenzy or lethargy and stupor.
Intoxication
*Reversible syndrome of symptoms after excessive use of a substance
*Direct effect on the central nervous system
*Disruption in physical and psychological functioning
*Social and occupational functioning is impaired
*Judgement disturbed – the sole focus is on getting the reward.
Substance Intoxication
The Physiological and mental readjustment that accompanies the discontinuation of an addictive substance
*Abrupt reduction or discontinuation of a substance used regularly over a prolonged period of time
Substance Withdrawal
*Clinically significant s/s as well as psychological changes such as disruption in thinking, feeling and behavior
*Often substance specific features
Substance-specific Syndrome
Pre-alcoholic Phase
Relieving everyday stress or tensions
*Tolerance may build up, and it takes one drink initially and later 2 or 3 to get the desired effect.
Alcohol Use Disorder
Phase I:
Early alcoholic phase
Blackouts, alcohol not the source
* No longer a pleasure, but a craving builds. Blackouts are common. Sneaking drinks. Guilt and defensiveness start to be common coping mechanisms. Denial and rationalization common
Alcohol Use Disorder
Phase II:
The crucial phase
Lost the ability to choose whether to drink;
Extremely ill
*Lost control of use completely, and addiction is evident. Binge drinking for hours or days even occurs. The individual is very ill in this phase. Anger and aggression are common manifestations. Drinking is the sole focus, and the person is willing to risk everything for the drink. Often in this phase, loss of job, marriage, family, friends, and self-respect are noted.
Alcohol Use Disorder
Phase III:
The chronic phase;
Emotional and physical disintegration;
Helplessness and life-threatening
*Emotional and physical disintegration. The person is usually intoxicated more often than not, and emotional disintegration is evidenced by profound helplessness and self-pity. Impaired reality testing may result in psychosis. Withdrawal triggers symptoms of hallucinations, tremors, convulsions, severe agitation, and panic.
Alcohol Use Disorder
Phase IV:
Nerve damage resulting in pain, burning, tingling, and prickly sensation in extremities.
*Research believes this is due to a Thiamine (Vit B) deficiency. Nutritional deficits are common in alcoholism as there is an insufficient intake of nutrients, and the toxic effects of alcohol result in the malabsorption of nutrients.
Effects of Alcohol: Peripheral Neuropathy
B Vitamin Deficiency mediated
*Acute alcoholic necrotizing myopathy or alcoholic rhabdomyolysis with a sudden onset of muscle pain, swelling, weakness, and myoglobinuria (coffee or red-tinged urine). This can extend to elevated CPK levels, and AST levels as no organs are spared. The chronic version of this is slow muscle wasting without laboratory findings.
Effects of Alcohol: Alcoholic Myopathy
The most serious form of Thiamine deficiency.
*Symptoms can include paralysis of ocular muscles, diplopia, ataxia, somnolence, and stupor. If thiamine is not replaced quickly, death will follow.
Effects of Alcohol:
Wernicke’s Encephalopathy
Syndrome of confusion, loss of recent memory, and confabulation.
*Frequently found in clients recovering from Wernicke’s Encephalopathy. The two disorders seem to go together in a progression. Oral Thiamine is the treatment.
Effects of Alcohol: Korsakoff’s Psychosis
*Esophagitis also esophageal varices
*Alcoholic Cardiomyopathy
*Gastritis
*Pancreatitis – acute or chronic
*Alcoholic Hepatitis
*Leukopenia
*Thrombocytopenia
*Sexual Dysfunction
Effects of Alcohol
The end stage of alcoholic liver disease results from long-term chronic alcohol abuse. Fibrous (scar) lesions replace widespread liver destruction.
Effects of Alcohol: Cirrhosis of the Liver
Complications Include:
Portal Hypertension
Ascites
Esophageal Varices
Hepatic Encephalopathy
Cirrhosis of the Liver
Complications Include:
Blood Alcohol levels between 100 and 200mg/dL
Alcohol Intoxication:
Within 4-12 hours of cessation of or reduction of alcohol in heavy/prolonged alcohol use
Alcohol Withdrawal
hallucinations, tremors, convulsions, severe agitation, and panic. Depression and suicidal ideations are common. Long-term heavy use- abrupt withdrawal can be fatal.
Unmanaged or acute withdrawal from alcohol results in a syndrome of symptoms that include
It can induce varying degrees of CNS depression. They include tranquilizing relief from anxiety to anesthesia, coma, and even death.
*Barbiturates
*Nonbarbiturate
*hypnotics
*Antianxiety agents
*Club Drugs
Sedative Drug classes:
All generics in this group end in “barbital”
Barbiturates
Estazolam, Restoril, Halcion, Lunesta, Zolpidem or Ambien – referred to as sleepers
Nonbarbiturate hypnotics
Xanax, Clonazepam, Diazepam, Lorazepam are most common. Green and white pills. Color often helps determine dose.
Antianxiety agents (Benzodiazepines)
Flunitrazepam, GHB commonly called Roofies, Liquid X, GHB, and rope or Rohypnol
Club drugs
are addictive, and you will need more to get the same effect with regular use.
*Physiological symptoms of withdrawal are common
*Psychological symptoms of heightened anxiety and paranoid thoughts are often severe.
*Often develop Cross Tolerance and Dependence
CNS depressants
One drug results in lessened response to other drugs
Cross-Tolerance
One drug can prevent withdrawal symptoms related to physical addiction to another drug
Cross-Dependence
Often used initially to treat anxiety or insomnia, they rapidly can advance to illegal and recreational use
Effects on the body are multisystem (Sleep and dream,
Respiratory depression,
Cardiovascular effects,
Renal function ,
Hepatic effects,
Body temperature, &
Sexual dysfunction).
Effects of sedative and anxiolytics:
___, _____, or anxiolytic _____ can range from disinhibition and aggressiveness to coma and death
Sedative/Hypnotic Use Disorder: Intoxication
- can begin in 12-24 hours and peak at 24-72 hours finally subsiding at 5-10 days
Short acting sedatives, symptoms
it may take 2-7 days for symptoms to start and they peak at day 5-8 but subside after 10-16 days.
For sedatives with longer half-lives:
_____ withdrawal has an onset that depends on the half life of the drug and severe withdrawal can be life threatening
Sedative, hypnotic, and anxiolytic Use Disorder: Withdrawal
can include autonomic hyperactivity (sweating and pulse greater than 100), increased hand tremors, insomnia, nausea, vomiting, hallucinations, illusions, psychomotor agitation, anxiety, and seizures and delirium
Sedative/Hypnotic Use Disorder: Symptoms
Psychomotor Stimulation
Augmentation or potentiation of norepinephrine, epinephrine or dopamine
Stimulant Use Disorder
Caffeine and nicotine exert their action directly on the cellular activity
General cellular stimulants
*CNS System
Tremor, restlessness, insomnia and agitation
*Cardiovascular/Pulmonary
*Increased BP, HR, Arrhythmias
*Relax bronchial smooth muscles
*Gastrointestinal and Renal
Constipation and difficulty urinating
*Sexual Dysfunction
Increased urges
Stimulant Use Disorder: Effects on the Body
Euphoria, impaired judgement, confusion and changes in vital signs
Coma and Death possible
Amphetamine and cocaine intoxication:
jittery and shaky
Restlessness and insomnia common
Caffeine intoxication
Dysphoria, fatigue, sleep disturbances and increased appetite
Amphetamine and cocaine withdrawal:
Headaches, fatigue, drowsiness, irritability, muscle pain/stiffness, nausea and vomiting
Caffeine Withdrawal:
Dysphoria, anxiety, difficulty concentrating, irritability, restless, increased appetite
Nicotine Withdrawal:
CNS
Cardiovascular
Respiratory
Reproductive
Sexual Functioning
Cannabis Use Disorder: Effects on the body
Impaired motor coordination, euphoria, anxiety, sensation of slowed time, and poor judgement
Conjunctival injection, increased appetite, dry mouth, tachycardia
Impaired motor skills 8-12 hours
Cannabis Use Disorder: Intoxication:
can take up to a week tells you a lot about the half life of this substance and how long it is in the body.
Cannabis Withdrawal: Timeframe
Irritability, anger, or aggression
Nervousness, restlessness, or anxiety
Sleep difficulty ( insomnia, disturbing dreams)
Decreased appetite or weight loss
Depressed mood
Physical symptoms such as abdominal pain, tremors, sweating, fever, chills, or headache
Cannabis Withdrawal: Symptoms
*Consistent with the half-life of most _____ drugs
*Usually last for several hours
*Initial Euphoria followed by apathy, dysphoria, psychomotor agitation or retardation, and impaired judgment
*Severe opioid intoxication
Respiratory depression, coma, and death
Opioid Intoxication: S/S
e.g., heroin
Symptoms occur within 6-8 hours, peak within 1-3 days and gradually subside 5-10 days
Opioid Short-Acting Drug:
e.g., Methadone
Symptoms occur within 1-3 days, peak between 4-6 days and subside in 14-21 days
Opioid Long-Acting Drug:
.g., Meperidine
Symptoms begin quickly, peak 8-12 hours and subside in 4-5 days
Opioid Ultra-Short-Acting Drug:
Dysphoria
Muscle aches
Nausea/Vomiting
Lacrimation (tearfulness) or rhinorrhea
Pupillary dilation
Piloerection (goose bumps)
Sweating
Abdominal cramping
Diarrhea
Yawning
Fever
Insomnia
Opioid Withdrawal
Symptoms Include
Questionnaire for assessment of alcohol use disorder
CAGE
CIWA
Clinical Institute Withdrawal Assessment for Alcohol Scale
COWS
Clinical Opiate Withdrawal Scale
Coexisting substance disorder and mental health disorder: therapies that target both
Cognitive and Behavioral Problems (CBT)
Dual Diagnosis
*nursing interventions include “the client”
*_____ must to be measurable
* AKA SMART goals
Outcomes
*Has detox occurred without complication?
Is the patient still in denial?
*Does the patient accept responsibility for their own behaviors?
*Has a correlation been made between personal problems and substance use?
*Does the client still make excuses or blame others for their substance use?
*Has the client remained substance free during treatment?
Evaluation
*Ativan Protocols – use of Benzodiazepines
*Anticonvulsants
*Multivitamin Therapy
-Thiamine (Vit B)
*Disulfiram (Antabuse)
*Gabapentin
*Other medications such as:
-Naltrexone
-Nalmefene
-SSRI’s
-Acamprosate (Campral)
Pharmacotherapy: Alcohol Withdrawal
*Narcotic Antagonists
-Naloxone or Narcan
-Naltrexone or RiVia
-Nalmefene or Revex
*Methadone
*Buprenorphine or Suboxone
*Clonidine
Pharmacotherapy: Opioid Withdrawal
*Phenobarbital (Luminal)
*Long-acting Benzodiazepines
Pharmacotherapy: Depressants
*Minor and Major Tranquilizers
*Anticonvulsants
*Antidepressants
Pharmacotherapy: Stimulants
