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Substance Related and Addictive Disorders Flashcards

1
Q

Are substance use disorders a choice?

A

no

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2
Q

Which 4 categories do substance use disorders fall into?

A
  1. impaired control
  2. risky use
  3. physical effects
  4. social impairment
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3
Q

If Sharon claims to be addicted to cocaine, what does she mean by addicted?

A

it means she has a repeated use of the substance that leads to loss of control; a primary chronic disease of brain reward, motivation, memory related circuitry

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4
Q

Often in college we were intoxicated, what does this mean/

A

when people are in the process of using a substance to xs

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5
Q

If you can have 6 shots of tequila one day and be drunk. The next time you have 6 shots, you feel nothing, so you take 3 more, just get a buzz. What is occurring?

A

you are building tolerance, taking a higher dose to achieve the same level of response achieved initially

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6
Q

What type of Sx does a person experiencing withdrawals experience?

A

physiological and psychological Sx

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7
Q

T/F The more intense Sx a person has the more likely the person is to start using the substance again to avoid the Sx.

A

true

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8
Q

Librium and Valium are synergistic, what does that mean?

A

it means that when they work together there is a intensification or prolonged exposure.

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9
Q

Kevin overdose on Morphine, so we pushed Narcan, what is Narcan to the opioid?

A

it is the antidote or has an antagonistic effect

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10
Q

What are the 3 neurotransmitters involved in substance use disorders?

A
  1. GABA
  2. Dopamine
  3. Opioid
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11
Q

What is the most widely used psychoactive substance in the world?

A

caffeine

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12
Q

What is the half-life and [peak] of caffeine?

A

half life 3-10 hours, the [peak] is 30-60 mins

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13
Q

What are the behavioral Si/Sx of caffeine intoxication?

A
  1. restlessness
  2. . nervousness
  3. excitement
  4. agitation
  5. rambling speech
  6. inexhaustibility
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14
Q

What are the physical Si/Sx of caffeine intoxication?

A
  1. flushed face
  2. diuresis
  3. GI disturbance
  4. muscle twitching
  5. tachycardia
  6. cardiac arrhythmias
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15
Q

What is the mg of caffeine intoxication?

A

> 250 mg

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16
Q

What can occur if extremely high doses of caffeine are ingested?

A
  1. grand mal seizures

2. respiratory failure

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17
Q

What do you experience after not drinking coffee for 2 days?

A
  1. insomnia
  2. N/V
  3. headache
  4. [poor]
  5. irritability (bitchiness)
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18
Q

When can you begin experiencing caffeine withdrawals? Peak? Resolve?

A

12-24 hrs after last dose and peak in 24-38 hrs and resolves w/in a wk

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19
Q

Craving, persistence, recurrent use, tolerance all attribute to which use disorder?

A

tobacco use disorder

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20
Q

At least 4 Sx contribute to tobacco withdrawal?

A
  1. irritability
  2. anxiety
  3. depression
  4. difficulty concentrating
  5. restlessness
  6. insomnia
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21
Q

How does a person’s body change after smoking cessation?

A

HR decreases 5-12 beats/min and weight gain of 4-7 lbs

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22
Q

What the MOA of nicotine?

A

occupies the receptors of Ach in both dopamine and SE neural pathways

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23
Q

What are some diseases that nicotine is associated w/?

A
  1. cancer
  2. heart disease
  3. emphysema
  4. HTN
  5. death
  6. primary RF for atherosclerosis
  7. CVA
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24
Q

What are some non-pharmacalogical methods to promote smoking cessation?

A
  1. behavioral therapy

2. Hypnosis

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25
In what med forms do nicotine replacement therapy come in?
1. gum 2. lozenges 3. nasal sprays 4. patched
26
What is are some important teachings for a pt with a nicotine patch?
1. remove the patch before applying a new one 2. rotate the sites 3. never place the patch on the pt's chest, only on the arm
27
What are some meds that a person can take to promote smoking cessation?
1. Chantix (varenicline) 2. Zyban or Wellbeutrin (burpropion) 3. Catapres (clonidine)
28
List some stimulants
1. cocaine 2. amphetamines 3. Methamphetamines 4. LSD 5. MDMA 6. Roofies
29
Gary says that the pt in Room 215 is experiencing stimulant abuse intoxication. What are Sx that you expect to see?
1. euphoria 2. elatedness 3. social 4. hypervigilant 5. sensitive 6. anxious 7. tense 8. angry
30
What are some physical Sx of stimulant use disorder?
1. chest pain 2. dilated pupils 3. cardiac arrhythmias 4. high or low BP 5. tachycardia or bradycardia 6. respiratory depression 7. N/V 8. chills 9. weakness 10. confusion 11. seizures 12. coma 13. psychomotor agitation or retardation
31
What are the 2 most serious side effects of stimulant use disorder?
SI and depression
32
What are some WS you may see in a pt who abused roofies or the date rape drug?
1. tiredness 2. vivid nightmares 3. increased appetite 4. insomnia or hypersomnia 5. psychomotor agitation or retardation
33
What 2 effects do cocaine have on the body?
1. anesthetic | 2. stimulant
34
When cocaine is smoked how long does it take effect? high?
takes effect in 4-6 seconds with a 5-7 min high then a deep depression
35
What are some tx for amphetamine use?
1. w/ psychosis: antipsychotic 2. w/o psychosis: Valium 3. once withdrawn: an antidepressant like Wellbutrin
36
What is the tx for cocaine abuse pt?
no drugs that reduce Sx, they may require hospitalization to remove the affected pt from the usual social setting and drug sources
37
What are hallucinogens associated w/?
1. reality disturbance 2. flashbacks 3. panic attacks 4. psychosis 5. delirium 6. mood and anxiety disorders
38
What are the 2 classifications for hallucinogens
1. Classic | 2. Dissociative
39
Hallucinogen intoxication is associated w/ by what?
psychological and behavioral changes
40
What are some common changes in pts taking hallucinogens?
1. paranoia 2. impaired judgment 3. intensification of perceptions 4. depersonalization 5. derealization 6. illusions 7. hallucinations
41
What are some physical Sx of hallucinogens?
1. blurred vision 2. tremors 3. incoordination 4. sweating 5. tachycardia 6. pupillary dilation 7. palpitations
42
Sara is addicted to taking mushrooms. She is in the clinic for detoxification. How do you intervene during intoxication?
talk the pt down and if the case is severe give an antipsychotic such as Haldol or a benzo like valium for short-term
43
Jorge comes into the ER after taking PCP at high dose, how is this treated by staff?
this is an medical ER
44
Describe a pt who has taking PCP at an extremely high dose?
1. belligerent 2. assaultive 3. impulsive 4. unpredictable
45
What are some Si/Sx of PCP intoxication?
1. nystagmus 2. HTN 3. tachycardia 4. ataxia 5. diminished response to pain 6. muscle rigidity 7. seizures 8. coma 9. hyperacusis 10. dyarthria
46
What is the tx for Jorge who has taken an extremely high dose of PCP?
since he cannot be talked down, he may require restraints and a calming medication such as a benzo
47
What are the WS for hallucinogens?
there is no official withdrawal, Dx, or pattern
48
ETHOL is a sedative but may produce what type of feeling initially?
euphoria
49
Binge drinking
drinking too much ETHOL quickly
50
Heavy drinking
drinking too much, too often
51
What is indicated by heavy women? Men?
8+ drinks/ wk for women and 14+/ men for men
52
What is the classic sign of ETHOL withdrawal?
shakes or jitters
53
When do shakes or jitters occur after ETHOL cessation?
6-8 hrs after
54
What are Si/Sx of alcohol cessation of those mild-moderate?
1. agitation 2. lack of appetite 3. N/V 4. insomnia 5. impaired cognition 6. mild perceptual changes 7. increased BP 8. Body temp
55
What can be given to a pt going ETHOL withdrawal for mild-moderate agitation?
Librium
56
What is your main concern for a pt going through ETHOL withdrawal?
Delirium
57
How long does it take to see psychotic Sx of a pt going through ETHOL withdrawal?
6-8 hrs
58
Why is it a concern when a pt develops delirium from ETHOL withdrawal?
this can cause unconsciousness and seizures.
59
How long does it take a pt to develop delirium?
72 hrs
60
What is commonly seen w. those undergoing delirium from ETHOL withdrawal?
delusions and hallucinations which may be unpredictable
61
What is Wernicke-Korsakoff Syndrome?
Wernicke- encephalopathy that is acute and reversible Korsakoff- chronic condition Both contribute to a thiamine deficiency due to poor nutrition
62
Can Wernicke's clear up?
yes or it may progress to Korsakoff's Syn.
63
What is the tx for Wernicke-Korsakoff?
thiamine q2d-q3d for 3-12 mos
64
Which organs of the body does ETHOL affect most?
1. brain 2. PNS 3. muscles 4. heart 5. esophagus 6. stomach 7. pancreas 8. liver 9. liver
65
How doe ETHOL affect the brain?
causes blackouts, ETHOL blocks the consolidation of new memories into ones through the hippocampus, and related lobe structures
66
How does ETHOL affect the PNS?
Peripheral Neuropathy chronic alcoholism leads to nutritional deficiencies and thiamine leading to a damaged PNS.
67
How does ETHOL affect the heart?
causes alcoholic cardiomyopathy. weakening and thinning of the muscles leading to hypertrophy and eventual HF
68
How does ETHOL affect the muscles?
alcoholic myopathy. causes muscle damage due to loss of muscle mass loss
69
How does ETHOL affect the esophagus?
causes esophagitis. vomiting rt ETHOL overuse. Esophageal varices can occur (medical ER0
70
How does ETHOL the stomach?
erode the mucosa which may lead to ulcers and bleeding
71
How does ETHOL affect the pancreas?
pancreatitis
72
How does ETHOL affect the liver?
cirrhosis, scar tissue blocks the flow of blood through the liver so a slowing process of nutrients, hormones, drugs, and naturally produced toxins.
73
How does ETHOL affect the blood.
causes leukopenia and thrombocytopenia
74
ETHOL use is associated w/ which types of cancer?
liver, breast and colorectal
75
What can small amount of inhalants cause?
1. disinhibition | 2. euphoria
76
What can a high amount of inhalants cause?
1. fearfulness 2. illusions 3. auditory and visual hallucinations 4. distorted body image
77
What type of behavior accompany inhalant intoxication?
1. aggressive behavior 2. impaired judgment 3. occupational fxning 4. impulsiveness
78
What are physical Sx for inhalant intoxication?
1. nausea 2. anorexia 3. nystagmus 4. depressed reflexes 5. diplopia
79
List the serious Sxs of ntoxication
1. delirium 2. dementia 3. psychosis
80
What is the tx for inhalant use disorder?
typically does not require any tx. Haldol can be given to manage severe agitation
81
Opioid use disorder is characterized by what?
tolerance; cravings result in larger amounts and longer periods of time being devoted to the drug and increasing tolerance to its effects
82
Si/Sx of opioid intoxication
1. bradycardia 2. hypotension 3. hypothermia 4. sedation 5. slurred speech 6. head nodding 7. euphoria 8. calmness 9. pupil constriction
83
Si/Sx of opioid withdrawal
1. tachycardia 2. HTN 3. hyperthermia 4. insomnia 5. diaphoresis 6. lacrimation 7. rhinorrhea 8. increased RR 9. N/V 10. mood dysphoria
84
How is an overdose on opioids treated?
1. promoting breathing by aspirating by aspirating secretions and inserting an airway 2. administer Narcan
85
What is the general tx for a person who w/ opioid use disorder?
1. therapy (individual, fam, CBT, and behavioral) 2. Support groups 3. Methadone
86
What is the MOA of methadone?
a synthetic narcotic that decreases the painful Sxs of opiate withdrawal by blocking the euphoric effects
87
Is Methadone addicting?
yes, so it will need to be withdrawn slowly
88
List side effects of Methadone
1. difficulty breathing 2. lightheadness 3. syncope 4. chest pain 5. pounding heartbeat 6. hives 7. rash 8. angioedema 9. hallucinations
89
What are other meds that aid in opioid use disorder?
1. Naltrexone 2. Clonidine 3. Subtex (buprenorphine) 4. Suboxone (combines with Narcan)
90
What type of drugs are included in the sedative, hypnotic, and antianxiety meds use disorder?
prescription sleeping meds like benzos, almost all anxiolytics
91
What is the typical feat of sedative, hypnotic, and anxiolytics use disorder?
craving
92
What might you see in a person who is undergoing sedative, hypnotic and anxiolytic use disorder?
1. slurred speech 2. incoordination 3. unsteady gait 4. nystagmus 5. impaired thinking 6. coma 7. inappropriate aggression and sexual behavior 8. mood fluctuation 9. impaired judgment
93
What is the tx for a person experiencing an Ativan overdose?
1. gastic lavage 2. activated charcoal 3. careful VS monitioring 4. unconscious: IV fluid line 5. ET Tube
94
What are 2 screening tools we learned in class?
1. CAGE | 2. CIWA-AR
95
What is the purpose of the CAGE questions?
screening for potential ETHOL problems
96
How many questions are in the CAGE questionnaire?
4 questions
97
What are the questions a part of the CAGE questionnaire?
1. cut down 2, annoyed anyone 3. guilty 4. Eye opener: do you start the morning with a drink?
98
What is the purpose of the CIWA-AR?
to determine the severity of withdrawal from ETHOL by assessing 10 Si/Sx
99
If Jay scores a 20 or more on the CIWA-AR, what does this mean?
it means he has experiencing severe withdrawal and may need to go to ICU
100
If Jay scored anything above 15 on the CIWA-AR, what type of meds should we give him,
this indicates he in severe withdrawal so he needs a PRN med
101
If Ernie scores 8-10 on the CIWA, what type of med should we give him?
a benzo

Mental Health (16 decks)

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