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Mental Health > Substance Related and Addictive Disorders > Flashcards

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
Q

In what med forms do nicotine replacement therapy come in?

A
  1. gum
  2. lozenges
  3. nasal sprays
  4. patched
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26
Q

What is are some important teachings for a pt with a nicotine patch?

A
  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
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27
Q

What are some meds that a person can take to promote smoking cessation?

A
  1. Chantix (varenicline)
  2. Zyban or Wellbeutrin (burpropion)
  3. Catapres (clonidine)
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28
Q

List some stimulants

A
  1. cocaine
  2. amphetamines
  3. Methamphetamines
  4. LSD
  5. MDMA
  6. Roofies
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29
Q

Gary says that the pt in Room 215 is experiencing stimulant abuse intoxication. What are Sx that you expect to see?

A
  1. euphoria
  2. elatedness
  3. social
  4. hypervigilant
  5. sensitive
  6. anxious
  7. tense
  8. angry
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30
Q

What are some physical Sx of stimulant use disorder?

A
  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
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31
Q

What are the 2 most serious side effects of stimulant use disorder?

A

SI and depression

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32
Q

What are some WS you may see in a pt who abused roofies or the date rape drug?

A
  1. tiredness
  2. vivid nightmares
  3. increased appetite
  4. insomnia or hypersomnia
  5. psychomotor agitation or retardation
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33
Q

What 2 effects do cocaine have on the body?

A
  1. anesthetic

2. stimulant

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34
Q

When cocaine is smoked how long does it take effect? high?

A

takes effect in 4-6 seconds with a 5-7 min high then a deep depression

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35
Q

What are some tx for amphetamine use?

A
  1. w/ psychosis: antipsychotic
  2. w/o psychosis: Valium
  3. once withdrawn: an antidepressant like Wellbutrin
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36
Q

What is the tx for cocaine abuse pt?

A

no drugs that reduce Sx, they may require hospitalization to remove the affected pt from the usual social setting and drug sources

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37
Q

What are hallucinogens associated w/?

A
  1. reality disturbance
  2. flashbacks
  3. panic attacks
  4. psychosis
  5. delirium
  6. mood and anxiety disorders
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38
Q

What are the 2 classifications for hallucinogens

A
  1. Classic

2. Dissociative

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39
Q

Hallucinogen intoxication is associated w/ by what?

A

psychological and behavioral changes

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40
Q

What are some common changes in pts taking hallucinogens?

A
  1. paranoia
  2. impaired judgment
  3. intensification of perceptions
  4. depersonalization
  5. derealization
  6. illusions
  7. hallucinations
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41
Q

What are some physical Sx of hallucinogens?

A
  1. blurred vision
  2. tremors
  3. incoordination
  4. sweating
  5. tachycardia
  6. pupillary dilation
  7. palpitations
42
Q

Sara is addicted to taking mushrooms. She is in the clinic for detoxification. How do you intervene during intoxication?

A

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
Q

Jorge comes into the ER after taking PCP at high dose, how is this treated by staff?

A

this is an medical ER

44
Q

Describe a pt who has taking PCP at an extremely high dose?

A
  1. belligerent
  2. assaultive
  3. impulsive
  4. unpredictable
45
Q

What are some Si/Sx of PCP intoxication?

A
  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
Q

What is the tx for Jorge who has taken an extremely high dose of PCP?

A

since he cannot be talked down, he may require restraints and a calming medication such as a benzo

47
Q

What are the WS for hallucinogens?

A

there is no official withdrawal, Dx, or pattern

48
Q

ETHOL is a sedative but may produce what type of feeling initially?

49
Q

Binge drinking

A

drinking too much ETHOL quickly

50
Q

Heavy drinking

A

drinking too much, too often

51
Q

What is indicated by heavy women? Men?

A

8+ drinks/ wk for women and 14+/ men for men

52
Q

What is the classic sign of ETHOL withdrawal?

A

shakes or jitters

53
Q

When do shakes or jitters occur after ETHOL cessation?

A

6-8 hrs after

54
Q

What are Si/Sx of alcohol cessation of those mild-moderate?

A
  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
Q

What can be given to a pt going ETHOL withdrawal for mild-moderate agitation?

56
Q

What is your main concern for a pt going through ETHOL withdrawal?

57
Q

How long does it take to see psychotic Sx of a pt going through ETHOL withdrawal?

58
Q

Why is it a concern when a pt develops delirium from ETHOL withdrawal?

A

this can cause unconsciousness and seizures.

59
Q

How long does it take a pt to develop delirium?

60
Q

What is commonly seen w. those undergoing delirium from ETHOL withdrawal?

A

delusions and hallucinations which may be unpredictable

61
Q

What is Wernicke-Korsakoff Syndrome?

A

Wernicke- encephalopathy that is acute and reversible
Korsakoff- chronic condition
Both contribute to a thiamine deficiency due to poor nutrition

62
Q

Can Wernicke’s clear up?

A

yes or it may progress to Korsakoff’s Syn.

63
Q

What is the tx for Wernicke-Korsakoff?

A

thiamine q2d-q3d for 3-12 mos

64
Q

Which organs of the body does ETHOL affect most?

A
  1. brain
  2. PNS
  3. muscles
  4. heart
  5. esophagus
  6. stomach
  7. pancreas
  8. liver
  9. liver
65
Q

How doe ETHOL affect the brain?

A

causes blackouts, ETHOL blocks the consolidation of new memories into ones through the hippocampus, and related lobe structures

66
Q

How does ETHOL affect the PNS?

A

Peripheral Neuropathy chronic alcoholism leads to nutritional deficiencies and thiamine leading to a damaged PNS.

67
Q

How does ETHOL affect the heart?

A

causes alcoholic cardiomyopathy. weakening and thinning of the muscles leading to hypertrophy and eventual HF

68
Q

How does ETHOL affect the muscles?

A

alcoholic myopathy. causes muscle damage due to loss of muscle mass loss

69
Q

How does ETHOL affect the esophagus?

A

causes esophagitis. vomiting rt ETHOL overuse. Esophageal varices can occur (medical ER0

70
Q

How does ETHOL the stomach?

A

erode the mucosa which may lead to ulcers and bleeding

71
Q

How does ETHOL affect the pancreas?

A

pancreatitis

72
Q

How does ETHOL affect the liver?

A

cirrhosis, scar tissue blocks the flow of blood through the liver so a slowing process of nutrients, hormones, drugs, and naturally produced toxins.

73
Q

How does ETHOL affect the blood.

A

causes leukopenia and thrombocytopenia

74
Q

ETHOL use is associated w/ which types of cancer?

A

liver, breast and colorectal

75
Q

What can small amount of inhalants cause?

A
  1. disinhibition

2. euphoria

76
Q

What can a high amount of inhalants cause?

A
  1. fearfulness
  2. illusions
  3. auditory and visual hallucinations
  4. distorted body image
77
Q

What type of behavior accompany inhalant intoxication?

A
  1. aggressive behavior
  2. impaired judgment
  3. occupational fxning
  4. impulsiveness
78
Q

What are physical Sx for inhalant intoxication?

A
  1. nausea
  2. anorexia
  3. nystagmus
  4. depressed reflexes
  5. diplopia
79
Q

List the serious Sxs of ntoxication

A
  1. delirium
  2. dementia
  3. psychosis
80
Q

What is the tx for inhalant use disorder?

A

typically does not require any tx. Haldol can be given to manage severe agitation

81
Q

Opioid use disorder is characterized by what?

A

tolerance; cravings result in larger amounts and longer periods of time being devoted to the drug and increasing tolerance to its effects

82
Q

Si/Sx of opioid intoxication

A
  1. bradycardia
  2. hypotension
  3. hypothermia
  4. sedation
  5. slurred speech
  6. head nodding
  7. euphoria
  8. calmness
  9. pupil constriction
83
Q

Si/Sx of opioid withdrawal

A
  1. tachycardia
  2. HTN
  3. hyperthermia
  4. insomnia
  5. diaphoresis
  6. lacrimation
  7. rhinorrhea
  8. increased RR
  9. N/V
  10. mood dysphoria
84
Q

How is an overdose on opioids treated?

A
  1. promoting breathing by aspirating by aspirating secretions and inserting an airway
  2. administer Narcan
85
Q

What is the general tx for a person who w/ opioid use disorder?

A
  1. therapy (individual, fam, CBT, and behavioral)
  2. Support groups
  3. Methadone
86
Q

What is the MOA of methadone?

A

a synthetic narcotic that decreases the painful Sxs of opiate withdrawal by blocking the euphoric effects

87
Q

Is Methadone addicting?

A

yes, so it will need to be withdrawn slowly

88
Q

List side effects of Methadone

A
  1. difficulty breathing
  2. lightheadness
  3. syncope
  4. chest pain
  5. pounding heartbeat
  6. hives
  7. rash
  8. angioedema
  9. hallucinations
89
Q

What are other meds that aid in opioid use disorder?

A
  1. Naltrexone
  2. Clonidine
  3. Subtex (buprenorphine)
  4. Suboxone (combines with Narcan)
90
Q

What type of drugs are included in the sedative, hypnotic, and antianxiety meds use disorder?

A

prescription sleeping meds like benzos, almost all anxiolytics

91
Q

What is the typical feat of sedative, hypnotic, and anxiolytics use disorder?

92
Q

What might you see in a person who is undergoing sedative, hypnotic and anxiolytic use disorder?

A
  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
Q

What is the tx for a person experiencing an Ativan overdose?

A
  1. gastic lavage
  2. activated charcoal
  3. careful VS monitioring
  4. unconscious: IV fluid line
  5. ET Tube
94
Q

What are 2 screening tools we learned in class?

A
  1. CAGE

2. CIWA-AR

95
Q

What is the purpose of the CAGE questions?

A

screening for potential ETHOL problems

96
Q

How many questions are in the CAGE questionnaire?

A

4 questions

97
Q

What are the questions a part of the CAGE questionnaire?

A
  1. cut down
    2, annoyed anyone
  2. guilty
  3. Eye opener: do you start the morning with a drink?
98
Q

What is the purpose of the CIWA-AR?

A

to determine the severity of withdrawal from ETHOL by assessing 10 Si/Sx

99
Q

If Jay scores a 20 or more on the CIWA-AR, what does this mean?

A

it means he has experiencing severe withdrawal and may need to go to ICU

100
Q

If Jay scored anything above 15 on the CIWA-AR, what type of meds should we give him,

A

this indicates he in severe withdrawal so he needs a PRN med

101
Q

If Ernie scores 8-10 on the CIWA, what type of med should we give him?

Mental Health (16 decks)

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