Substance Related Disorder

Question 1

What is Concurrent Disorder?

Answer 1

The combination of a psychiatric comorbidity and substance use disorder

Question 2

What is Misuse?

Answer 2

Use of a substance for a purpose not consistent with legal or medical guidlines, as in the non-medical use of prescription medications

Question 3

What is the difference between Substance abuse and Substance Dependency?

Answer 3

Abuse: Maladaptive pattern of substance use despite adverse outcome,

Dependency: Mor4e severe, involves tolerance, withdrawal, compulsive use.

Question 4

Describe addiction and the 3 that must be included as an addiction?

Answer 4

The persistent, compulsive dependency on or use of a substance or behaviour despite its negative consequences and the increase frequency of those consequences.

• Biological
• Psychological
• Social

Question 5

Ture or false

A compulsive behaviour only has a social elements.

Answer 5

False, it has social and psychological. No biological elements

Question 6

Describe Wernicke’s syndrome

Answer 6

Acute confusional state
Ophthalmoplegia
Ataxia

Large doses of IV thiamine 2-3 time daily for 1-2 wks
It is a thiamine deficiency due to poor nutrition associated with alcohol use or malabsorption of nutrients

Question 7

Describe Korsakoff’ syndrome

Answer 7

Amnesia
Confabulation
Psychosis

Thiamine treatment for 3-12 months, pt may never fully recover, although cognitive improvement may occur with thiamine and nutritional support

Question 8

What is the legal alcohol concentration in Quebec?

Answer 8

0.08g

Question 9

In the CNS DEPRESSANTS (benzo, barbiturates…), what are the S/S of Withdrawal person?

Answer 9

N/V 
Tachycardia
Insomnia
Grand mal seizure
Diaphoresis
Tremors
Anxiety/Irritability
Hallucinations/Delusions/Illusions

Question 10

In the CNS DEPRESSANTS (benzo, barbiturates…), what are the S/S of Intoxication?

Answer 10

Impaired judgement
Impaired attention and memory
Disinhibition of sexual or aggressive drives

Question 11

What are the stages of change in the Transtheoretical Model of Change?

Answer 11

Pre-contemplation: no intention on changing behaviour
Contemplation: awaree a problem exists but with no commitment to action
Preparation: intent on taking action to address the problem
Action: active modification of behaviour
Maintenance: sustained change, new behaviour replaces old
Relapse: fall back into old patterns of behaviour

Question 12

Describe the interventions for a CNS depressant, in an intoxicated patient.

Answer 12

Monitor VS q15min & respiratory depression
Oxygen, intubation, mechanical ventilation
If recent ingestion: induced vomiting, gastric lavage, activated charcoal
monitor ECG & lab values for shock
IV fluids
Continue monitoring VS frequently for respiratory complications, cardiac arrest, possible seizures

Question 13

Describe the interventions for a CNS depressant, in a withdrawal patient.

Answer 13

MD may prescribe a carefully titrated drug in a similar classification so as to minimize symptoms of withdrawal

*Abrupt withdrawal can lead to death

Question 14

Describe the interventions for a CNS stimulant, in an intoxicated patient.

Answer 14

antipsychotics,
Nursing/Medical management:
Fever,
Convulsions
Respiratory distress or cardiovascular shock
Hypertension, tachycardia,
Acidification of urine (ammonium chloride for amphetamine)

Question 15

Describe the interventions for a CNS stimulant, in a withdrawal patient.

Answer 15

Supportive measures
Diazepam (Valium)
Lorazepam (Ativan) may be prescribed for mild to moderate withdrawal symptoms

Question 16

Describe the interventions for Opioids, in an intoxicated patient.

Answer 16

Opioid antagonist (naloxone) to quickly reverse CNS depression

Question 17

Describe the interventions for Opioids, in a Withdrawal patient.

Answer 17

Methadone tapering
Clonidine- naltrexone detoxification
Buprenorphine substitution

Question 18

What is the purpose the use of Benzodiazepines in a detoxification and alcohol withdrawal treatment?

Answer 18

1. Alcohol withdrawal delirium
2. Decreases withdrawal symptoms
3. Prevents seizures and delirium tremens
4. Stabilizes VS

Question 19

What is the purpose the use of Alpha Adrenergic Blockers in a detoxification and alcohol withdrawal treatment?

Answer 19

1. Reduces autonomic withdrawal symptoms

2. Alcohol withdrawal delirium

Question 20

What is the purpose the use of Naltrexone Acamprosate Topiromate in a detoxification and alcohol withdrawal treatment?

Answer 20

1. Reduces or eliminates alcohol craving

Question 21

What is the purpose the use of Methadone, in an intervention for Opioid addiction?

Answer 21

Blocks craving and effects of opioids

Question 22

What is the purpose the use of Naltrexone, in an intervention for Opioid addiction?

Answer 22

Blocks euphoric effects of opioids

Question 23

What is the purpose the use of Alpha Adrenergic Blockers, in an intervention for Opioid addiction?

Answer 23

Suppresses opioid withdrawal symptoms

Question 24

What is the purpose the use of Buprenorphine, in an intervention for Opioid addiction?

Answer 24

Blocks S/S of opioid withdrawal