Substance Related Disorder Flashcards
1
Q
How can you tell if someone has a problem with abuse
A
ASSESSMENT
2
Q
Dependence must have 3 or more of the following:
A
- tolerance
- withdrawal
- need for more than intended
- inability to stop even when want to
- social, occupational, recreational problems
- great deal of effort/time in acquiring substance
- continued use despite knowing problems involved
3
Q
Abuse
A
- maladaptive pattern of sub abuse which leads to impairment or distress in 1 or more of the following:
- failure to fulfill major role obligation (work, school, home)
- recurrent sub use in hazardous situations
- recurrent sub-related legal problems
- continued use despite problems
4
Q
Intoxication
A
- development of substance-specific syndrome due to ingestion of substance
- not due to general medical condition
- not better accounted for by another medical disorder
5
Q
Withdrawal
A
- development of substance specific syndrome due to cessation or reduction of intake
- causes clinically significant distress or impairment
- not due to general medical condition or accounted for by other mental disorder
6
Q
S&S of substance abuse
A
- frequent accidents or injury
- watery, reddened eyes, tremors, slurred speech
- increasing isolation
- absenteeism
- drowsiness, flushed face
- disappearing prescriptions
7
Q
Abuse Assessment
A
- amount/type of alcohol or drugs used
- medical problems associated with alcohol or drugs in pt and family members
- blood/urine drug screens; BAC
- look for s/s (red, watery eyes, smell, tracks)
8
Q
Interview Approaches
A
- matter of fact
- nonjudgmental
- be prepared for defensiveness
- genuine concern helps overcome this
- be aware of own feelings and avoid projecting negative attitudes onto patient
- get accurate info (HIGH priority)
- initially focus on legal drug use (caffeine, nicotine)
9
Q
What is primary drug problem in North America
A
alcohol
10
Q
Psychodynamic Theory of Alcohol Abuse
A
- stereotypical characteristics (low self-esteem, passivity, introversion)
- result of and not cause of sub dependence
11
Q
Biologic Theory of Alcohol Abuse
A
- heredity
- predisposition
- children of alcoholics are 4-10x more likely to become alcoholics
12
Q
___% of alcohol is absorbed by small intestine
A
80
13
Q
On an empty stomach ___% of alcohol is in the bloodstream within ___min
A
50; 15
14
Q
Alcohol is equally distributed thru the body tissue according to______
A
water content
15
Q
Men tend to be able to drink more than women because
A
muscle contains more water than fat tissue does
16
Q
___mL of alcohol is metabolized per hour in a healthy body
A
15
17
Q
Some common myths of alcohol:
A
hot coffee, sweating, and other home remedies don’t increase ETOH metabolism or hasten up sobering process
18
Q
Women become more intoxicated then men because _____
A
- alcohol dehydranase
- women’s bodies don’t undergo first pass metabolism
19
Q
BAL of 0.0
A
no alcohol
20
Q
BAL of 0.05
A
euphoria, decreased inhibition
21
Q
BAL of 0.08
A
legally drunk in many states
22
Q
BAL of 0.1
A
labile mood, talkative
23
Q
BAL of 0.15-0.2
A
double vision, slurred speech
24
Q
BAL of 0.3
A
altered perceptions, hallucinations
25
BAL of 0.4
stupor, coma
26
BAL of 0.4-0.5
severe respiratory depression, DEATH
27
Alcohol is a ____
CNS depressant
28
Effects of alcohol
- black outs
| - brain atrophy (gray matter loss)
29
Rebound phenomenon
- first sedation, then psychomotor activity increases
- if alcohol dependent
* will have withdrawal symptoms
30
Symptoms of alcohol withdrawal
-tremors, diaphoresis, palpitations
31
Delirium tremors occur __-__ hours after last drink
48-72
| -first assessment question needs to be when was last drink!!
32
Symptoms of delirium tremors:
- extreme motor agitation
- hallucinations, seizures
- increased HR, BP, fever
- coarse tremors
- diaphoresis (soaking wet)
33
What will you give to treat delirium tremors
IV fluids and vitamins (B's)
34
Wernicke-Korsakoff Syndrome is the result of
poor nutrition
35
Symptoms of Wernicke
- amnesia, memory loss
- confabulation
* falsification of memory
* trying to fill in gaps they don't remember
- Vitamin B1 and B3 deficiency
36
Disulfiram (Antabuse)
- makes drinking painful
- if drink alcohol will become violently ill
* sweating, flushing, throbbing HA, N/V
- need to teach pt not to drink alcohol
* mouth wash, after shave, purel
37
Naltrexone (Revia)
- decreases pleasure of drinking
- increases abstinence and reduces alcohol craving
- need to let other Dr aware you are taking
* may have decreased response to pain meds
38
Acamprosate (Campral)
- restores chemical balance in alcoholic brain
- can be used once abstinence has begun, but not while alcohol-dependent person is still drinking
- thought to enhance abstinence behaviors
39
Fetal Alcohol Syndrome (FAS)
- 10% of pregnant women drink
- alcohol inhibits development during 1st trimester
- 3rd most common cause of mental retardation
* ONLY cause that is preventable
40
What is a good screening tool for alcohol
CAGE
- have you ever felt you should Cut down on drinking
- have people Annoyed you by criticizing drinking
- felt bad or Guilty about drinking
- had Eye-opener in morning to steady nerves or get rid of hangover
* *2 is positive, suggestive of alcoholism
* *3 or 4 is diagnostic
41
Phenobarbital, Seconal, Amytal
Barbiturates
42
Barbiturates are a CNS
- depressant
| - coma and death are possible
43
Barbiturates uses
- anxiety
| - help people sleep
44
Symptoms that can occur while on barbiturates or even while detoxing from
anxiety, muscle twitching, tremors, dizziness, N/V, orthostatic hypotension
45
____withdrawal of barbiturates for detox
- gradual
- symptoms begin 8 hours after last dose
- if stop cold turkey (more severe symptoms)
46
Ativan, Klonopin, Valium, Xanax
Benzodiazepines
47
Gamma Hydroxybutyrate (GHB)
- Liquid X, Liquid Ecstasy, Georgia Homeboy
- mixing with alcohol can lead to death
- PO, snorted, injected
48
Glue, rubber cement, hair spray, etc
- Inhalants
- dangerous bc amount inhaled cannot be controlled
- death from asphyxiation, suffocation, choking on vomit
- cross blood brain barrier quickly
49
Big side effect of inhalants
- mouth ulcers
| - also GI problems, anorexia, confusion, HA, ataxia
50
Dilaudid, Demerol, Oxycontin, Heroin, Fentanyl, Codeine
- Opioid's, Narcotics
- swallowed, injected, snorted, smoked
- CNS depressant (drowsiness or nodding and sleep are common effects)
51
What class is the only one with an antidote
- Opioids
| - Narcan
52
Withdrawal and detox from CNS depressants
- leg spasms
- yawning
- piloerection (goosebumps)
- restless; irritable
- diarrhea, vomiting
- can last up to one week
53
What med can help with cravings of CNS depressants
Clonidine (CCB used for BP)
| -patch is good for a week to help with side effects and take edge off
54
Methodone
- helps prevent withdrawal symptoms
| - very addictive
55
What class of drug is Cocaine
stimulant
56
Cocaine
- white, odorless powder
- introduced as anesthetic
- psychological dependence greater than physical
- don't need meds to help them detox
* may get anti-anxiety to help nerves
57
Formication
- believe bugs under skin or sense foul smell
| - common in cocaine users
58
Crack
- smoked, cheaper than cocaine
- AKA "rocks"
- mixed with baking soda, water, heated and hardened
- will have dilated pupils, increased BP, paranoid
* worry about pt with hypertension and arrhythmia
59
Adderol, Speed, Crank, Ice, Meth
Amphetamines
60
Amphetamines
- high will last longer with these (may look manic)
| * not eating, sleeping, all over the place
61
Methamphetamine (crystal meth)
- longer high than cocaine, less expensive
- don't sleep, eat
- DENTAL problems
- intense feeling of pleasure
- paranoid
- RAGE when high wears off (tweaking)
62
Ecstasy
- club drug
- heightened sexuality, decreased inhibition
- psychedelic effects
- can cause tachycardia, dry mouth, increased BP
- memory impairment
- serotonin syndrome
* loss of serotonin neurons
63
Hallucinogens (psychotomimetic)
- heighten awareness or cause terrifying psychosis like reactions
- "bad trip"
64
Mescaline
- natural from cactus
- colors are vivid; sounds intense
- pupil dilation and tremors
- high can last up to 12 hours
65
Psilocybin
- mushrooms
- sense of unreality
- perceptual alterations
66
Marijuana
- most widely used in US illegally
- euphoria, relaxed, increases hunger (munchies)
- red eyes, dilated pupils, increased HR, dry mouth
- antiemetic effects make useful for chemo pt
67
Lysergic Acid Diethylamide (LSD)
- synesthesia (blending of senses)
* see sounds, smell colors, etc
- flashbacks
* scary; may feel like going crazy
- psychotic episodes
* bad trips, anxiety, paranoia, acute panic
68
Phencyclidine and Ketamine
- angel dust, PCP, Special K (Ketamine)
- PCP: often go to ER, are very violent
* back an forth between coma and violence
* caution when providing care bc unpredictable
- BP and HR elevated
- blank stare
69
Salvia
- legal herb
- psychoactive properties
- lasts 1-5 minutes
- increased sights, uncontrollable laughter, visions, improved moods
70
Nurse Pt Relationship
- build trust (pt safety is priority)
- be genuine, empathetic
- apply rules consistently
- instill hope (careful not to instill false hope)
- confront denial
- manage manipulation
71
"You say you have not been drinking, but I can smell alcohol on your breath" is an example of
Confrontation
72
Lifestyle Changes
- exercise increases mental and physical vitality
- relaxation, avoid stress, plenty of rest
- balanced diet
- mineral and vitamin supplementation
- detach from old playmates and playgrounds
73
The presence of at least on psych disorder in addition to a substance abuse/dependence
Dual Diagnosis
74
Examples of some dual diagnosis
- Schizophrenia
* alcohol is a depressant and pot is a hallucinogen that relaxes and bring down, cocaine is stimulant that will keep them up
- Depression
* use stimulants to boost energy
- Personality Disorders
* pretty much anything can be used
75
Issues with treating pt with dual diagnosis
- treatment disrupted (one unit to another)
- some believe detox must occur first
- unrealistic expectations by staff
- difficulty concentrating in group
- funding
76
Nurses Role
- nonjudgmental
- watch the "wow" factor
- ask pt how substances affect mood
- education about effects of drugs/alcohol
- strategies for relapse prevention
- set limits, enforce rules
- supportive, gentle confrontation techniques
