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Psych Test 1 > Substance Related Disorder > Flashcards

Substance Related Disorder Flashcards

1
Q

How can you tell if someone has a problem with abuse

A

ASSESSMENT

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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
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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
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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
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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
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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
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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)
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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)
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9
Q

What is primary drug problem in North America

A

alcohol

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10
Q

Psychodynamic Theory of Alcohol Abuse

A
  • stereotypical characteristics (low self-esteem, passivity, introversion)
  • result of and not cause of sub dependence
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11
Q

Biologic Theory of Alcohol Abuse

A
  • heredity
  • predisposition
    • children of alcoholics are 4-10x more likely to become alcoholics
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12
Q

___% of alcohol is absorbed by small intestine

A

80

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13
Q

On an empty stomach ___% of alcohol is in the bloodstream within ___min

A

50; 15

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14
Q

Alcohol is equally distributed thru the body tissue according to______

A

water content

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15
Q

Men tend to be able to drink more than women because

A

muscle contains more water than fat tissue does

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16
Q

___mL of alcohol is metabolized per hour in a healthy body

A

15

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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

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18
Q

Women become more intoxicated then men because _____

A
  • alcohol dehydranase

- women’s bodies don’t undergo first pass metabolism

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19
Q

BAL of 0.0

A

no alcohol

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20
Q

BAL of 0.05

A

euphoria, decreased inhibition

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21
Q

BAL of 0.08

A

legally drunk in many states

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22
Q

BAL of 0.1

A

labile mood, talkative

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23
Q

BAL of 0.15-0.2

A

double vision, slurred speech

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24
Q

BAL of 0.3

A

altered perceptions, hallucinations

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25
Q

BAL of 0.4

A

stupor, coma

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26
Q

BAL of 0.4-0.5

A

severe respiratory depression, DEATH

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27
Q

Alcohol is a ____

A

CNS depressant

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28
Q

Effects of alcohol

A
  • black outs

- brain atrophy (gray matter loss)

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29
Q

Rebound phenomenon

A
  • first sedation, then psychomotor activity increases
  • if alcohol dependent
    • will have withdrawal symptoms
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30
Q

Symptoms of alcohol withdrawal

A

-tremors, diaphoresis, palpitations

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31
Q

Delirium tremors occur __-__ hours after last drink

A

48-72

-first assessment question needs to be when was last drink!!

32
Q

Symptoms of delirium tremors:

A
  • extreme motor agitation
  • hallucinations, seizures
  • increased HR, BP, fever
  • coarse tremors
  • diaphoresis (soaking wet)
33
Q

What will you give to treat delirium tremors

A

IV fluids and vitamins (B’s)

34
Q

Wernicke-Korsakoff Syndrome is the result of

A

poor nutrition

35
Q

Symptoms of Wernicke

A
  • amnesia, memory loss
  • confabulation
    • falsification of memory
    • trying to fill in gaps they don’t remember
  • Vitamin B1 and B3 deficiency
36
Q

Disulfiram (Antabuse)

A
  • 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
Q

Naltrexone (Revia)

A
  • 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
Q

Acamprosate (Campral)

A
  • 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
Q

Fetal Alcohol Syndrome (FAS)

A
  • 10% of pregnant women drink
  • alcohol inhibits development during 1st trimester
  • 3rd most common cause of mental retardation
    • ONLY cause that is preventable
40
Q

What is a good screening tool for alcohol

A

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
Q

Phenobarbital, Seconal, Amytal

A

Barbiturates

42
Q

Barbiturates are a CNS

A
  • depressant

- coma and death are possible

43
Q

Barbiturates uses

A
  • anxiety

- help people sleep

44
Q

Symptoms that can occur while on barbiturates or even while detoxing from

A

anxiety, muscle twitching, tremors, dizziness, N/V, orthostatic hypotension

45
Q

____withdrawal of barbiturates for detox

A
  • gradual
  • symptoms begin 8 hours after last dose
  • if stop cold turkey (more severe symptoms)
46
Q

Ativan, Klonopin, Valium, Xanax

A

Benzodiazepines

47
Q

Gamma Hydroxybutyrate (GHB)

A
  • Liquid X, Liquid Ecstasy, Georgia Homeboy
  • mixing with alcohol can lead to death
  • PO, snorted, injected
48
Q

Glue, rubber cement, hair spray, etc

A
  • Inhalants
  • dangerous bc amount inhaled cannot be controlled
  • death from asphyxiation, suffocation, choking on vomit
  • cross blood brain barrier quickly
49
Q

Big side effect of inhalants

A
  • mouth ulcers

- also GI problems, anorexia, confusion, HA, ataxia

50
Q

Dilaudid, Demerol, Oxycontin, Heroin, Fentanyl, Codeine

A
  • Opioid’s, Narcotics
  • swallowed, injected, snorted, smoked
  • CNS depressant (drowsiness or nodding and sleep are common effects)
51
Q

What class is the only one with an antidote

A
  • Opioids

- Narcan

52
Q

Withdrawal and detox from CNS depressants

A
  • leg spasms
  • yawning
  • piloerection (goosebumps)
  • restless; irritable
  • diarrhea, vomiting
  • can last up to one week
53
Q

What med can help with cravings of CNS depressants

A

Clonidine (CCB used for BP)

-patch is good for a week to help with side effects and take edge off

54
Q

Methodone

A
  • helps prevent withdrawal symptoms

- very addictive

55
Q

What class of drug is Cocaine

A

stimulant

56
Q

Cocaine

A
  • 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
Q

Formication

A
  • believe bugs under skin or sense foul smell

- common in cocaine users

58
Q

Crack

A
  • 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
Q

Adderol, Speed, Crank, Ice, Meth

A

Amphetamines

60
Q

Amphetamines

A
  • high will last longer with these (may look manic)

* not eating, sleeping, all over the place

61
Q

Methamphetamine (crystal meth)

A
  • longer high than cocaine, less expensive
  • don’t sleep, eat
  • DENTAL problems
  • intense feeling of pleasure
  • paranoid
  • RAGE when high wears off (tweaking)
62
Q

Ecstasy

A
  • club drug
  • heightened sexuality, decreased inhibition
  • psychedelic effects
  • can cause tachycardia, dry mouth, increased BP
  • memory impairment
  • serotonin syndrome
    • loss of serotonin neurons
63
Q

Hallucinogens (psychotomimetic)

A
  • heighten awareness or cause terrifying psychosis like reactions
  • “bad trip”
64
Q

Mescaline

A
  • natural from cactus
  • colors are vivid; sounds intense
  • pupil dilation and tremors
  • high can last up to 12 hours
65
Q

Psilocybin

A
  • mushrooms
  • sense of unreality
  • perceptual alterations
66
Q

Marijuana

A
  • 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
Q

Lysergic Acid Diethylamide (LSD)

A
  • 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
Q

Phencyclidine and Ketamine

A
  • 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
Q

Salvia

A
  • legal herb
  • psychoactive properties
  • lasts 1-5 minutes
  • increased sights, uncontrollable laughter, visions, improved moods
70
Q

Nurse Pt Relationship

A
  • 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
Q

“You say you have not been drinking, but I can smell alcohol on your breath” is an example of

A

Confrontation

72
Q

Lifestyle Changes

A
  • 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
Q

The presence of at least on psych disorder in addition to a substance abuse/dependence

A

Dual Diagnosis

74
Q

Examples of some dual diagnosis

A
  • 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
Q

Issues with treating pt with dual diagnosis

A
  • treatment disrupted (one unit to another)
  • some believe detox must occur first
  • unrealistic expectations by staff
  • difficulty concentrating in group
  • funding
76
Q

Nurses Role

A
  • 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

Psych Test 1 (6 decks)

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