Substance-Related Disorders Flashcards
To use wrongfully or in a harmful way . Improper treatment or conduct that may result in injury
Abuse
A compulsive or chronic requirement. The need is so strong as to generate distress ( either physical or psychological ) if left unfulfilled
Dependence
A physical and mental state of exhilaration and emotional frenzy or lethargy and stupor
Intoxication
The physiological and mental readjustment that accompanies the discontinuation of an addictive substance
Withdrawal
- Peripheral neuropathy
- Alcoholic myopathy
- Wernicke’s encephalopathy
- Korsakoff’s psychosis
- Alcoholic cardiomyopathy
- Esophagitis
- Gastritis
- Pancreatitis
- Alcoholic hepatitis
- Cirrhosis of the liver
- Leukopenia
- Thrombocytopenia
- Sexual dysfunction
Alcohol - CNS depressants - effects on the body
Tremors, N&V,malaise, weakness, tachycardia, sweating, elevated BP, anxiety, irritability, headache, insomnia, seizures
Alcohol - withdrawal symptoms ( 4-6 hours after last drink )
Barbiturates, nonbarbiturates hypnotics and antianxiety agents
Sedatives, Hypnotics, or Anxiolytics
- Effects on sleep and dreaming
- Respiratory depression
- Cardiovascular : hypotension
- Hepatic effects - jaundice ; renal
- Decrease in body temperature
- Sexual dysfunction
Sedatives, Hypnotics, or Anxiolytics - CNS depressants - effects on the body
N&V, malaise, weakness, tachycardia, sweating, anxiety, irritability, tremors, seizures
Sedatives, Hypnotics, or Anxiolytics - withdrawal symptoms ( within one week of last use)
- Relaxation
- Loss of inhibition
- Lack of concentration
- Drowsiness
- Slurred speech
- Sleep
CNS depressants - symptoms of use
Amphetamine and related drugs; cocaine ; caffeine, nicotine
CNS stimulants
- Hyperactivity
- Euphoria
- Restlessness
- Talkativeness
- Increased pulse
CNS stimulants - symptoms of use
- CNS: tremors, restlessness …
- Cardiovascular/pulmonary : increased BP, HR, relax bronchial smooth muscles
- GI/GU: constipation, anorexia, urinary retention
- Sexual: aphrodisiac effect
CNS stimulants - effects on body
Depression, anxiety, irritability, fatigue, insomnia, hypersomnia, paranoid or suicidal ideation, apathy, social withdrawal ;
Cocaine + amphetamines - withdrawal symptoms ( within 2-4 days)
Large doses of the drug can result in convulsions or death from cardiac arrhythmias or respiratory paralysis
Cocaine
Refers to a group of compounds that includes opium, opium derivatives, and synthetic substitutes
Opioid
- Opium
- Morphine
- Codeine
Opioids of natural origin
- Heroin
- Hydromorphone (Dilaudid)
- Oxycodone
- Hydrocodone
Opioid derivatives
- Meperidine (Demerol)
- Methadone ( Dolophine)
- ….
Synthetic Opiate-like Drugs
- CNS: euphoria, mental clouding, pupillary constriction , respiratory depression , N/V
- GI: treatment of diarrhea; constipation, fecal impaction
- Cardiac: hypotension
- Sexual : decrease
Opioids - effects on the body
- Craving for the drug
- N/V
- Muscle aches
- Lacrimation/ rhinorrhea (tears/nose)
- Pupillary dilation
- Sweating, diarrhea, fever, insomnia
Opioids - withdrawal ( 6-8 hr , peak 2 or 3 day, disappear in 7-10 days )
CIWA-Ar
The Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised ; used to assess risk and severity of withdrawal from alcohol
CAGE
questionnaire for determining whether an individual has a problem with substances
ND for the clients withdrawing from CNS depressants : tremors, hypertension, N&V, hallucinations, illusions, tachycardia, anxiety, seizures
Risk for injury
ND for the clients withdrawing from CNS stimulants : intense feeling of depression, “crashing”, suicidal ideation
Risk for suicide
Disulfiram ( Antabuse )
provides measure of control for the individual who desires to avoid impulse drinking
Occur within 5-10 min of ingestion of alcohol
- Flushed skin
- Respiratory difficulty
- N&V, dizziness
- Hypotension, blurred vision, confusion
- Respiratory depression, MI, acute CHF, convulsions, death
Disulfiram alcohol reaction
- Should not be administered - at least 12 hr abstained from alcohol
- When discontinued - 2 weeks alcohol sensitivity
- Aware of alcohol containing substances - vanilla extract, nail polish remover…
- Contraindicated for clients with high risk for alcohol ingestion
Nursing responsibilities - Disulfiram
Chlordiazepoxide (Librium )
benzodiazepine - substitution therapy in alcohol withdrawal ; used to relive anxiety and to control agitation caused by alcohol
Phenobarbital
anticonvulsant - for management of alcohol withdrawal seizures
Methadone ( Dolophine )
to suppress opioid withdrawal symptoms
- Know it is for for short term use
- Tapered down over time
- Taken in addition to rest, adequate nutrition and psychotherapy
Nursing responsibilities - Methadone
Naloxone ( Narcan)
narcotic antagonist, complete or partial reversal of opioid depression
n/v, sweating, tachycardia, increased blood pressure, tremulousness, seizures, ventricular tachycardia and fibrillation, pulmonary edema, and cardiac arrest which may result in death
Side effects of Narcan
N&V, diarrhea, diaphoresis
Heroin withdrawal
- Paralysis of the ocular muscles
- Diplopia (double vision)
- Ataxia (lack of voluntary coordination)
- Somnolence and stupor - death
Wernicke’s encephalopathy - thiamine deficiency in alcoholics
- Confusion
- Loss of recent memory
- Confabulation - honest lying
Korsakoff’s psychosis - frequently encountered in clients recovering from Wernicke’s encephalopathy
TX: thiamine
