Substance Use Disorder Flashcards
Most important element
Build a trusting relationship with the
patient
Assessment for SUD
Obtain a thorough medical history • Know s/s of substance use, withdrawal symptoms specific to each substance • Build a trusting relationship with the patient • Non-judgmental, empathetic attitude • Be aware of resources in the community
ETOH Intoxication S/S
Slurred speech, Dizziness,
Incoordination, Unsteady gait,
Nystagmus, Impaired attention/memory,
Coma or double vision
ETOH Withdrawal 8 to 12 hours
Autonomic hyperactivity (hight BP, increased heart rate etc); Perceptual disturbances and hallucinations
ETOH Withdrawal 12-24 hours
Generalized/tonic-clonic seizures
ETOH Withdrawal other
Nausea, vomiting; can be life-threatening
CIWA Categories
Agitation (0–7) Anxiety (0–7) Auditory Disturbances (0–7) Clouding of Sensorium (0–4) Headache (0–7) Nausea/Vomiting (0–7) Paroxysmal Sweats (0–7) Tactile disturbances (0–7) Tremor (0–7) Visual disturbances (0–7)
CIWA <10
supportive, n on-pharmacologic therapy and close monitoring are indicated )unless patient has hx of alchol withdrawl seizures or co-morbid cardiovascular conditions
CIWA 10 - 15
Lorazepam is indcated to reduce symptoms and the risk of major complications
CIWA >15
Strong consideration should be given to hospitalizing inmates who exhibit severe symptoms, as they are at increased risk for serious complications
ETOH WD treatment drugs
Benzodiazepines, anticonvulsants
(carbamazepine, gabapentin), clonidine,
propranolol
ETOH treament supplement
Thiamine
Why do we use thiamine
B1 deficiency can occur with chronic ETOH use. This results in wernkeis encephalopathy. Confusion CNS effects
Naltrexone
mu opioid receptor antagonist - used in ETOH disorder
Acamprosate used in ETOH MOA
binds to and blocks glutamate
receptors
Disulfiram
irreversibly inhibits aldehyde
dehydrogenase preventing metabolism of alcohol
Opioid Intoxication S/S
Pinpoint pupils; Psychomotor retardation, “nodding off;” Drowsiness, slurred speech; Impaired memory and attention; Reduced respirations, respiratory depression or distress
Opioid Withdrawal
Dilated pupils, yawning, runny
nose/tearing; Piloerection; Restlessness,
muscle aches; Stomach cramps, diarrhea,
tachycardia; tremors (less common), hot/cold
sweats, insomnia; feels life threatening to the
person
COWS categories.
Resting heart rate (0–4) Gastrointestinal upset in past 30 minutes (0–5) Sweating (0–4) Tremor of hands (0–4) Restlessness (0–5) Yawning during assessment (0–4) Pupil size (0–5) Anxiety or irritability (0–4) Bone or joint aches associated with withdrawal (0–4) Gooseflesh skin (0–5) Runny nose or tearing (0–4)
COWS mild
5-12
COWS Moderate
13-24
COWS moderately severe
21-36
COWS severe
36
Treatment of opoids includes
alpha-2 adrenergic
agonists
Drugs used to treat OUD
Buprenophine, Methadone, Nextrexone, Naloxone
Bupreophine class
mu receptor partial agonist
Methadone class
Full opoid agonist
Naltrexone class
mu opoid receptor atnagonist
Benzo withdrawal symptoms
sx similar to alcohol
withdrawal
Benzo withdrawal starts
starts 2-3 days after cessation
or up to 5 with long acting; can be life
threatening
Do not prescribe ____ on a long term basis
benzos
Cannabis Intoxication S/S
Red eyes (dilation of conjunctival
blood vessels, mild tachycardia, dry mouth;
Heightened sensitivity to environmental stimuli,
Slowing perception of time; Depersonalization,
Derealization; Impaired memory, increased
appetite; Delirium, paranoia, or psychosis;
Impaired motor skills and attention
(up to 8 to
12 hours after use)
Cannabis Withdrawal starts
1-2 weeks of cessation
Cannabis S/S
Irritability, cravings, headaches;
Anxiety/restlessness, tremors; Insomnia, vivid
dreams; Decreased appetite, wt loss, stomach
pain; Hyperemesis syndrome
Nicotinic acetylcholine receptor agonist - half life
2 hour
Nicotine activates
dopamine vTa pathway,
increases endogenous epinephrine and
norepinephrine
nicotine has
stimulant effects on the body
Nicotine intoxication
skeletal muscle relaxation, improved
attention, learning, reaction time and probelm- solving (short term); decreased appetite
Nicotine withdrawal begins
within 2 hours and peaks 24 to 48 hours
Nicotine withdral S/S
Insomnia; Increased coughing (short- term); Irritability, cravings, tension; Increased
appetite, weight gain; Poor focus
Nicotine Replacement therapy
Relieve nicotine withdrawal symptoms by providing nicotine
without the use of tobacco
NRT Side Effects
common to all NRT: GI symptoms, HA, local irritation
NRT forms
Patch, gum, lozenges, inhalers, nasal spray, mouth spray, SL
tablets
Varenicline (Chantix)
partial nicotine agonist
Varenicline (Chantix) MOA and use
Reduces the symptoms of nicotine withdrawal
• Blocks nicotine from binding to the receptor that mediates the
reinforcing effects of nicotine that leads to nicotine dependence.
• Reduces rewarding aspects of cigarette smoking.
Bupropion (Zyban)
antidepressant,
Bupropion (Zyban) MOA and use
dopamine/norepinephrine-reuptake inhibitor
• Enhances CNS noradrenergic and dopaminergic release
